1
|
Plasencia G, Gray SC, Hall IJ, Smith JL. Multimorbidity clusters in adults 50 years or older with and without a history of cancer: National Health Interview Survey, 2018. BMC Geriatr 2024; 24:50. [PMID: 38212690 PMCID: PMC10785430 DOI: 10.1186/s12877-023-04603-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Multimorbidity is increasing among adults in the United States. Yet limited research has examined multimorbidity clusters in persons aged 50 years and older with and without a history of cancer. An increased understanding of multimorbidity clusters may improve the cancer survivorship experience for survivors with multimorbidity. METHODS We identified 7580 adults aged 50 years and older with 2 or more diseases-including 811 adults with a history of primary breast, colorectal, cervical, prostate, or lung cancer-from the 2018 National Health Interview Survey. Exploratory factor analysis identified clusters of multimorbidity among cancer survivors and individuals without a history of cancer (controls). Frequency tables and chi-square tests were performed to determine overall differences in sociodemographic characteristics, health-related characteristics, and multimorbidity between groups. RESULTS Cancer survivors reported a higher prevalence of having 4 or more diseases compared to controls (57% and 38%, respectively). Our analysis identified 6 clusters for cancer survivors and 4 clusters for controls. Three clusters (pulmonary, cardiac, and liver) included the same diseases for cancer survivors and controls. CONCLUSIONS Diseases clustered differently across adults ≥ 50 years of age with and without a history of cancer. Findings from this study may be used to inform clinical care, increase the development and dissemination of multilevel public health interventions, escalate system improvements, and initiate innovative policy reform.
Collapse
Affiliation(s)
- Gabriela Plasencia
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
- Department of Family Medicine & Community Health, Duke University Medical Center, Durham, NC, USA.
- National Clinician Scholars Program, Duke University, Durham, NC, USA.
| | - Simone C Gray
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ingrid J Hall
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judith Lee Smith
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
2
|
Shipeolu BA, Marie Ahlin K, Fuller-Thomson E. Black-White Racial Disparities in Disabilities Among Older Americans Between 2008 and 2017: Improvements in Cognitive Disabilities but no Progress in Activities of Daily Living or Functional Limitations. Int J Aging Hum Dev 2024; 98:84-102. [PMID: 37643122 PMCID: PMC10699102 DOI: 10.1177/00914150231196092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The objectives of this study were to examine the prevalence of race-based disparities in cognitive problems, functional limitations (FLs), and activity of daily living (ADL) limitations between US Black and White older adults in 2008 and 2017, to explore how age, sex, income, and education attenuate these racial disparities, and to determine if Black-White health disparities are narrowing. Secondary analysis of the nationally representative American Community Surveys including 423,066 respondents aged ≥65 (388,602 White, 34,464 Black) in 2008 and 536,984 (488,483 White, 48,501 Black) in 2017. Findings indicate that Black-White racial disparities were apparent for all three outcomes in 2008 and 2017. Approximately half of the racial disparities was attenuated when adjustments were made for education and income. Racial disparities in cognition declined between 2008 and 2017 (p < .001) but persisted unabated in FLs and ADL limitations. Further exploration on the mechanisms of racial disparities is warranted.
Collapse
Affiliation(s)
| | - Katherine Marie Ahlin
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
| | - Esme Fuller-Thomson
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Institute for Life Course and Aging, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine & Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
3
|
Jain P, Binder A, Chen B, Parada H, Gallo L, Alcaraz J, Horvath S, Bhatti P, Whitsel E, Jordahl K, Baccarelli A, Hou L, Stewart J, Li Y, LaMonte M, Manson J, LaCroix A. The Association of Epigenetic Age Acceleration and Multimorbidity at Age 90 in the Women's Health Initiative. J Gerontol A Biol Sci Med Sci 2023; 78:2274-2281. [PMID: 36107798 PMCID: PMC10692424 DOI: 10.1093/gerona/glac190] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Epigenetic age acceleration (EAA), a measure of accelerated biological aging, has been associated with an increased risk of several age-related chronic conditions. This is the first study to prospectively examine the relationship between EAA and both multimorbidity count and a weighted multimorbidity score among long-lived postmenopausal women. METHODS We included 1 951 women from the Women's Health Initiative who could have survived to age 90. EAA was estimated using the Horvath pan-tissue, Hannum, PhenoAge, and GrimAge "clocks." Twelve chronic conditions were included in the multimorbidity count. The multimorbidity score was weighted for each morbidity's relationship with mortality in the study population. Using mixed-effects Poisson and linear regression models that included baseline covariates associated with both EAA and multimorbidity, we estimated relative risks (RRs) and 95% confidence intervals (CIs) for the relationships between each EAA measure at the study baseline with both multimorbidity count and weighted multimorbidity score at age 90, respectively. RESULTS For every one standard deviation increase in AgeAccelPheno, the rate of multimorbidity accumulation increased 6% (RR = 1.06; 95% CI = 1.01-1.12; p = .025) and the multimorbidity score by 7% (RR = 1.07; 95% CI = 1.01-1.13; p = .014) for women who survived to age 90. The results for a one standard deviation increase in AgeAccelHorvath, AgeAccelHannum, and AgeAccelGrim with multimorbidity accumulation and score were weaker compared to AgeAccelPheno, and the latter 2 did not reach statistical significance. CONCLUSION AgeAccelPheno and AgeAccelHannum may predict multimorbidity count and score at age 90 in older women and, thus, may be useful as a biomarker predictor of multimorbidity burden in the last decades of life.
Collapse
Affiliation(s)
- Purva Jain
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Alexandra Binder
- Cancer Epidemiology Program, University of Hawaii Cancer Center, Honolulu, Hawaii, USA
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California,USA
| | - Brian Chen
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
- San Diego Moores Cancer Center, University of California, San Diego, California, La Jolla, California, USA
| | - Linda C Gallo
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, California, USA
| | - John Alcaraz
- San Diego Moores Cancer Center, University of California, San Diego, California, La Jolla, California, USA
| | - Steve Horvath
- Department of Human Genetics, David Geffen School of Medicine, UCLA, Los Angeles, California,USA
- Department of Biostatistics, School of Public Health, University of California, Los Angeles, California,USA
| | - Parveen Bhatti
- Cancer Control Research, BC Cancer, Vancouver, British Columbia, Canada
| | - Eric A Whitsel
- Department of Epidemiology, Gillings School of Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kristina Jordahl
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Andrea A Baccarelli
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, New York, New York, USA
| | - Lifang Hou
- Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois,USA
| | - James D Stewart
- Department of Epidemiology, Gillings School of Public Health and Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Yun Li
- Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Computer Science, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo―SUNY, Buffalo, New York, USA
| | - JoAnn E Manson
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrea Z LaCroix
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
4
|
Merino-Soto C, Núñez Benítez MÁ, Domínguez-Guedea MT, Toledano-Toledano F, Moral de la Rubia J, Astudillo-García CI, Rivera-Rivera L, Leyva-López A, Angulo-Ramos M, Flores Laguna OA, Hernández-Salinas G, Rodríguez Castro JH, González Peña OI, Garduño Espinosa J. Medical outcomes study social support survey (MOS-SSS) in patients with chronic disease: A psychometric assessment. Front Psychiatry 2023; 13:1028342. [PMID: 36713918 PMCID: PMC9874003 DOI: 10.3389/fpsyt.2022.1028342] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Purpose Currently, information on the psychometric properties of the Medical outcomes study-social support survey (MOS-SSS) for patients with chronic disease in primary health care, suggests problems in the dimensionality, specifically predominant unidimensionality in a multidimensional measure. The aim of this study was to determine the internal structure (dimensionality, measurement invariance and reliability) and association with other variables. Methods A total of 470 patients with chronic disease from a Family Medicine Unit at the Instituto Mexicano del Seguro Social, IMSS, with a mean age of 51.51 years were included. Participants responded to the Questionnaire of Sociodemographic Variables (Q-SV), SF-36 Health-Related Quality of Life Scale-version 1.1, and MOS-SSS. Results Non-parametric (Mokken scaling analysis) and parametric (confirmatory factor analysis) analyses indicated unidimensionality, and three-factor model was not representative. A new 8-item version (MOS-S) was developed, where measurement invariance, equivalence with the long version, reliability, and relationship with the SF-36 were satisfactory. Conclusion The MOS-SSS scale is unidimensional, and the shortened version yields valid and reliable scores for measuring social support in patients with chronic disease at the primary health care.
Collapse
Affiliation(s)
- Cesar Merino-Soto
- Instituto de Investigación de Psicología, Universidad de San Martín de Porres, Surquillo, Peru
| | | | | | - Filiberto Toledano-Toledano
- Hospital Infantil de México Federico Gómez, Unidad de Investigación en Medicina Basada en Evidencias, Mexico City, Mexico
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Unidad de Investigación Sociomédica, Mexico City, Mexico
- Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Dirección de Investigación y Diseminación del Conocimiento, Mexico City, Mexico
| | | | | | - Leonor Rivera-Rivera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Ahidée Leyva-López
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública (INSP), Cuernavaca, Morelos, Mexico
| | - Marisol Angulo-Ramos
- Instituto Nacional de Ciencias e Innovación para la Formación de Comunidad Científica, INDEHUS, Dirección de Investigación y Diseminación del Conocimiento, Mexico City, Mexico
| | - Omar Arodi Flores Laguna
- Facultad de Ciencias Empresariales y Jurídicas, Universidad de Montemorelos, Montemorelos, Mexico
| | - Gregorio Hernández-Salinas
- Tecnológico Nacional de México/Instituto Tecnológico Superior de Zongolica-Extensión Tezonapa, Heroica Veracruz, Mexico
| | - Jorge Homero Rodríguez Castro
- División de Estudios de Posgrado e Investigación, Tecnológico Nacional de Mexico/Instituto Tecnologico de Ciudad Victoria, Ciudad Victoria, Tamaulipas, Mexico
| | - Omar Israel González Peña
- Hospital Infantil de México Federico Gómez, Unidad de Investigación en Medicina Basada en Evidencias, Mexico City, Mexico
| | - Juan Garduño Espinosa
- Dirección de Investigación, Hospital Infantil de México Federico Gómez, Instituto Nacional de Salud, Mexico City, Mexico
| |
Collapse
|
5
|
Puthusseryppady V, Bregola A, Camino J, Backhouse T, Mioshi E. Is Carer Management Style Associated with Longitudinal Functional Decline in Dementia? J Alzheimers Dis 2023; 96:1139-1149. [PMID: 37955085 DOI: 10.3233/jad-230075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
BACKGROUND Various intrinsic (related to dementia) and extrinsic (not related to dementia) factors have been suggested to contribute separately to disability in people living with dementia (PLwD). OBJECTIVE To investigate if the combination of specific intrinsic and extrinsic factors at baseline is associated with longitudinal declines in activities of daily living (ADL) performance of PLwD at 12-month follow-up. METHODS 141 community-dwelling PLwD-carer dyads were assessed on their global cognition (ACE-III), apathy (CBI-R), carer management styles (DMSS), medical comorbidities (CCI), and ADL performance (DAD) at baseline, and for a subset of participants (n = 53), at 12-month follow-up. Multiple linear regression models were run to assess: 1) the relationships between PLwD's DAD scores and the remaining variables at baseline and 2) whether these variables' scores at baseline were associated with longitudinal change in the PLwD's DAD scores. RESULTS At baseline, having lower ACE-III (β= 0.354, p < 0.001), higher CBI-R (β= -0.284, p < 0.001), higher DMSS criticism (β= -0.367, p = 0.013), lower DMSS encouragement (β= 0.370, p = 0.014), and higher CCI scores (β= -2.475, p = 0.023) were significantly associated with having lower DAD scores. The PLwD's DAD scores significantly declined from baseline to follow-up (p < 0.001, d = 1.15), however this decline was not associated with the baseline scores of any of the independent variables. Instead, it was associated with declines in the PLwD's ACE-III scores from baseline to follow-up (β= 1.021, p = 0.001). CONCLUSIONS In our limited sample, cognitive changes seem to be the main factor underlying longitudinal decline in ADL performance for PLwD. Carer management styles appear associated with current ADL performance but not with longitudinal ADL decline.
