Aging with multimorbidity: a systematic review of the literature

A literature search was carried out to summarize the existing scientific evidence concerning occurrence, causes, and consequences of multimorbidity (the coexistence of multiple chronic diseases) in the elderly as well as models and quality of care of persons with multimorbidity. According to pre-established inclusion criteria, and using different search strategies, 41 articles were included (four of these were methodological papers only). Prevalence of multimorbidity in older persons ranges from 55 to 98%. In cross-sectional studies, older age, female gender, and low socioeconomic status are factors associated with multimorbidity, confirmed by longitudinal studies as well. Major consequences of multimorbidity are disability and functional decline, poor quality of life, and high health care costs. Controversial results were found on multimorbidity and mortality risk. Methodological issues in evaluating multimorbidity are discussed as well as future research needs, especially concerning etiological factors, combinations and clustering of chronic diseases, and care models for persons affected by multiple disorders. New insights in this field can lead to the identification of preventive strategies and better treatment of multimorbid patients.     

2002—2022年我国多重慢病领域研究热点及演进趋势分析

背景 多重慢病成为慢性疾病病程发展中的一大特征,为我国公共卫生发展带来挑战。我国多重慢病研究发展处于起步阶段,文献数量较少,且缺乏系统、全面的文献分析。目的 本研究旨在对我国多重慢病领域的研究热点和演进趋势进行文献计量学及可视化分析,把握该领域的研究前沿与发展方向,从而为未来研究方向提供参考。方法 选择中国知网作为中文数据来源,Web of Science核心合集作为外文数据来源,检索2002—2022年由我国研究者发表的多重慢病领域的研究文献,采用CiteSpace软件绘制2002—2022年国内和国外期刊中由我国研究者发表的多重慢病研究机构合作网络图谱和关键词共现网络图谱,分析我国多重慢病研究的时空分布情况,探索该领域的研究热点及发展趋势。结果 2002—2022年,我国多重慢病研究发文数量呈整体递增趋势。中文文献出现频次排名前5位的关键词依次是“共病,342次”“老年人,161次”“抑郁症,155次”“慢性病,106次”“糖尿病,94次”;英文文献排名前5位的关键词依次是“prevalence,126次”“older adults,92次”“multimorbidity,91次”...     

Problem gambling subtypes based on psychological distress,alcohol abuse and impulsivity

The notion of comorbidities within problem gambling populations has important clinical implications, particularly for appropriate treatment matching. The comorbidities most commonly cited in problem gambling literature include depression, anxiety, alcohol abuse and impulsivity. Previous research shows evidence of patterns in multiple co-occurring comorbidities and that there may be different subtypes of gamblers based on these patterns. To further the current understanding of gambling subtypes, the aim of our study was to identify subtypes of gamblers currently in treatment. Hierarchical Cluster Analysis yielded four mutually exclusive groups of 202 gamblers: (1) gamblers with comorbid psychological problems (35%); (2) ‘pure’ gamblers without other comorbidities (27%); (3) gamblers with comorbid alcohol abuse (25%); and (4) ‘multimorbid’ gamblers (13%). The four groups differed on demographic information, drug use and gambling behaviours including gambling activity and problem gambling severity. Gamblers with comorbid psychological problems were more likely to be older women on low income, more likely to report a family history of psychological problems and were more often electronic gaming machine players. As expected, ‘pure’ gamblers had lower problem gambling severity and were more likely to report current abstinence. Gamblers with comorbid alcohol abuse were more likely to be young men who used stimulant drugs, endorsed a higher quality of life and worked full-time. ‘Multimorbid’ gamblers were elevated on all comorbidities, had general problems related to their health and wellbeing and reported high rates of hostility and aggression. These groups combine elements of existing conceptual models of gambling subtypes and may require different treatments.     

居家老年多病共存患者多重用药体验的质性研究

背景　近年来老年多病共存患者多重用药问题突出,严重降低其生活质量。重视患者用药体验是减轻其用药问题的关键要素,研究居家老年多病共存患者多重用药体验可为解决其用药问题提供新视角。目的　探讨居家老年多病共存患者多重用药体验及影响因素,为制定有效干预方案提供依据。方法　采用方便抽样法从郑州市2个城区（高新区、金水区）选取3家社区卫生服务中心,每家社区卫生服务中心分别选取4~5例老年多病共存多重用药患者,最终共纳入14例患者为研究对象。采用半结构深度访谈法,于2019年5-8月对14例患者进行访谈。访谈内容主要包括：患者多重用药时,对生活的影响、目前药物管理的现状、存在的问题及其如何解决、希望在多重用药过程中通过何种方式得到何种帮助。对访谈资料进行整理分析,并提炼主题。结果　通过对访谈资料整理分析,共提炼出6个主题：用药相关知识需求较大、经济压力沉重、用药管理实践欠佳、情绪认知改变、日常生活障碍、家庭支持不足。结论　居家老年多病共存患者多重用药体验不容乐观,各级医疗卫生机构应关注这一现象。应加强慢性病常用药物的健康宣教,提升全民药物素养;规范临床药师和全科医生培训管理机制,完善慢性病医保制度;重视患者心理感受,强化家庭和社会支持作用,从而改善患者用药体验和生活质量。     

Características del uso inadecuado de medicamentos en pacientes pluripatológicos de edad avanzada

Objective

To analyse potentially inappropriate prescribing (PIP) in elderly polypathological patients (PP).