Collapse
Affiliation(s)
- Vaisakh Puthusseryppady
- School of Health Sciences, University of East Anglia, Norwich, UK
- Department of Neurobiology and Behavior, University of California Irvine, Irvine, CA, USA
| | - Allan Bregola
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Julieta Camino
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Tamara Backhouse
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - Eneida Mioshi
- School of Health Sciences, University of East Anglia, Norwich, UK
| |
Collapse
|
6
|
The association between multimorbidity and mobility disability-free life expectancy in adults aged 85 years and over: A modelling study in the Newcastle 85+ cohort. PLoS Med 2022; 19:e1004130. [PMID: 36374907 PMCID: PMC9662726 DOI: 10.1371/journal.pmed.1004130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/20/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Mobility disability is predictive of further functional decline and can itself compromise older people's capacity (and preference) to live independently. The world's population is also ageing, and multimorbidity is the norm in those aged ≥85. What is unclear in this age group, is the influence of multimorbidity on (a) transitions in mobility disability and (b) mobility disability-free life expectancy (mobDFLE). METHODS AND FINDINGS Using multistate modelling in an inception cohort of 714 85-year-olds followed over a 10-year period (aged 85 in 2006 to 95 in 2016), we investigated the association between increasing numbers of long-term conditions and (1) mobility disability incidence, (2) recovery from mobility disability and (3) death, and then explored how this shaped the remaining life expectancy free from mobility disability at age 85. Models were adjusted for age, sex, disease group count, BMI and education. We defined mobility disability based on participants' self-reported ability to get around the house, go up and down stairs/steps, and walk at least 400 yards; participants were defined as having mobility disability if, for one or more these activities, they had any difficulty with them or could not perform them. Data were drawn from the Newcastle 85+ Study: a longitudinal population-based cohort study that recruited community-dwelling and institutionalised individuals from Newcastle upon Tyne and North Tyneside general practices. We observed that each additional disease was associated with a 16% increased risk of incident mobility disability (hazard ratio (HR) 1.16, 95% confidence interval (CI): 1.07 to 1.25, p < 0.001), a 26% decrease in the chance of recovery from this state (HR 0.74, 95% CI: 0.63 to 0.86, p < 0.001), and a 12% increased risk of death with mobility disability (HR: 1.12, 95% CI: 1.07- to .17, p < 0.001). This translated to reductions in mobDFLE with increasing numbers of long-term conditions. However, residual and unmeasured confounding cannot be excluded from these analyses, and there may have been unobserved transitions to/from mobility disability between interviews and prior to death. CONCLUSIONS We suggest 2 implications from this work. (1) Our findings support calls for a greater focus on the prevention of multimorbidity as populations age. (2) As more time spent with mobility disability could potentially lead to greater care needs, maintaining independence with increasing age should also be a key focus for health/social care and reablement services.
Collapse
|
7
|
Brucker DL, Lauer E, Boege S. Americans Aging With Disabilities Are More Likely to Have Multiple Chronic Conditions. JOURNAL OF DISABILITY POLICY STUDIES 2022. [DOI: 10.1177/10442073221107079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Using data from the 2010 to 2017 National Health Interview survey, bivariate and multivariate regression analyses were utilized to estimate the percentage and odds of having multiple chronic conditions (two or more, three or more) among U.S. adults ages 65 and over with and without disabilities, controlling for sociodemographic factors and presence of psychological distress. Older adults with and without disabilities in the United States most frequently reported having hypertension, arthritis, and diabetes. Regression results indicate that older adults with disabilities are significantly more likely to experience two or more and three or more chronic conditions than older adults without disabilities, controlling for sociodemographic factors and health behaviors. These findings highlight a need for improvement in coordinated care that considers both disability and multiple chronic conditions in the management of patient health to support well-being in aging.
Collapse
Affiliation(s)
| | - Eric Lauer
- University of New Hampshire, Durham, USA
- Point32Health, Canton, MA, USA
| | | |
Collapse
|
8
|
Palmowski Y, Balmer S, Hu Z, Winkler T, Schnake KJ, Kandziora F, Pumberger M. Relationship Between the OF Classification and Radiological Outcome of Osteoporotic Vertebral Fractures After Kyphoplasty. Global Spine J 2022; 12:646-653. [PMID: 33131331 PMCID: PMC9109556 DOI: 10.1177/2192568220964051] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The OF classification is a new classification for osteoporotic vertebral fractures. The aim of this study was to clarify the relationship between preoperative OF subgroups and the postoperative outcome after kyphoplasty in patients with such fractures. METHODS Patients who underwent kyphoplasty of a single osteoporotic vertebral fracture were included and divided into groups according to the OF subgroups. Pre- and postoperative plain radiographs were analyzed in regard to the restoration of vertebral body height and local kyphotic angle (LKA). Additionally, clinical data including pre- and postoperative Visual Analogue Scale pain scores was documented. The clinical and radiological results were compared pre- and postoperatively within groups and between groups. RESULTS A total of 156 patients from OF subgroups 2 to 4 were included (OF 2: n = 58; OF 3: n = 36; OF 4: n = 62). Patients from all groups experienced significant pain relief postoperatively (P < .001). Patients with OF 2 fractures showed a repositioning of the vertebral body height in the anterior and middle portions (both P < .001), but no significant improvement in LKA. For OF 3 and 4 fractures, there was a significant restoration of vertebral body height (P < .001 for both) and a significant improvement of LKA (P < .001 for both). The highest average restoration was noted in the OF 4 group. CONCLUSIONS A higher OF subgroup is related to a higher radiological benefit from kyphoplasty. This confirms that the OF classification is an appropriate tool for the preoperative assessment of osteoporotic fractures.
Collapse
Affiliation(s)
| | | | - Zhouyang Hu
- Charité University Medicine
Berlin, Berlin, Germany
| | - Tobias Winkler
- Charité University Medicine
Berlin, Berlin, Germany
- Berlin Institute of Health Center
for Regenerative Therapies, Charité Universitätsmedizin, Berlin, Germany
| | | | | | | |
Collapse
|
9
|
Van Wilder L, Pype P, Mertens F, Rammant E, Clays E, Devleesschauwer B, Boeckxstaens P, De Smedt D. Living with a chronic disease: insights from patients with a low socioeconomic status. BMC FAMILY PRACTICE 2021; 22:233. [PMID: 34789153 PMCID: PMC8598397 DOI: 10.1186/s12875-021-01578-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/27/2021] [Indexed: 11/10/2022]
Abstract
Background Little is known about how patients with low socioeconomic status (SES) experience their chronic disease, and how it impacts health-related quality of life (HRQoL). Compared to their more affluent counterparts, worse outcomes have been reported. A better understanding of the domains of HRQoL that are relevant to these specific populations is therefore needed. We explored the experiences of living with a chronic disease in low SES persons. Methods A qualitative interview study was performed in Flanders, Belgium. Semi-structured interviews were conducted in chronically ill patients, selected through purposive sampling. Interviews were audio-recorded and transcribed verbatim. Analysis followed an inductive and iterative approach. Results Fifteen patients were interviewed. Six major themes were identified: a heavy bag to carry, loss of autonomous life, inner and outer loneliness, emotional imbalance, unmet need for support, and coping strategies. Patients experienced their illness as an additional problem on top of all other problems (i.e. financial/social problems, traumatic life events). In general, the disease burden and non-disease burden were mutually reinforcing, resulting in greater dependency, greater risk of social isolation, greater psychological distress, and greater risk of impaired HRQoL. Conclusions This study is the first to provide detailed insight into the experiences of living with a chronic disease in low SES persons. A conceptual model is proposed that can be used in daily clinical practice to raise awareness among clinicians and health care providers that the patient’s needs go beyond the disease itself. Future research is needed to validate and test the model. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01578-7.
Collapse
Affiliation(s)
- Lisa Van Wilder
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.
| | - Peter Pype
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Fien Mertens
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Elke Rammant
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Els Clays
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.,Department of Translational Physiology, Infectiology and Public Health, Ghent University, Merelbeke, Belgium
| | | | - Delphine De Smedt
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| |
Collapse
|
10
|
Demontès M, Eymard Duvernay S, Allavena C, Jovelin T, Reynes J, Hentzien M, Ravaux I, Delobel P, Bregigeon S, Rey D, Ferry T, Gagneux-Brunon A, Robineau O, Pugliese P, Duvivier C, Cabié A, Chirouze C, Jacomet C, Lamaury I, Merrien D, Hoen B, Hocqueloux L, Cheret A, Katlama C, Arvieux C, Krolak-Salmon P, Makinson A. Multimorbidity in Elderly Persons According to the Year of Diagnosis of Human Immunodeficiency Virus Infection: A Cross-sectional Dat'AIDS Cohort Study. Clin Infect Dis 2021; 71:2880-2888. [PMID: 31813982 DOI: 10.1093/cid/ciz1171] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/07/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND We assessed prevalence of multimorbidity (MM) according to year of human immunodeficiency virus (HIV) diagnosis in elderly people living with HIV (PLWH). METHODS This was a cross-sectional study of MM in PLWH aged ≥70 years from the Dat'AIDS French multicenter cohort. MM was defined as at least 3 coexistent morbidities of high blood pressure, diabetes mellitus, osteoporosis, non-AIDS cancer, chronic renal failure, cardiovascular and cerebrovascular disease, obesity, undernutrition, or hypercholesterolemia. Logistic regression models evaluated the association between MM and calendar periods of HIV diagnosis (1983-1996, 1997-2006, and 2007-2018). The secondary analysis evaluated MM as a continuous outcome, and a sensitivity analysis excluded PLWH with nadir CD4 count <200 cells/μL. RESULTS Between January 2017 and September 2018, 2476 PLWH were included. Median age was 73 years, 75% were men, median CD4 count was 578 cells/μL, and 94% had controlled viremia. MM prevalence was 71%. HBP and hypercholesterolemia were the most prevalent comorbidities. After adjustment for age, gender, smoking status, hepatitis C and hepatitis B virus coinfection, group of exposure, nadir CD4 count, CD4:CD8 ratio, and last CD4 level, calendar period of diagnosis was not associated with MM (P = .169). MM was associated with older age, CD4/CD8 ratio <0.8, and nadir CD4 count <200 cells/μL. Similar results were found with secondary and sensitivity analyses. CONCLUSIONS MM prevalence was high and increased with age, low CD4/CD8 ratio, and nadir CD4 count <200 cells/μL but was not associated with calendar periods of HIV diagnosis. Known duration of HIV diagnosis does not seem to be a criterion for selecting elderly PLWH at risk of MM.
Collapse
Affiliation(s)
- Marie Demontès
- Memory Clinical and Research Center of Lyon, Lyon Institute for Elderly, Hospices civils de Lyon, Université Lyon, Inserm, Lyon, France
| | - Sabrina Eymard Duvernay
- University of Montpellier, Unité TransVIHMI, France Institute of Research for Development Unité Mixte Internationale (UMI) 233, Inserm U1175, Montpellier, France
| | - Clotilde Allavena
- Infectious Diseases Department, University of Nantes, Centre hospitalier universitaire Hôtel Dieu, Nantes, France
| | - Thomas Jovelin
- Infectious Diseases Department, University of Nantes, Centre hospitalier universitaire Hôtel Dieu, Nantes, France
| | - Jacques Reynes
- Infectious and Tropical Diseases Department, Montpellier University Hospital, and UMI 233, Inserm U1175, Montpellier, France
| | - Maxime Hentzien
- Reims Teaching Hospitals, Robert Debré Hospital, Department of Internal Medicine, Infectious Diseases, and Clinical Immunology, Reims, France
| | - Isabelle Ravaux
- Aix Marseille Université, Centre Nationale de la Recherche Scientifique (CNRS), Institut de Recherche pour le Développement (IRD), Inserm, Assistance Publique-Hôpitaux de Marseille (AP-HM), Unité de Recherche sur les Maladies Infectieuses, Institut Hospitalo-Universitaire (IHU) Méditerranée-Infection, Marseille, France
| | - Pierre Delobel
- Infectious and Tropical Diseases Department Inserm, Unité Mixte de Recherche (UMR) 1043, Toulouse, France
| | - Sylvie Bregigeon
- Aix Marseille Universiteé, AP-HM Sainte-Marguerite, Marseille, France
| | - David Rey
- University Hospitals of Strasbourg, Nouvel Hôpital Civil, Human Immunodeficiency Virus Care Center, Strasbourg, France
| | - Tristan Ferry
- Infectious Diseases Department, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France
| | - Amandine Gagneux-Brunon
- Department of Infectious and Tropical Diseases, Centre hospitalier universitaire Saint-Etienne, Groupe Immunité des Muqueuses et Agents Pathogènes, Jean Monnet University, University of Lyon, Saint-Etienne, France
| | - Olivier Robineau
- Infectious Diseases Department, Gustave Drion Hospital, Tourcoing, France
| | - Pascal Pugliese
- Infectious Diseases Department, University of Nice, Centre hospitalier universitaire L'Archet, Nice, France
| | - Claudine Duvivier
- Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants malades, Infectious and Tropical Diseases Department, Institut Pasteur, Centre Médical de l'Institut Pasteur, Infectious Diseases Centre Necker-Pasteur, IHU Imagine, Institut Cochin, CNRS 8104, Inserm U1016, Paris, France
| | - André Cabié
- Clinical Investigation Centre, Antilles Guyane, Inserm 1424 and Infectious and Tropical Diseases Department, Centre Hospitalier Universitaire de la Martinique and University of the Antilles, Equipe d'Acceuil, Fort-de-France, France
| | - Catherine Chirouze
- Infectious and Tropical Diseases Department, Centre Hospitalier Regional Universitaire Besançon, UMR CNRS 6249 Bourgogne Franche Comté University, Besançon, France
| | - Christine Jacomet
- Infectious Diseases Department, Centre hospitalier universitaire Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Lamaury
- Department of Infectious and Tropical Diseases, Dermatology, Internal Medicine, University Hospital Guadeloupe, Pointe-à-Pitre, France
| | - Dominique Merrien
- Internal Medicine Department, Centre Hospitalier Vendée (CHD) Vendée, La Roche-sur-Yon, France
| | - Bruno Hoen
- Infectious and Tropical Diseases Department, Centre Hospitalier Regional Universitaire Besançon, UMR CNRS 6249 Bourgogne Franche Comté University, Besançon, France
| | - Laurent Hocqueloux
- Department of Infectious and Tropical Diseases, Centre hospitalier universitaire d'Orléans-La Source, Orléans, France
| | - Antoine Cheret
- Internal Medicine Department, Centre hospitalier universitaire Bicètre, Bicètre, France.,University of Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Christine Katlama
- Sorbonne Université, Inserm, Pierre Louis Institute of Epidemiology and Public Health, Unité Mixte de Recherche en Santé 1136, AP -HP, Hôpitaux Universitaires Pitié Salpêtrière-Charles Foix, Department of Infectious and Tropical Diseases, Paris, France
| | - Cédric Arvieux
- Centre hospitalier universitaire Rennes, Infectious Diseases and Intensive Care Unit, Rennes, France
| | - Pierre Krolak-Salmon
- Memory Clinical and Research Center of Lyon, Lyon Institute for Elderly, Hospices civils de Lyon, Université Lyon, Inserm, Lyon, France
| | - Alain Makinson
- Infectious and Tropical Diseases Department, Montpellier University Hospital, and UMI 233, Inserm U1175, Montpellier, France
| | | |
Collapse
|
11
|
Comorbidity Patterns of Older Lung Cancer Patients in Northeast China: An Association Rules Analysis Based on Electronic Medical Records. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17239119. [PMID: 33291317 PMCID: PMC7729838 DOI: 10.3390/ijerph17239119] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 12/12/2022]
Abstract
Purposes: This study aims to identify the comorbidity patterns of older men with lung cancer in China. Methods: We analyzed the electronic medical records (EMRs) of lung cancer patients over age 65 in the Jilin Province of China. The data studied were obtained from 20 hospitals of Jilin Province in 2018. In total, 1510 patients were identified. We conducted a rank–frequency analysis and social network analysis to identify the predominant comorbidities and comorbidity networks. We applied the association rules to mine the comorbidity combination with the values of confidence and lift. A heatmap was utilized to visualize the rules. Results: Our analyses discovered that (1) there were 31 additional medical conditions in older patients with lung cancer. The most frequent comorbidities were pneumonia, cerebral infarction, and hypertension. (2) The network-based analysis revealed seven subnetworks. (3) The association rules analysis provided 41 interesting rules. The results revealed that hypertension, ischemic cardiomyopathy, and pneumonia are the most frequent comorbid combinations. Heart failure may not have a strong implicating role in these comorbidity patterns. Cerebral infarction was rarely combined with other diseases. In addition, glycoprotein metabolism disorder comorbid with hyponatremia or hypokalemia increased the risk of anemia by more than eight times in older lung cancer patients. Conclusions: This study provides evidence on the comorbidity patterns of older men with lung cancer in China. Understanding the comorbidity patterns of older patients with lung cancer can assist clinicians in their diagnoses and contribute to developing healthcare policies, as well as allocating resources.
Collapse
|
12
|
Zheng DD, Christ SL, Lam BL, Feaster DJ, McCollister K, Lee DJ. Patterns of Chronic Conditions and Their Association With Visual Impairment and Health Care Use. JAMA Ophthalmol 2020; 138:387-394. [PMID: 32105300 DOI: 10.1001/jamaophthalmol.2020.0052] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Visual impairment and visual disorders often co-occur with other chronic conditions. Understanding patterns of multimorbidity is important for reducing health care use and improving health outcomes. Objective To identify chronic condition patterns and their association with visual impairment and health care use in a nationally representative sample. Design, Setting, and Participants This cross-sectional study used National Health Interview Survey data for 387 780 individuals aged 18 years and older, representative of the civilian noninstitutionalized US population, from January 1, 2002, to December 31, 2014. Statistical analysis was performed from June to November 2018. Exposures Participants were classified in subgroups with different combinations of self-reported chronic conditions using latent class analysis. Main Outcomes and Measures Self-reported visual impairment, emergency department visit, and hospitalization use in the previous 12 months. Results Among the 387 780 individuals included in the study, 51.8% were female, 77.6% were white, and the mean (SD) age was 46.2 (18.0) years. Latent class analysis identified 5 different classes, with 70.5% of the participants belonging to the healthy group. The other 4 groups represented various degrees and patterns of multimorbidity. The hypertensive group (19.6%) had a high prevalence of hypertension (62.6%), the respiratory conditions group (4.4%) had a high prevalence of emphysema (47.7%) and asthma (45.6%), the heart disease group (3.6%) had high prevalence of coronary heart disease (69.8%), and the severely impaired group (1.8%) had higher prevalence of most conditions compared with the other groups. In the adjusted analysis, compared with the healthy group, participants in all 4 disease groups had elevated risk of visual impairment: heart condition group (odds ratio [OR], 3.19; 95% CI, 2.92-3.48), hypertensive group (OR, 3.28; 95% CI, 3.10-3.48), respiratory condition group (OR, 3.87; 95% CI, 3.56-4.20), and severely impaired group (OR, 10.19; 95% CI, 9.20-11.28). All 4 disease groups had elevated risk of reporting emergency department use and hospitalization. For the severely impaired group, the OR for emergency department use was 9.39 (95% CI, 8.53-10.34), and the OR for hospitalization was 10.80 (95% CI, 9.80-11.92). Conclusions and Relevance In this study, individuals in all 4 multimorbidity groups had an elevated risk of visual impairment and health care use compared with the healthy group. Characteristics of high-risk groups identified by this study may help in the development and implementation of interventions to avert the more serious consequences of having multiple chronic conditions.
Collapse
Affiliation(s)
- D Diane Zheng
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Sharon L Christ
- Department of Human Development and Family Studies and Statistics, Purdue University, West Lafayette, Indiana
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - Kathryn McCollister
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida
| |
Collapse
|
13
|
Wahlqvist M, Möller C, Möller K, Danermark B. Similarities and Differences in Health, Social Trust, and Financial Situation in People With Usher Syndrome, a Bio-Psychosocial Perspective. Front Psychol 2020; 11:1760. [PMID: 32982818 PMCID: PMC7485379 DOI: 10.3389/fpsyg.2020.01760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022] Open
Abstract
Purpose The primary aim was to describe the similarities and differences among the general health, physical health, psychological health, social trust, and financial situations of people with Usher syndrome (USH) types 1, 2, and 3. A second aim was to explore whether age, gender, clinical diagnosis, visual field, visual acuity, and degree of hearing impairment were associated with the general health, physical health, psychological health, social trust, and financial situations of people with USH. Methods In this study, 162 people with USH living in Sweden were included, and all three types of the disease were represented. Data concerning vision, hearing, and genetics were retrieved from the Swedish Usher database. Group comparison using frequencies, χ2-tests and Kruskal-Wallis tests for group comparison were used. To examine the effect of independent variables on poor health outcomes, a logistic regression analysis was conducted. Results Problems with poor health, social trust, and finances were found for all three types; however, more similarities than differences were found. The results of the regression model were ambiguous; it is not clear which independent measures contributed the most to poor outcomes. People with USH3 tended to report the most problems regarding the dependent outcome measures. Conclusion The observations of the associations between the independent variables and poor health, social trust and finances made in the present study are important to bear in mind in a rehabilitation setting; however, they do not fully explain how people with USH actually feel or rate their health. More research is needed to confirm the knowledge that exists within the clinical setting and the life stories told by the people with USH to merge existing knowledge into a rehabilitation setting based on evidence.
Collapse
Affiliation(s)
- Moa Wahlqvist
- Audiological Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Swedish Institute for Disability Research, wÖrebro University, Örebro, Sweden.,The Swedish National Resource Center for Deafblindness, Lund, Sweden
| | - Claes Möller
- Audiological Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Swedish Institute for Disability Research, wÖrebro University, Örebro, Sweden
| | - Kerstin Möller
- Swedish Institute for Disability Research, wÖrebro University, Örebro, Sweden
| | - Berth Danermark
- Swedish Institute for Disability Research, wÖrebro University, Örebro, Sweden
| |
Collapse
|
14
|
Rector JL, Marceau K, Friedman EM. Moderation of the Association Between Chronic Medical Conditions and Functional Limitations Over Time by Physical Activity: Effects of Age. J Gerontol A Biol Sci Med Sci 2020; 75:168-174. [PMID: 30783672 PMCID: PMC6909926 DOI: 10.1093/gerona/glz020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Indexed: 12/13/2022] Open
Abstract
Background Age-related accumulation of chronic medical conditions increases disability in older adults. Physical activity potently combats chronic conditions and disability. However, it is unclear whether activity maintenance alleviates the effects of chronic conditions on disability and if this buffering effect differs with age. This study examined whether long-term physical activity can forestall functional limitations in the face of accumulating chronic conditions among middle-aged and older adults. Methods Participants (n = 2,119; 54.7% female) were from the Survey of Midlife Development in the United States. Self-reported physical activity, number of chronic conditions, and functional limitations were obtained across 18–20 years. Functional limitations were regressed against the change in chronic conditions, physical activity, and their interaction over time in a multilevel model of change. Baseline age was added as an additional moderator. Results Faster accumulation of chronic conditions [B(SE) = 2.08(0.32), p < .001] and steeper declines in activity [B(SE) = −2.29(0.41), p < .001] were associated with greater increases in functional limitations over time. Among those with faster-than-average increases in conditions, those who maintained activity had a slower progression of functional limitations, compared to those whose activity declined more rapidly [B(SE) = −11.18(3.96), p = .005]. Baseline age moderated the buffering effect of activity maintenance; older adults were protected against functional limitations only when conditions accumulated slowly [B(SE) = 0.23(0.08), p = .005]. Conclusion This study provides evidence for an age-dependent buffering effect of activity maintenance on the longitudinal relationship between chronic conditions and functional limitations. Intervention strategies using physical activity to forestall disability should target midlife adults and consider the rate of condition accumulation.
Collapse
Affiliation(s)
- Jerrald L Rector
- Human Development and Family Studies, Purdue University, West Lafayette, Indiana
| | - Kristine Marceau
- Human Development and Family Studies, Purdue University, West Lafayette, Indiana
| | - Elliot M Friedman
- Human Development and Family Studies, Purdue University, West Lafayette, Indiana
| |
Collapse
|
15
|
Byrd DR, Gonzales E, Moody DLB, Marshall GL, Zahodne LB, Thorpe RJ, Whitfield KE. Interactive Effects of Chronic Health Conditions and Financial Hardship on Episodic Memory among Older Blacks: Findings from the Health and Retirement Study. RESEARCH IN HUMAN DEVELOPMENT 2020; 17:41-56. [PMID: 33192185 PMCID: PMC7665222 DOI: 10.1080/15427609.2020.1746159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Previous research links chronic health conditions and financial hardship to cognitive outcomes among older Blacks. However, few studies have explored the moderating effect of financial hardship on chronic disease burden and specific cognitive domains. This study examined whether financial hardship (as measured by difficulty paying monthly bills) modifies the impact of self-reported chronic health conditions (e.g., diabetes, stroke) on episodic memory among 871 older Blacks (50+ years) in the Health and Retirement Study (2006). Financial hardship modified the association between chronic disease burden and episodic memory performance such that individuals who reported very little difficulty paying their monthly bills had significantly lower memory scores at high levels of disease burden compared to those reporting high financial difficulty after controlling for age, gender and education (F 2, 49 = 5.03, p= 0.010). This cross-sectional study suggests that both financial and physical wellbeing may have joint effects on cognitive health in older Blacks.
Collapse
Affiliation(s)
| | - Ernest Gonzales
- New York University, Silver School of Social Work, New York, NY, USA
| | | | | | | | - Roland J. Thorpe
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
16
|
Palmowski Y, Balmer S, Bürger J, Schömig F, Hu Z, Pumberger M. Influence of operative timing on the early post-operative radiological and clinical outcome after kyphoplasty. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2560-2567. [PMID: 32556626 DOI: 10.1007/s00586-020-06491-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 05/10/2020] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To clarify the relationship between operative timing and the early post-operative radiological and clinical outcome after kyphoplasty. METHODS We conducted a retrospective cohort study including patients who underwent kyphoplasty of a single vertebra. Patients were divided into three groups (acute [< 2 weeks], subacute [2-6 weeks] or chronic [6-51 weeks]) based on the interval between fracture and surgery. The relative vertebral body height (VBH) and local kyphotic angle (LKA) of the fractured vertebra (measured on plain radiographs) as well as pain and use of analgesics were compared pre- and post-operatively (day 2) and between the groups. RESULTS A total of 230 patients (100 with acute, 91 with subacute and 39 with chronic fractures) with fractures from T4 to L5 were included. In all groups, there was a significant post-operative improvement in the anterior (8.9-12.9%) and middle (10.7-13.4%) VBH (all groups: p < 0.001), LKA (acute: 3.8°, p < 0.001; subacute: 4.3°, p < 0.001; chronic: 1.7°, p = 0.046) and pain. The use of analgesics significantly decreased post-operatively in the acute and subacute groups, but did not significantly change in the chronic group. Patients from acute (p = 0.042) and subacute (p = 0.027) groups showed significantly better post-operative correction of the LKA than the chronic group. CONCLUSION Kyphoplasty is effective for vertebral height restoration as well as pain relief for both acute, subacute and chronic fractures. However, the achievable correction of the fracture-related local kyphosis decreases significantly after 6 weeks. Therefore, we recommend making a final decision about conservative vs. operative treatment within 6 weeks to ensure better height restoration in surgically treated patients.
Collapse
Affiliation(s)
- Yannick Palmowski
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany.
| | - Sophie Balmer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany
| | - Justus Bürger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany
| | - Friederike Schömig
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany
| | - Zhouyang Hu
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany
| | - Matthias Pumberger
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Center for Musculoskeletal Surgery, Chariteplatz 1, 10117, Berlin, Germany
| |
Collapse
|
17
|
Nicolson PJA, Williamson E, Lee H, Morris A, Garrett A, Sanchez-Santos MT, Lamb SE. Synergistic effects of hip/knee osteoarthritis and comorbidities on mobility and self-care limitations among older adults: Cross-sectional analysis of the Oxford pain, Activity and Lifestyle study. JOURNAL OF COMORBIDITY 2020; 10:2235042X20974529. [PMID: 33330114 PMCID: PMC7720340 DOI: 10.1177/2235042x20974529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 10/28/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate synergistic effects of hip/knee osteoarthritis (OA) and comorbidities on mobility or self-care limitations among older adults. METHODS We used baseline, cross-sectional data from the Oxford Pain, Activity and Lifestyle (OPAL) study. Participants were community-dwelling adults aged 65 years or older who completed a postal questionnaire. Participants reported demographic information, hip/knee OA, comorbidities and mobility and self-care limitations. We used modified Poisson regression models to estimate the independent and combined relative risks (RR) of mobility or self-care limitations, the relative excess risk due to interaction (RERI) between hip/knee OA and comorbidities, attributable proportion of the risk due to the interaction and the ratio of the combined effect and the sum of the individual effects, known as the synergy index. RESULTS Of the 4,972 participants included, 1,532 (30.8%) had hip/knee OA, and of them 42.9% reported mobility limitations and 8.4% reported self-care limitations. Synergistic effects impacting self-care limitations were observed between hip/knee OA and anxiety (RR: 3.09, 95% Confidence Interval (CI): 2.00 to 4.78; RERI: 0.93, 95% CI: 0.01 to 1.90), and between hip/knee OA and depressive symptoms (RR: 2.71, 95% CI: 1.75 to 4.20; RERI: 0.58, 95% CI: 0.03 to 1.48). The portion of the total RR attributable to this synergism was 30% and 22% respectively. CONCLUSIONS This study demonstrates that synergism between hip/knee OA and anxiety or depressive symptoms contribute to self-care limitations. These findings highlight the importance of assessing and addressing anxiety or depressive symptoms when managing older adults with hip/knee OA to minimize self-care limitations.
Collapse
Affiliation(s)
- Philippa JA Nicolson
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Esther Williamson
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Hopin Lee
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
- School of Medicine and Public Health, University of Newcastle, New South Wales, Australia
| | - Alana Morris
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Angela Garrett
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Maria T Sanchez-Santos
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
| | - Sarah E Lamb
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK
- College of Medicine and Health, University of Exeter, UK
| |
Collapse
|
18
|
Lee MJ, Romero S, Jia H, Velozo CA, Gruber-Baldini AL, Shulman LM. Self-efficacy for managing hypertension and comorbid conditions. World J Hypertens 2019; 9:30-41. [DOI: 10.5494/wjh.v9.i3.30] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/04/2019] [Accepted: 11/26/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Self-efficacy is defined an individual’s belief in completing necessary actions to achieve the desired goal. For individuals with hypertension and other chronic conditions, self-efficacy has been an essential factor to predict adherence to treatment behaviors.
AIM To examine self-efficacy for managing chronic conditions in individuals with hypertension.
METHODS A total of 1087 individuals with chronic conditions in two groups (hypertension and non-hypertension groups) were selected in this study. The two groups’ self-efficacy for managing chronic conditions were investigated using the five domains of patient reported outcomes measurement information system self-efficacy for managing chronic conditions measures (PROMIS-SE); daily activities, emotions, medication and treatment, social interactions, and symptoms. Also, the relationships between self-efficacy and other health-related outcomes for the hypertension group were examined using structural equation modeling.
RESULTS Among 1087 participants, 437 reported having hypertension. The hypertension and non-hypertension groups were statistically different in self-efficacy for managing daily activities [F (1, 598) = 5.63, P < 0.05]. Structural equation modeling indicated that for individuals with hypertension, two domains of PROMIS-SE (managing daily activities and emotions) significantly predict global physical health (P < 0.001 and P < 0.01 sequentially), and one domain (managing emotions) significantly predicts mental health (P < 0.001). Hypertension patients’ general quality of life was significantly predicted by global physical health (P < 0.001) and mental health (P < 0.001).
CONCLUSION The hypertension group reported deficits in self-efficacy in managing daily activities as compared to the non-hypertension group. In this hypertension group, self-efficacy functioned as an indirect predictor of general quality of life, mediated by global physical and mental health.
Collapse
Affiliation(s)
- Mi Jung Lee
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32610, United States
- Huan-Guang Jia, NF/SG VHS, Center of Innovation on Disability and Rehabilitation Research-GNV, Gainesville, FL 32601, United States
| | - Sergio Romero
- Department of Occupational Therapy, University of Florida, Gainesville, FL 32610, United States
- Huan-Guang Jia, NF/SG VHS, Center of Innovation on Disability and Rehabilitation Research-GNV, Gainesville, FL 32601, United States
| | | | - Craig A Velozo
- Division of Occupational Therapy, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Ann L Gruber-Baldini
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| | - Lisa M Shulman
- Department of Neurology, University of Maryland School of Medicine, Baltimore, MD 21201, United States
| |
Collapse
|
19
|
Takae R, Hatamoto Y, Yasukata J, Kose Y, Komiyama T, Ikenaga M, Yoshimura E, Yamada Y, Ebine N, Higaki Y, Tanaka H. Physical Activity and/or High Protein Intake Maintains Fat-Free Mass in Older People with Mild Disability; the Fukuoka Island City Study: A Cross-Sectional Study. Nutrients 2019; 11:nu11112595. [PMID: 31671741 PMCID: PMC6893506 DOI: 10.3390/nu11112595] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/21/2019] [Accepted: 10/22/2019] [Indexed: 12/21/2022] Open
Abstract
Body composition changes with age, with fat mass (FM) increasing and fat-free mass (FFM) decreasing. Higher physical activity and high or adequate protein intake are thought to be beneficial in preventing the loss of skeletal muscle mass in the elderly. We aimed to investigate the relationships between physical activity, protein intake, and FFM in older people with mild disability. Total energy expenditure (TEE) under free-living conditions was assessed using the doubly-labelled water (DLW) method, and physical activity was measured using a triaxial accelerometer. Dietary intake was assessed using a self-recorded food intake diary during the DLW period. Percent FFM was significantly positively correlated with protein intake and physical activity level (PAL) after adjustment for age and sex (protein intake r = 0.652, p < 0.001, PAL r = 0.345, p = 0.011). In multiple linear regression analysis, when PAL, moderate-to-vigorous physical activity (MVPA), or protein intake were included, 31%, 32%, and 55%, respectively, of the variation in %FFM was explained. Moreover, the addition of both PAL/MVPA and protein intake explained 61%/60%, respectively, of the variation in %FFM. Either protein intake above the currently recommended level or higher levels of physical activity would be beneficial for the maintenance of high %FFM.
Collapse
Affiliation(s)
- Rie Takae
- Graduate School of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Yoichi Hatamoto
- Institute for Physical Activity, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan.
| | - Jun Yasukata
- Institute for Physical Activity, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, 8-19-1 Nanakuma Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan.
| | - Yujiro Kose
- Institute for Physical Activity, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, 8-19-1 Nanakuma Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan.
| | - Takaaki Komiyama
- Graduate School of Sports and Health Science, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
- Center for Education in Liberal Arts and Sciences, Osaka University, 1-17 Machikaneyamachou, Toyonaka, Osaka 560-0043, Japan.
| | - Masahiro Ikenaga
- Institute for Physical Activity, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Eiichi Yoshimura
- Department of Food and Health Sciences, Prefectural University of Kumamoto Faculty of Environmental and Symbiotic Sciences, 3-1-100 Tsukide, Higashi-ku, Kumamoto 862-8502, Japan.
| | - Yosuke Yamada
- Department of Nutrition and Metabolism, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health, and Nutrition, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8636, Japan.
| | - Naoyuki Ebine
- Faculty of Health and Sports Science, Doshisha University, 1-3 Miyakodani Tatara, Kyotanabe-shi, Kyoto 610-0394, Japan.
| | - Yasuki Higaki
- Institute for Physical Activity, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, 8-19-1 Nanakuma Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan.
| | - Hiroaki Tanaka
- Institute for Physical Activity, Fukuoka University, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
- Faculty of Sports and Health Science, Fukuoka University, Fukuoka, 8-19-1 Nanakuma Jonan-ku, Fukuoka-shi, Fukuoka 814-0180, Japan.
| |
Collapse
|
20
|
Newman-Griffis D, Porcino J, Zirikly A, Thieu T, Camacho Maldonado J, Ho PS, Ding M, Chan L, Rasch E. Broadening horizons: the case for capturing function and the role of health informatics in its use. BMC Public Health 2019; 19:1288. [PMID: 31615472 PMCID: PMC6794808 DOI: 10.1186/s12889-019-7630-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 09/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background Human activity and the interaction between health conditions and activity is a critical part of understanding the overall function of individuals. The World Health Organization’s International Classification of Functioning, Disability and Health (ICF) models function as all aspects of an individual’s interaction with the world, including organismal concepts such as individual body structures, functions, and pathologies, as well as the outcomes of the individual’s interaction with their environment, referred to as activity and participation. Function, particularly activity and participation outcomes, is an important indicator of health at both the level of an individual and the population level, as it is highly correlated with quality of life and a critical component of identifying resource needs. Since it reflects the cumulative impact of health conditions on individuals and is not disease specific, its use as a health indicator helps to address major barriers to holistic, patient-centered care that result from multiple, and often competing, disease specific interventions. While the need for better information on function has been widely endorsed, this has not translated into its routine incorporation into modern health systems. Purpose We present the importance of capturing information on activity as a core component of modern health systems and identify specific steps and analytic methods that can be used to make it more available to utilize in improving patient care. We identify challenges in the use of activity and participation information, such as a lack of consistent documentation and diversity of data specificity and representation across providers, health systems, and national surveys. We describe how activity and participation information can be more effectively captured, and how health informatics methodologies, including natural language processing (NLP), can enable automatically locating, extracting, and organizing this information on a large scale, supporting standardization and utilization with minimal additional provider burden. We examine the analytic requirements and potential challenges of capturing this information with informatics, and describe how data-driven techniques can combine with common standards and documentation practices to make activity and participation information standardized and accessible for improving patient care. Recommendations We recommend four specific actions to improve the capture and analysis of activity and participation information throughout the continuum of care: (1) make activity and participation annotation standards and datasets available to the broader research community; (2) define common research problems in automatically processing activity and participation information; (3) develop robust, machine-readable ontologies for function that describe the components of activity and participation information and their relationships; and (4) establish standards for how and when to document activity and participation status during clinical encounters. We further provide specific short-term goals to make significant progress in each of these areas within a reasonable time frame.
Collapse
Affiliation(s)
- Denis Newman-Griffis
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA. .,Department of Computer Science and Engineering, The Ohio State University, 2015 Neil Avenue, DL 395, Columbus, OH, 43210, USA.
| | - Julia Porcino
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Ayah Zirikly
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Thanh Thieu
- Department of Computer Science, Oklahoma State University, 116-A MSCS, Stillwater, OK, 74078, USA
| | - Jonathan Camacho Maldonado
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Pei-Shu Ho
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Min Ding
- Information Technology Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD, 20899, USA
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| | - Elizabeth Rasch
- Rehabilitation Medicine Department, National Institutes of Health, Mark O. Hatfield Clinical Research Center, 6707 Democracy Boulevard, Suite 856, MSC 5493, Bethesda, MD, 20892, USA
| |
Collapse
|
21
|
Byrd DR, Thorpe RJ, Whitfield KE. Greater Disease Burden, Greater Risk? Exploring Cognitive Change and Health Status Among Older Blacks. J Aging Health 2019; 32:807-816. [PMID: 31165660 DOI: 10.1177/0898264319853138] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: The objective of study is to examine the relationships between health status and changes in cognition over time among middle to older aged Blacks. Method: Data come from the Baltimore Study of Black Aging-Patterns of Cognitive Aging. At baseline, 602 Black participants, ranging from ages 48 to 95 years, were enrolled. At follow-up, approximately 3 years later, 450 participants were re-interviewed. Results: After accounting for baseline cognition, age, sex, and education, a greater number of health conditions was associated with slower perceptual speed (b = -5.099, p = .022). Average peak expiratory flow was also associated with improvements in working memory (b = 0.029, p = .019) and perceptual speed (b = 0.026, p = .026), controlling for model covariates. Discussion: Study findings demonstrate that greater disease burden is associated with declines in specific fluid cognitive abilities in middle to later life among Blacks. This finding highlights the importance of reducing health disparities that disproportionately affect Blacks.
Collapse
Affiliation(s)
| | - Roland J Thorpe
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | | |
Collapse
|
22
|
Bernardes GM, Mambrini JVDM, Lima-Costa MF, Peixoto SV. [Multimorbidity profile associated with disability among the elderly living in the Metropolitan Region of Belo Horizonte, Brazil]. CIENCIA & SAUDE COLETIVA 2019; 24:1853-1864. [PMID: 31166518 DOI: 10.1590/1413-81232018245.17192017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 08/03/2017] [Indexed: 11/22/2022] Open
Abstract
The scope of this paper was to investigate the associations of disability in three domains (BADL, IADL and mobility) with cardiovascular diseases, diabetes and multimorbidity profile, among the elderly living in the Metropolitan Region of Belo Horizonte (MRBH). A cross-sectional study was conducted with a representative sample of 2,172 elderly persons (60 years and over). Disability, for each domain (BADL, IADL and mobility), was assessed as reporting great difficulty or need for help to perform at least one activity among those investigated, and self-reported diseases included arterial hypertension, myocardial infarction or angina, stroke, diabetes, and combinations of these diseases. Adjusted Poisson regression was used, and the attributable population fraction was also estimated. A major contribution of Cerebral Vascular Accidents (strokes) to disability in all domains was observed, especially BADLs, as well as the presence of infarction or angina in disability in IADLs and mobility, especially when combined with diabetes and hypertension. The multimorbidity profile can be used to identify vulnerable groups, which should be the target of prevention and rehabilitation, reducing the financial and social cost of this event among the elderly.
Collapse
Affiliation(s)
- Gabriella Marques Bernardes
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil.
| | - Juliana Vaz de Melo Mambrini
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil. .,Instituto René Rachou, Fiocruz. Belo Horizonte MG Brasil
| | - Maria Fernanda Lima-Costa
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil. .,Instituto René Rachou, Fiocruz. Belo Horizonte MG Brasil
| | - Sérgio Viana Peixoto
- Programa de Pós-Graduação em Saúde Coletiva, Instituto René Rachou, Fiocruz. Av. Augusto de Lima 1715, Barro Preto. 30190-009 Belo Horizonte Brasil. .,Instituto René Rachou, Fiocruz. Belo Horizonte MG Brasil.,Escola de Enfermagem, Universidade Federal de Minas Gerais. Belo Horizonte MG Brasil
| |
Collapse
|
23
|
Crews JE, Jones GC, Kim JH. Double Jeopardy: The Effects of Comorbid Conditions among Older People with Vision Loss. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x0610001s07] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This retrospective study used national survey data to examine multiple effects of nine comorbid conditions—breathing problems, depression risk, diabetes, heart problems, hearing impairment, hypertension, joint problems, low back pain, and stroke—on physical functioning, participation, and health status among older adults with visual impairments. Bivariate and multivariate procedures were used to compare older adults who had neither visual impairment nor these conditions with adults of similar age who had one of the nine conditions only, visual impairment only, or both visual impairment and the condition. Findings indicate that older adults with visual impairment frequently experience comorbid conditions, and that these conditions are associated with difficulties in walking and climbing steps, shopping, and socializing, and with significantly more self-reports of declining health. Results suggest that interventions by health care and mental health providers, as well as enhanced rehabilitation services, have the potential to reduce or prevent the deleterious effects of comorbid conditions.
Collapse
Affiliation(s)
- John E. Crews
- Disability and Health Program, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, 1600 Clifton Road, NE, Mail Stop E88, Atlanta, GA 30333
| | - Gwyn C. Jones
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention
| | - Julie H. Kim
- Flushing Hospital Medical Center, 45th Avenue at Parsons Boulevard, Flushing, NY 11355
| |
Collapse
|
24
|
Mishra AA, Friedman EM, Christ SL, Denning M. The Association of Psychological Well-Being with Disablement Processes in a National Sample. Appl Psychol Health Well Being 2019; 11:262-285. [PMID: 30724036 DOI: 10.1111/aphw.12152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Objectives were to explore subgroups of individuals with differential disability trajectories and evaluate the protective effects of psychological well-being (i.e. hedonic and eudaimonic) in the presence of multiple disease conditions (or multimorbidity) and sociodemographic disadvantages. METHODS Data come from the prospective longitudinal cohort study the Midlife Development in the United States (n = 3,904). Three waves of data spanning a 20-year period were used to identify subgroups with different disability trajectories. Subgroup membership was then modelled as a function of psychological well-being assessed at wave 1 of the study using multinomial logistic regression. RESULTS Three unique groups were identified: a normative group with initially low and slowly increasing levels of disability; a group with high levels of disability that was stable over time; and a group with moderate initial levels of disability that increased over time. Hedonic well-being at wave 1 was associated with membership in the risk groups relative to the normative group. CONCLUSION Individuals may follow one of three disability pathways mostly as a function of multimorbidity. However, hedonic well-being was associated with having an advantageous disability trajectory regardless of multimorbidity status. Cultivating psychological well-being may improve disability outcomes in aging individuals.
Collapse
|
25
|
Wahlqvist M, Möller C, Möller K, Danermark B. Physical and Psychological Health in Persons with Deafblindness that is due to Usher Syndrome Type II. JOURNAL OF VISUAL IMPAIRMENT & BLINDNESS 2019. [DOI: 10.1177/0145482x1310700305] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction The objectives of the study reported here were to describe the physical and psychological health of persons with Usher syndrome Type II (USH2) and to explore any differences in terms of gender. Methods The participants were recruited from the Swedish Usher database. In the first step, 122 persons received the questionnaire by mail, and 96 (aged 18–84, with a mean age of 55, 53% of whom were female) agreed to participate. The Health on Equal Terms questionnaire was used, which covered such items as health, living conditions, and social relationships. Results for the participants with USH2 were compared to those of a reference group of 5,738 persons who were drawn from a random sample of the Swedish population retrieved from the Swedish Public Health Institute. The odds ratio (adjusted for gender and age), and its 95% confidence interval were calculated. Results The participants with USH2 reported that their physical and psychological health was significantly poorer than that of the Swedish reference group. They revealed major problems involving headache, fatigue, depression, suicidal thoughts, and suicide attempts. For the male participants, the psychological differences were even more marked than those of the male reference group. Discussion The identification of factors associated with physical and psychological health and well-being is important for the design of future rehabilitation strategies for people with USH2. Special focus must be placed on the psychological well-being of men with USH2. Implications for practitioners The management of rehabilitation services for persons with USH2 calls for interdisciplinary teamwork to provide adequate resources to cope with the physical and psychological health issues demonstrated in this study.
Collapse
Affiliation(s)
- Moa Wahlqvist
- Institute for Health and Medicine, Swedish Institute for Disability Research, Örebro University, S-701 82 Örebro, Sweden, and Audiological Research Centre, University Hospital, Örebro, Sweden
| | - Claes Möller
- Swedish Institute for Disability Research, Örebro University, and Audiological Research Centre, University Hospital Örebro, S-701 85 Örebro, Sweden
| | - Kerstin Möller
- Swedish Institute for Disability Research, Örebro University, and Audiological Research Centre, University Hospital Örebro, Sweden
| | - Berth Danermark
- Swedish Institute for Disability Research, Örebro University, and Audiological Research Centre, University Hospital Örebro, Sweden
| |
Collapse
|
26
|
Parmar MC, Saikia N. Chronic morbidity and reported disability among older persons from the India Human Development Survey. BMC Geriatr 2018; 18:299. [PMID: 30522436 PMCID: PMC6284309 DOI: 10.1186/s12877-018-0979-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 11/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of disability and chronic morbidity among the elderly has been increasing substantially in India in recent years. Yet, the use of nationally representative data to investigate the relationship between chronic morbidity and reported disability in the country has been minimal. The objective of this study is twofold: i) to quantify the association between chronic morbidities and overall disabilities in the activities of daily living (ADLs) among elderly people in India, and ii) to understand how various chronic morbidities influence individual ADLs, specifically, walking, toileting and dressing. METHODS We used data from the India Human Development Survey-II (IHDS-II) as a basis for this study. We computed the Katz Index of independence in ADL to examine the burden of disability among the elderly. Ordered logistic regression was carried out to examine the effect of chronic morbidities on: i) the disability index (where 0 = no disability; 1 = disability in 1 or 2 ADLs; and 2 = disability in 3 ADLs), and ii) disabilities in three ADLs in the population over-60 years of age in India. RESULTS The percentage of people scoring lower Katz index (indicating severe and mild disability) in at least one of the three ADLs is very high in India (17.91% for males and 26.21% for females). Irrespective of the type of ADL, the Katz score is lower in elderly females than in elderly males. Elderly people who are illiterate and belong to the poorest wealth quintile report lower Katz scores in ADL. Both bivariate and multivariate analyses confirm that all three types of chronic morbidities are positively and significantly associated with a disability condition in the ADLs. Yet, the effects of morbidities vary greatly according to the type of disability. For instance, while diabetes affect walking (OR: 2.56; 95% CI: 2.29-2.86), and toileting (OR: 2.63; 95% CI: 2.26-3.07), high blood pressure mainly affects walking (OR: 2.29, 95% CI: 2.09-2.5) and dressing disabilities (OR: 2.13, 95% CI: 1.84-2.46). CONCLUSIONS Chronic morbidity is a decisive factor in old age disability. It is crucial to reduce chronic morbidity in a timely way to minimise the enormous associated burden of disability.
Collapse
Affiliation(s)
- Mukesh C Parmar
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.
| | - Nandita Saikia
- Centre for the Study of Regional Development, School of Social Sciences, Jawaharlal Nehru University, New Delhi, India.,International Institute for Applied Systems Analysis, Laxenburg, Austria
| |
Collapse
|
27
|
Friedman EM, Mroczek DK, Christ SL. Multimorbidity, inflammation, and disability: a longitudinal mediational analysis. Ther Adv Chronic Dis 2018; 10:2040622318806848. [PMID: 31452864 PMCID: PMC6700847 DOI: 10.1177/2040622318806848] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/14/2018] [Indexed: 01/19/2023] Open
Abstract
Background: Using longitudinal data from the Survey of Mid-Life Development in the United
States, this study examined the role of systemic inflammation in mediating
the link between multimorbidity and increases in and onset of functional
limitations over a 17–19 year follow-up period. Methods: Participants completed questionnaire assessments of chronic conditions and
functional limitations. Interleukin-6, C-reactive protein, and fibrinogen
were assayed in serum. Structural equation models were used to predict
increases in and onset of functional limitations associated with baseline
multimorbidity status; mediation by inflammation was also determined. Results: Multimorbidity (versus 0–1 conditions) predicted more
functional limitations and greater odds of onset of limitations over time.
Significant indirect effects showed that inflammation partially mediated the
link between multimorbidity and changes in, but not onset of,
limitations. Discussion: These results show that inflammation, a nonspecific marker of multiple
disease conditions, explains in part the degree to which multimorbidity is
disabling.
Collapse
Affiliation(s)
- Elliot M Friedman
- Department of Human Development and Family Studies, Purdue University, 1202 West State Street, West Lafayette, IN 47907, USA
| | - Daniel K Mroczek
- Department of Psychology and Feinberg School of Medicine, Northwestern University, Evanston, IL, USA
| | - Sharon L Christ
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, USA
| |
Collapse
|
28
|
Abstract
Higher income neighborhoods are associated with better health, a relation observed in many cross-sectional studies. However, prior research focused on the prevalence of health conditions, and examining the incidence of new health conditions may provide stronger support for a potential causal role of neighborhoods on health. We used the 2004 and 2014 waves of the Midlife in the United States Study (n = 1726; ages 34-83) to examine health condition incidence as a function of neighborhood income. Among participants who had lived in the same neighborhood across the time period, we hypothesized that higher neighborhood income would be associated with a lower incidence of health conditions ten years later. Health included 18 chronic conditions related to mental (anxiety, depression) and physical (cardiovascular, immune) health. Multinomial logistic regression analyses adjusting for individual income and sociodemographics indicated that the odds of developing two or more new health conditions (no new health conditions as referent), was significantly lower (OR = 0.92, CI: 0.86, 0.99) for every $10,000 increment in neighborhood income. Associations did not vary by age or neighborhood tenure. Results add to a literature documenting that higher neighborhood income is associated with better health.
Collapse
|
29
|
Thorpe RJ, Wynn AJ, Walker JL, Smolen JR, Cary MP, Szanton SL, Whitfield KE. Relationship Between Chronic Conditions and Disability in African American Men and Women. J Natl Med Assoc 2018; 108:90-8. [PMID: 26928493 DOI: 10.1016/j.jnma.2015.12.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Race differences in chronic conditions and disability are well established; however, little is known about the association between specific chronic conditions and disability in African Americans. This is important because African Americans have higher rates and earlier onset of both chronic conditions and disability than white Americans. METHODS We examined the relationship between chronic conditions and disability in 602 African Americans aged 50 years and older in the Baltimore Study of Black Aging. Disability was measured using self-report of difficulty in activities of daily living (ADL). Medical conditions included diagnosed self-reports of asthma, depressive symptoms, arthritis, cancer, diabetes, cardiovascular disease (CVD), stroke, and hypertension. RESULTS After adjusting for age, high school graduation, income, and marital status, African Americans who reported arthritis (women: odds ratio (OR)=4.87; 95% confidence interval(CI): 2.92-8.12; men: OR=2.93; 95% CI: 1.36-6.30) had higher odds of disability compared to those who did not report having arthritis. Women who reported major depressive symptoms (OR=2.59; 95% CI: 1.43-4.69) or diabetes (OR=1.83; 95% CI: 1.14-2.95) had higher odds of disability than women who did not report having these conditions. Men who reported having CVD (OR=2.77; 95% CI: 1.03-7.41) had higher odds of disability than men who did not report having CVD. CONCLUSIONS These findings demonstrate the importance of chronic conditions in understanding disability in African Americans and how it varies by gender. Also, these findings underscore the importance of developing health promoting strategies focused on chronic disease prevention and management to delay or postpone disability in African Americans. PUBLICATION INDICES Pubmed, Pubmed Central, Web of Science database.
Collapse
Affiliation(s)
- Roland J Thorpe
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Center for Biobehavioral Health Disparities Research, Duke University.
| | - Anastasia J Wynn
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
| | | | - Jenny R Smolen
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health
| | | | - Sarah L Szanton
- Hopkins Center for Health Disparities Solutions, Johns Hopkins Bloomberg School of Public Health, Center for Biobehavioral Health Disparities Research, Duke University, Johns Hopkins School of Nursing, Johns Hopkins University
| | - Keith E Whitfield
- Center for Biobehavioral Health Disparities Research, Duke University, Department of Psychology and Neuroscience, Duke University
| |
Collapse
|
30
|
Liu LY, Li Y, Lamontagne A. The effects of error-augmentation versus error-reduction paradigms in robotic therapy to enhance upper extremity performance and recovery post-stroke: a systematic review. J Neuroeng Rehabil 2018; 15:65. [PMID: 29973250 PMCID: PMC6033222 DOI: 10.1186/s12984-018-0408-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 06/19/2018] [Indexed: 11/10/2022] Open
Abstract
Despite upper extremity function playing a crucial role in maintaining one's independence in activities of daily living, upper extremity impairments remain one of the most prevalent post-stroke deficits. To enhance the upper extremity motor recovery and performance among stroke survivors, two training paradigms in the fields of robotics therapy involving modifying haptic feedback were proposed: the error-augmentation (EA) and error-reduction (ER) paradigms. There is a lack of consensus, however, as to which of the two paradigms yields superior training effects. This systematic review aimed to determine (i) whether EA is more effective than conventional repetitive practice; (ii) whether ER is more effective than conventional repetitive practice and; (iii) whether EA is more effective than ER in improving post-stroke upper extremity motor recovery and performance. The study search and selection process as well as the ratings of methodological quality of the articles were conducted by two authors separately, and the results were then compared and discussed among the two reviewers. Findings were analyzed and synthesized using the level of evidence. By August 1st 2017, 269 articles were found after searching 6 databases, and 13 were selected based on criteria such as sample size, type of participants recruited, type of interventions used, etc. Results suggest, with a moderate level of evidence, that EA is overall more effective than conventional repetitive practice (motor recovery and performance) and ER (motor performance only), while ER appears to be no more effective than conventional repetitive practice. However, intervention effects as measured using clinical outcomes were under most instance not 'clinically meaningful' and effect sizes were modest. While stronger evidence is required to further support the efficacy of error modification therapies, the influence of factors related to the delivery of the intervention (such as intensity, duration) and personal factors (such as stroke severity and time of stroke onset) deserves further investigations as well.
Collapse
Affiliation(s)
- Le Yu Liu
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada. .,Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CRIR (CISSS Laval), Laval, Canada.
| | - Youlin Li
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada.,Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CRIR (CISSS Laval), Laval, Canada
| | - Anouk Lamontagne
- School of Physical and Occupational Therapy, McGill University, 3654 Promenade Sir-William-Osler, Montréal, Québec, H3G 1Y5, Canada.,Feil and Oberfeld Research Centre, Jewish Rehabilitation Hospital site of CRIR (CISSS Laval), Laval, Canada
| |
Collapse
|
31
|
Avedisova AS, Zhabin MO, Akzhigitov RG, Gudkova AA. [The problem of multiple somatic and/or psychiatric pathology basic concepts and prevalence]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:5-13. [PMID: 29927396 DOI: 10.17116/jnevro2018118515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The literature of the last decades shows the growing interest to multiple pathologies in medicine including psychiatry and neurology. Multiple pathology is often determined as multimorbidity or comorbidity. Multiple pathology is a common phenomenon, which is the rule rather than the exception. In the medical care system, it is burden for the patient and for the physician in clinical, organizational and economic aspects. The review addresses all these issues in the aspect of terminology and prevalence.
Collapse
Affiliation(s)
- A S Avedisova
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia; Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - M O Zhabin
- Serbsky National Medical Research Center for Psychiatry and Narcology, Moscow, Russia; Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - R G Akzhigitov
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - A A Gudkova
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| |
Collapse
|
32
|
Davie G, Samaranayaka A, Derrett S. The role of pre-existing comorbidity on the rate of recovery following injury: A longitudinal cohort study. PLoS One 2018; 13:e0193019. [PMID: 29466432 PMCID: PMC5821361 DOI: 10.1371/journal.pone.0193019] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 02/02/2018] [Indexed: 11/17/2022] Open
Abstract
Understanding the role of comorbidity in recovery following injury is an important challenge given the increasing prevalence of multimorbidity (2 or more comorbidities) in many countries. The Prospective Outcomes of Injury Study recruited 2856 injured 18–64 year olds that had registered for entitlements with New Zealand’s universal no-fault injury insurer. Recovery, or lack of, in this longitudinal cohort was measured using the World Health Organization Disability Assessment Schedule at 3, 12 and 24 months post-injury. Twenty-one pre-existing chronic conditions were used to identify comorbidity. To investigate whether rates of recovery differed by pre-injury comorbidity, the interaction between time and comorbidity was modelled using Generalised Estimating Equations. Of 1,862 participants with complete data, the distribution reporting none, one comorbidity, or multimorbidity pre-injury was 51%, 27%, and 21% respectively. Longitudinal analysis estimated no difference (log odds per year 0.05, 95% Confidence Interval -0.17 to 0.27) between the rate of change of disability for those with one pre-injury comorbidity compared to those with none. Those with pre-injury multimorbidity had significantly slower reduction in disability over time than those with no pre-injury comorbidity (log odds per year 0.27, 95% Confidence Interval 0.05 to 0.48). In a working age cohort, the rate of recovery in the 24 months following injury was similar for those with none or one pre-existing comorbidity and significantly slower for those with multimorbidity. It is important that further research explores mechanisms driving this, and that researchers and health providers identify and implement better supports for injured people with multimorbidity.
Collapse
Affiliation(s)
- Gabrielle Davie
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
33
|
Fortin M, Almirall J, Nicholson K. Development of a research tool to document self-reported chronic conditions in primary care. JOURNAL OF COMORBIDITY 2017; 7:117-123. [PMID: 29354597 PMCID: PMC5772378 DOI: 10.15256/joc.2017.7.122] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Researchers interested in multimorbidity often find themselves in the dilemma of identifying or creating an operational definition in order to generate data. Our team was invited to propose a tool for documenting the presence of chronic conditions in participants recruited for different research studies. OBJECTIVE To describe the development of such a tool. DESIGN A scoping review in which we identified relevant studies, selected studies, charted the data, and collated and summarized the results. The criteria considered for selecting chronic conditions were: (1) their relevance to primary care services; (2) the impact on affected patients; (3) their prevalence among the primary care users; and (4) how often the conditions were present among the lists retrieved from the scoping review. RESULTS Taking into account the predefined criteria, we developed a list of 20 chronic conditions/categories of conditions that could be self-reported. A questionnaire was built using simple instructions and a table including the list of chronic conditions/categories of conditions. CONCLUSIONS We developed a questionnaire to document 20 self-reported chronic conditions/categories of conditions intended to be used for research purposes in primary care. Guided by previous literature, the purpose of this questionnaire is to evaluate the self-reported burden of multimorbidity by participants and to encourage comparability among research studies using the same measurement.
Collapse
Affiliation(s)
- Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, and Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - José Almirall
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, and Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, Ontario, Canada
| |
Collapse
|
34
|
Portz JD, Kutner JS, Blatchford PJ, Ritchie CS. High Symptom Burden and Low Functional Status in the Setting of Multimorbidity. J Am Geriatr Soc 2017; 65:2285-2289. [PMID: 28857119 DOI: 10.1111/jgs.15045] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To enhance understanding of the relationship between multimorbidity, symptom burden, and functional status in individuals with life-limiting illness. DESIGN Secondary analysis of baseline data from a randomized clinical trial conducted in the Palliative Care Research Cooperative Group. Group differences were tested using a t-test; multivariate regression analysis was used to determine the effect of multiple variables on functional status and symptom burden. SETTING Fifteen Palliative Care Research Cooperation sites. PARTICIPANTS Adults who participated in a parent statin-discontinuation clinical trial were included in the analysis (N = 381). Inclusion criteria were diagnosis of a life-limiting illness, statin use for 3 months or longer, life expectancy longer than 1 month, and declining functional status. MEASUREMENTS Cancer diagnosis (solid organ and hematologic malignancies), multimorbidity (Charlson Comorbidity Index (CCI) score), symptom burden (Edmonton Symptom Assessment Scale (ESAS) score, number of symptoms with ESAS severity score >4), functional status (Australia-modified Karnofsky Performance Scale (AKPS)). RESULTS Fifty-one percent had a primary diagnosis of cancer; mean age 74.1 ± 11.6. Participants had multiple comorbid illnesses (CCI score 4.9 ± 2.8), multiple symptoms (ESAS score 27.2 ± 15.9), and poor functional status (AKPS = 53 ± 13). In univariate and multivariate analyses, multimorbidity was associated with greater symptom burden (4.2 vs 3.1 moderate or severe symptoms (t = -3.2, P = .002), 12% vs 6% with severe symptoms (t = -3.7, P < .001)), but cancer diagnosis was not. In univariate and multivariate analyses, higher symptom burden was associated with poorer functional status (F = 11.6, P < .001), but multimorbidity was not. CONCLUSION Symptoms cannot be attributed solely to a diagnosis of cancer. The association between symptom burden and functional status underscores the importance of clinical attention to symptoms in individuals with multimorbidity.
Collapse
Affiliation(s)
- Jennifer D Portz
- Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | - Jean S Kutner
- Internal Medicine, School of Medicine, University of Colorado, Aurora, Colorado
| | | | - Christine S Ritchie
- Internal Medicine, University of California, San Francisco, San Francisco, California
| |
Collapse
|
35
|
Jamerson BD, Fillenbaum GG, Sloane R, Morey MC. A New Method of Identifying Characteristics of Needing Help to Take Medications in an Older Representative Community-Dwelling Population: The Older Adults Medication Assist Scale. J Am Geriatr Soc 2017; 64:1195-202. [PMID: 27321598 DOI: 10.1111/jgs.14166] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To determine the sociodemographic characteristics, health conditions, and cognitive and functional status associated with baseline prevalence and new need for help taking medication 3 years later and to construct a brief scale indicative of need for help taking medications. DESIGN Retrospective cross-sectional and 3-year longitudinal study. SETTING Five-county area in north-central Piedmont, North Carolina. PARTICIPANTS Representative community-dwelling sample of black and white individuals aged 65 and older (N = 4,136). MEASUREMENTS Information was obtained in person in participants' homes using structured questionnaires. Health conditions included sensory impairment and self-report of physician-diagnosed conditions. Cognitive status was assessed using the 10-item Short Portable Mental Status Questionnaire. Functional status was assessed using the three-item Rosow-Breslau scale, the five-item Katz activity of daily living scale, and a modified six-item Older Americans Resources and Services instrumental activities of daily living scale. RESULTS Characteristics associated with need for help taking medications were aged 80 and older, being male, living with others, having four or more chronic conditions, and impaired cognitive or functional status (c-statistic 0.94, 77.1% sensitivity, 87.9% specificity). Predictors of new need for help with medications 3 years later included aged 75 and older at baseline, being male, and impaired cognitive and functional status (c-statistic 0.75). CONCLUSION This brief scale can help identify persons needing help with medications and could be useful in assisting clinicians with medication management.
Collapse
Affiliation(s)
- Brenda D Jamerson
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center on Biobehavioral Health Disparities Research, Duke University, Durham, North Carolina.,Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
| | - Gerda G Fillenbaum
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center on Biobehavioral Health Disparities Research, Duke University, Durham, North Carolina
| | - Richard Sloane
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
| | - Miriam C Morey
- Claude D. Pepper Older Americans Independence Center, Duke University, Durham, North Carolina.,Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.,Geriatric Research Education and Clinical Center, Veterans Administration Medical Center, Durham, North Carolina
| |
Collapse
|
36
|
Ritchie CS, Zhao F, Patel K, Manola J, Kvale EA, Snyder CF, Fisch MJ. Association between patients' perception of the comorbidity burden and symptoms in outpatients with common solid tumors. Cancer 2017; 123:3835-3842. [PMID: 28608952 DOI: 10.1002/cncr.30801] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/17/2017] [Accepted: 04/26/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND Cancer patients' symptom burden is commonly attributed to their cancer and treatment. Increasingly, cancer patients have many other chronic comorbid conditions. However, the degree to which these comorbid conditions may contribute to the patient-reported symptom burden is unclear. METHODS This study explored the relations between the presence of comorbid conditions, the symptom experience and burden, and the perceived bother from cancer or comorbid conditions in 3106 cancer patients. The associations between the number of comorbidities (identified from current medications), the patient-reported symptom burden (the number of symptoms scored as ≥7 on the 13-item MD Anderson Symptom Inventory physical scale), the patient-reported bother from comorbid conditions and from cancer (from "not at all" to "extremely"), and the clinician-reported difficulty in caring for patients' symptoms were examined. RESULTS According to medication lists, 19% of the patients had at least 5 of 12 comorbid conditions. Approximately 39% rated at least 1 symptom as ≥ 7, and this proportion increased with an increasing number of comorbid conditions (48% with ≥ 5 comorbid conditions vs 36% with 1 comorbid condition). One-third of the patients reported moderate or worse bother, and this was significantly associated with an increased number of comorbid conditions (odds ratio [OR], 2.4) and an increased symptom burden (OR, 1.22). Clinician ratings of difficulty in managing patients' symptoms were significantly associated with bother from cancer (OR, 2.0), comorbid conditions (OR, 1.6), and symptom burden (OR, 1.1). CONCLUSIONS Comorbidity is common in cancer patients and is associated with a greater symptom burden and clinician reports of difficulty in managing patients' symptoms. Greater attention to comorbid conditions is needed to optimize the symptom management of cancer patients with multimorbidity. Cancer 2017;123:3835-3842. © 2017 American Cancer Society.
Collapse
Affiliation(s)
- Christine S Ritchie
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California.,Jewish Home of San Francisco, San Francisco, California
| | - Fengmin Zhao
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kanan Patel
- Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California.,Jewish Home of San Francisco, San Francisco, California
| | - Judith Manola
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elizabeth A Kvale
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama.,Birmingham VA Medical Center, Birmingham, Alabama
| | - Claire F Snyder
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
37
|
Yorke AM, Curtis AB, Shoemaker M, Vangsnes E. The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS). Arch Gerontol Geriatr 2017; 72:164-168. [PMID: 28667843 DOI: 10.1016/j.archger.2017.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 05/19/2017] [Accepted: 05/24/2017] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multimorbidity, the presence of two or more chronic diseases, is a public health concern. The measurement of grip strength has been proposed as a measure of overall body strength and is reliable and easy to measure. The purpose of this study was to investigate the relationship between the number of chronic diseases and common co-occurring chronic diseases with grip strength. METHODS A cross-sectional analysis was conducted of 5877 respondents (2744=male, 3103=female) from the 2008 Health and Retirement Study (HRS) who completed grip strength measurements (kg). RESULTS As the number of chronic diseases increased, an incremental decrease in grip strength occurred and became more pronounced with ≥3 chronic diseases present (b=3.1, 95% CI=2.3-3.9, p<0.001). No statistically significant relationship was identified between specific chronic diseases (except for stroke) and grip strength. CONCLUSION Multimorbidity has a statistically significant negative relationship on grip strength. Grip strength should be considered as a physical performance measure to incorporate into the care of patients with multimorbidity.
Collapse
Affiliation(s)
- Amy M Yorke
- Interdisciplinary Health Sciences, Western Michigan University, Kalamazoo, MI, United States; Physical Therapy Department, University of Michigan-Flint, Flint, MI, United States.
| | - Amy B Curtis
- Interdisciplinary Health Sciences, Western Michigan University, Kalamazoo, MI, United States.
| | - Michael Shoemaker
- Department of Physical Therapy, Grand Valley State University, Grand Rapids, Michigan, United States.
| | - Eric Vangsnes
- Department of Physician Assistant, Western Michigan University, Kalamazoo, MI, United States.
| |
Collapse
|
38
|
Yokota RTC, Van Oyen H, Looman CWN, Nusselder WJ, Otava M, Kifle YW, Molenberghs G. Multinomial additive hazard model to assess the disability burden using cross-sectional data. Biom J 2017; 59:901-917. [PMID: 28332222 DOI: 10.1002/bimj.201600157] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 12/27/2016] [Accepted: 02/03/2017] [Indexed: 11/11/2022]
Abstract
Population aging is accompanied by the burden of chronic diseases and disability. Chronic diseases are among the main causes of disability, which is associated with poor quality of life and high health care costs in the elderly. The identification of which chronic diseases contribute most to the disability prevalence is important to reduce the burden. Although longitudinal studies can be considered the gold standard to assess the causes of disability, they are costly and often with restricted sample size. Thus, the use of cross-sectional data under certain assumptions has become a popular alternative. Among the existing methods based on cross-sectional data, the attribution method, which was originally developed for binary disability outcomes, is an attractive option, as it enables the partition of disability into the additive contribution of chronic diseases, taking into account multimorbidity and that disability can be present even in the absence of disease. In this paper, we propose an extension of the attribution method to multinomial responses, since disability is often measured as a multicategory variable in most surveys, representing different severity levels. The R function constrOptim is used to maximize the multinomial log-likelihood function subject to a linear inequality constraint. Our simulation study indicates overall good performance of the model, without convergence problems. However, the model must be used with care for populations with low marginal disability probabilities and with high sum of conditional probabilities, especially with small sample size. For illustration, we apply the model to the data of the Belgian Health Interview Surveys.
Collapse
Affiliation(s)
- Renata T C Yokota
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 1050, Brussels, Belgium.,Department of Sociology, Interface Demography, Vrije Universit eit Brussel, Brussels, Belgium
| | - Herman Van Oyen
- Department of Public Health and Surveillance, Scientific Institute of Public Health, 1050, Brussels, Belgium.,Department of Public Health, Ghent University, Ghent, Belgium
| | - Caspar W N Looman
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wilma J Nusselder
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Yimer Wasihun Kifle
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Universiteit Hasselt, Diepenbeek, Belgium.,Center for Health Economics Research and Modeling of Infectious Diseases (CHERMID), Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Geert Molenberghs
- Interuniversity Institute for Biostatistics and statistical Bioinformatics (I-BioStat), Universiteit Hasselt, Diepenbeek, Belgium.,Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-BioStat), KU Leuven, Leuven, Belgium
| |
Collapse
|
39
|
Mowbray O, Washington T, Purser G, O'Shields J. Problem Drinking and Depression in Older Adults with Multiple Chronic Health Conditions. J Am Geriatr Soc 2016; 65:146-152. [PMID: 27748504 DOI: 10.1111/jgs.14479] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To examine the intersection of depression and alcohol use among older adults with multiple chronic health conditions (MCCs). DESIGN Wave 1 data from the National Social Life, Health and Aging Project (2005-06). SETTING Community-based sampling throughout the United States. PARTICIPANTS Individuals aged 57 to 85 who identified as active alcohol consumers (N = 1,643). MEASUREMENTS Participants reported whether they currently had MCCs, problem drinking (defined as affirming two or more of the four CAGE screening questions), symptoms associated with depression, and other social and health measures. RESULTS Although older adults with MCCs were no more likely to be problem drinkers than those with no MCCs, those with MCCs and depression were nearly five times as likely to experience problem drinking as older adults with MCCs and no depression. CONCLUSION Older adults with MCCs have differences that have implications for health, including mental health problems. Implementing screening and assessment in medical care settings for problem drinking and improving self-management interventions to include consequences of alcohol use components are critical avenues for reducing healthcare expenditures and improving quality of life of individuals with MCC.
Collapse
Affiliation(s)
- Orion Mowbray
- School of Social Work, University of Georgia, Athens, Georgia
| | | | - Greg Purser
- School of Social Work, University of Georgia, Athens, Georgia
| | - Jay O'Shields
- School of Social Work, University of Georgia, Athens, Georgia
| |
Collapse
|
40
|
Multi-morbidity, disability and adaptation strategies among community-dwelling adults aged 75 years and older. Disabil Health J 2016; 9:593-9. [DOI: 10.1016/j.dhjo.2016.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 02/10/2016] [Accepted: 03/18/2016] [Indexed: 11/18/2022]
|
41
|
Abstract
The purpose of this pilot study was to describe daily-living habits of Native American women with chronic diseases. The participants were 14 females who were either healthy (the control group) or had rheumatoid arthritis (RA), diabetes mellitus (DM), or both (RA+DM). Participants underwent an evaluation of joint motion and were interviewed regarding daily-living routines and habits, and social and family role integration. The results showed that participants with RA and RA+DM had more joint limitations, more disability, and less role integration than participants in the control and DM groups. Using the toilet was the first task of the day for the majority of participants. Most participants took showers in the morning, and the face was usually one of the first body parts washed. The order in which daily tasks were performed is reported for each participant.
Collapse
|
42
|
Abstract
In this study, the author examined the effects of psychosocial and health factors on the ADL disability trajectory of low-income frail elders living in the community. She analyzed three-year longitudinal data with a maximum of 15 repeated observations from a cohort of elderly participants in Michigan’s Medicaid Waiver Program ( N=3,161), using the hierarchical linear modeling approach. Baseline data of this cohort were taken in 1999; a reassessment was conducted about every three months. The analysis shows that major risk factors for a poor activity of daily living (ADL) disability trajectory include being Black, older, living with nonspouse others, and no confidence in functional improvement. Presence of arthritis, cancer, and cognitive limitation had significant and modest effects on ADL disability trajectories. The findings have implications to community-based intervention programs for frail elderly persons in the community.
Collapse
|
43
|
Peek MK, Coward RT. Antecedents of Disability for Older Adults with Multiple Chronic Health Conditions. Res Aging 2016. [DOI: 10.1177/0164027500224005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Data from community-dwelling older adults (65+) with two or more chronic health conditions who participated in a 30-month longitudinal panel survey ( N = 898) are used to examine the factors that are associated with the presence and development of functional disabilities. Both logistic regression and discrete time hazard models are used to address the risk factors associated with the presence and development of activities of daily living and instrumental activities of daily living disabilities. Results indicate that education, income, and age are consistent predictors of disability, and that arthritis and obesity have consistently stronger effects on disability than do other chronic conditions. A need for stronger conceptual models focusing on disability is discussed.
Collapse
|
44
|
Goins RT, Spencer SM, Roubideaux YD, Manson SM. Differences in Functional Disability of Rural American Indian and White Older Adults With Comorbid Diabetes. Res Aging 2016. [DOI: 10.1177/0164027505279717] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examines racial/ethnic differences in functional disability among a sample of rural older adults with comorbid diabetes. In 2002, interviews were conducted with 62 rural American Indian and 64 White community-dwelling persons aged 65 years or older. Examination of disability levels by group suggested that functional disability for Whites was concentrated in the lower levels (1-2 limitations), whereas disability for American Indians was concentrated in the higher levels (3 or more limitations). Adjusted prevalence rates indicated that American Indian older adults were significantly more likely than Whites to require assistance with dressing, walking, bathing, and shopping. Conversely, for reaching the toilet in time, Whites were significantly more likely than American Indians to report a limitation. Results of this study, coupled with previous literature, suggest that American Indians are more functionally disabled than other racial/ethnic groups and have a marked need for future long-term care.
Collapse
|
45
|
Vu THT, Lloyd-Jones DM, Liu K, Stamler J, Garside DB, Daviglus ML. Optimal Levels of All Major Cardiovascular Risk Factors in Younger Age and Functional Disability in Older Age: The Chicago Heart Association Detection Project in Industry 32-Year Follow-Up Health Survey. Circ Cardiovasc Qual Outcomes 2016; 9:355-63. [PMID: 27382089 DOI: 10.1161/circoutcomes.115.002519] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 05/27/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The associations of optimal levels of all major cardiovascular disease risk factors, that is, low risk, in younger age with subsequent cardiovascular disease morbidity and mortality have been well documented. However, little is known about associations of low-risk profiles in younger age with functional disability in older age. METHODS AND RESULTS The sample included 6014 participants from the Chicago Heart Association Detection Project in Industry Study. Low-risk status, defined as untreated systolic/diastolic blood pressure ≤120/≤80 mm Hg, untreated serum total cholesterol <5.18 mmol/l, not smoking, body mass index < 25 kg/m(2), and no diabetes mellitus, was assessed at baseline (1967 to 1973). Functional disability, categorized as (1) any disability in activities of daily living (ADLs), (2) any disability in instrumental ADLs but not in ADL, or (3) no disability, was assessed from the 2003 health survey. There were 39% women, 4% Black, with a mean age of 43 years and 6% low-risk status at baseline. After 32 years, 7% reported having limitations in performing any ADL and 11% in any instrumental ADL only. The prevalence of any ADL limitation was lowest in low-risk people and increased in a graded fashion with less-favorable risk factor groups (P trend <0.001). Compared with those with 2+ high-risk factors, the multivariable-adjusted odds of having any disability in ADLs versus no disability in people with low risk, any moderate risk, and 1 high-risk factor at baseline were lower by 58%, 48%, and 37%, respectively. Results were similar for instrumental ADLs, in both men and women. CONCLUSIONS Having an optimal cardiovascular disease risk factor profile at younger age is associated with the lowest rate of functional disability in older age.
Collapse
Affiliation(s)
- Thanh-Huyen T Vu
- From the Department of Preventive Medicine (T.-H.T.V., D.M.L.-J., K.L., J.S., M.L.D.) and Department of Medicine, Feinberg School of Medicine (D.M.L.-J.), Northwestern University, Chicago, IL; and Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL (D.B.G., M.L.D.).
| | - Donald M Lloyd-Jones
- From the Department of Preventive Medicine (T.-H.T.V., D.M.L.-J., K.L., J.S., M.L.D.) and Department of Medicine, Feinberg School of Medicine (D.M.L.-J.), Northwestern University, Chicago, IL; and Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL (D.B.G., M.L.D.)
| | - Kiang Liu
- From the Department of Preventive Medicine (T.-H.T.V., D.M.L.-J., K.L., J.S., M.L.D.) and Department of Medicine, Feinberg School of Medicine (D.M.L.-J.), Northwestern University, Chicago, IL; and Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL (D.B.G., M.L.D.)
| | - Jeremiah Stamler
- From the Department of Preventive Medicine (T.-H.T.V., D.M.L.-J., K.L., J.S., M.L.D.) and Department of Medicine, Feinberg School of Medicine (D.M.L.-J.), Northwestern University, Chicago, IL; and Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL (D.B.G., M.L.D.)
| | - Daniel B Garside
- From the Department of Preventive Medicine (T.-H.T.V., D.M.L.-J., K.L., J.S., M.L.D.) and Department of Medicine, Feinberg School of Medicine (D.M.L.-J.), Northwestern University, Chicago, IL; and Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL (D.B.G., M.L.D.)
| | - Martha L Daviglus
- From the Department of Preventive Medicine (T.-H.T.V., D.M.L.-J., K.L., J.S., M.L.D.) and Department of Medicine, Feinberg School of Medicine (D.M.L.-J.), Northwestern University, Chicago, IL; and Institute for Minority Health Research, University of Illinois at Chicago, Chicago, IL (D.B.G., M.L.D.)
| |
Collapse
|
46
|
Furner SE, Giloth BE, Arguelles L, Miles TP, Goldberg JH. A Co-Twin Control Study of Physical Function in Elderly African American Women. J Aging Health 2016; 16:28-43. [PMID: 14979309 DOI: 10.1177/0898264303260391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This study investigated variables associated with physical functioning limitations among elderly African American women, controlling for genetics and common family environment. Method: Activities of daily living limitations (ADL) and instrumental activities of daily living limitations (IADL) are examined in 180 pairs of African American elderly twins using a co-twin control design. The association of chronic disease, other physical problems, lifestyle, and demographic factors with both measures are investigated. Results: Arthritis, hypertension, and more than 1 chronic disease are associated with ADL limitations and arthritis; diabetes, heart attack, and more than 1 chronic disease are associated with IADL limitations in univariate analyses. In multivariate analyses, a different set of additional variables is associated with the two measures. Discussion: Among elderly African American women, physical functioning limitations are influenced by the presence of chronic diseases, other physical problems, lifestyle, and demographics. These associations are not due to genetics or common family environment effects.
Collapse
Affiliation(s)
- Sylvia E Furner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, USA
| | | | | | | | | |
Collapse
|
47
|
Abstract
This article presents a methodologic framework for a disability-adjusted life expectancy (DALE), an extended and enhanced variety of the common health expectancy indicator. The DALE is based on a causal link running from risk factors through diseases and disability to mortality. This causal link allows the DALE to be used for evaluation of potential interventions and analysis of observed trends. The DALE methodology consists of a combination multistate life table with explicitly modeled disease processes and disease-specific disability weights. In this article, two illustrations are presented: the impact on the DALE of trends in cardiovascular disease epidemiology and the benefits of nonsmoking. Two problems of the DALE are discussed: estimating "all other causes" disability and the presence of comorbidity.
Collapse
|
48
|
Sharkey JR, Haines PS. Use of Telephone-Administered Survey for Identifying Nutritional Risk Indicators Among Community-Living Older Adults in Rural Areas. J Appl Gerontol 2016. [DOI: 10.1177/073346480202100307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The ability of Elderly Nutrition Programs, especially in rural areas, to address increasing needs for disparate program services is linked to determining which older people are most likely to be at nutritional risk and what constitutes the potential risk. The purpose of this study is to characterize nutritional risk factors in a probability sample of rural elders (n = 152) through telephone interviews using a 67-question modified version of the Nutrition Screening Initiative's Level I and II screens. Participants reported high levels of unintentional weight loss, medication use, multiple health conditions, and depression. This study demonstrates that comprehensive information on general health, eating habits, living environment, and functional status can be collected from rural elders by telephone. Because much of the reported nutritional risk in this sample occurs in residents living in areas not receiving nutrition services, expanded nutritional risk data can be used to anticipate need for programs and services in areas not presently served.
Collapse
|
49
|
Thomas BJ, Sanders DS, Oliva MS, Orrs MS, Glick P, Ruit S, Chen W, Luoto J, Tasfaw AK, Tabin GC. Blindness, cataract surgery and mortality in Ethiopia. Br J Ophthalmol 2016; 100:1157-62. [PMID: 27267606 DOI: 10.1136/bjophthalmol-2015-308328] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/18/2016] [Indexed: 11/03/2022]
Abstract
PURPOSE To examine the relationships between blindness, the intervention of cataract surgery and all-cause mortality in a rural Ethiopian population. DESIGN Population-based, interventional prospective study. METHODS Community-based detection methods identified blind Ethiopian persons from two selected kebeles in Amhara region, Ethiopia. Data from 1201 blind patients were collected-628 cataract-blind and 573 blind from other conditions. Free cataract surgery was provided for consenting, cataract-blind patients. Follow-up surveys were conducted after 12 months (±1 month)-the main outcome measure for this report is all-cause mortality at 1 year. RESULTS During the follow-up period, 110 persons died from the selected population (mortality 9.2%), which consisted of those cataract-blind patients who received cataract surgery (N=461), cataract-blind patients who did not receive surgery (N=167) and all non-cataract-blind patients (N=573). Of the 461 patients who received cataract surgery, 44 patients died (9.5%). Of the 740 patients who did not receive surgery, 66 died (8.9%)-28 patients from the cohort of cataract-blind patients who did not receive surgery (16.8%) and 38 patients from the cohort of non-cataract blind (6.6%). Subgroup analysis revealed significantly increased odds of mortality for cataract-blind patients over 75 years of age who did not receive surgery and for unmarried patients of all age groups. CONCLUSIONS In this population, mortality risk was significantly elevated for older cataract-blind patients when compared with non-cataract-blind patients-an elevation of risk that was not noted in an age-matched cohort of cataract-blind patients who underwent cataract surgery as early as 1-year follow-up.
Collapse
Affiliation(s)
- Benjamin J Thomas
- Division of International Ophthalmology, Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Himalayan Cataract Project, Waterbury, Vermont, USA
| | - David S Sanders
- Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthew S Oliva
- Himalayan Cataract Project, Waterbury, Vermont, USA Department of Ophthalmology, Casey Eye Institute, Oregon Health & Science University, Portland, Oregon, USA
| | - Mark S Orrs
- Department of Political Science, Lehigh University, Bethlehem, Pennsylvania, USA School of International and Public Affairs, Columbia University, New York, New York, USA
| | | | - Sanduk Ruit
- Division of International Ophthalmology, Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Division of International Ophthalmology, Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Wei Chen
- Department of Epidemiology, University of Utah Medical Center, Salt Lake City, Utah, USA
| | - Jill Luoto
- RAND Corporation, Arlington, Virginia, USA
| | | | - Geoffrey C Tabin
- Division of International Ophthalmology, Department of Ophthalmology, John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA Himalayan Cataract Project, Waterbury, Vermont, USA
| |
Collapse
|
50
|
Hayashi Y, Godai A, Yamada M, Yoshikura N, Harada N, Koumura A, Kimura A, Okayasu S, Matsuno Y, Kinosada Y, Itoh Y, Inuzuka T. Reduction in the numbers of drugs administered to elderly in-patients with polypharmacy by a multidisciplinary review of medication using electronic medical records. Geriatr Gerontol Int 2016; 17:653-658. [PMID: 27137480 DOI: 10.1111/ggi.12764] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 01/08/2016] [Accepted: 01/29/2016] [Indexed: 01/05/2023]
Abstract
AIM Polypharmacy is a major problem for elderly patients in developed countries. We investigated whether a multidisciplinary medication review using electronic medical records could reduce the number of drugs administered to elderly patients receiving polypharmacy. METHODS The present study included 432 elderly patients (188 women, 244 men; 267 patients aged 65-74 years and 165 patients aged ≥75 years) who were admitted to and discharged from the Department of Neurology and Geriatrics, Gifu University Hospital, between 2004 and 2011; those who died at the hospital were excluded. The names, categories, and numbers of orally administered drugs at admission and discharge were examined retrospectively using electronic medical records. The histories of continuous oral immunotherapy use at the hospital, falls during the 2 years before hospital admission and the presence of fall risk factors were also evaluated. P-values <0.05 were considered statistically significant. RESULTS On average 1.14 ± 3.07 fewer types of drugs were given to patients at discharge than at admission in patients receiving polypharmacy (P < 0.001). However, the number of drugs given to patients undergoing continuous oral immunotherapy increased by 1.67 ± 3.47 (P < 0.001). The number of drugs was reduced in 33.1% of fallers, and 36.3% of non-fallers. In both fallers and non-fallers, there was a reduction in drug categories associated with falls. CONCLUSIONS Multidisciplinary medication review using electronic medical records could significantly reduce the numbers of drugs taken by elderly inpatients receiving polypharmacy, including drugs associated with falls, in both fallers and non-fallers Geriatr Gerontol Int 2017; 17: 653-658.
Collapse
Affiliation(s)
- Yuichi Hayashi
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Ayumi Godai
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Megumi Yamada
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Nobuaki Yoshikura
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Naoko Harada
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akihiro Koumura
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Akio Kimura
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Shinji Okayasu
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Yasuko Matsuno
- Division of Nursing, Gifu University Hospital, Gifu, Japan
| | - Yasutomi Kinosada
- Department of Biomedical Informatics, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yoshinori Itoh
- Department of Pharmacy, Gifu University Hospital, Gifu, Japan
| | - Takashi Inuzuka
- Department of Neurology and Geriatrics, Gifu University Graduate School of Medicine, Gifu, Japan
| |
Collapse
|