中国老年人不同体重状态下多病共存现状研究

目的 描述不同年龄段中国老年人不同体重状态下的多病共存情况,分析体重状态与多病共存的关系。方法 采用2002—2018年中国老年健康影响因素跟踪调查数据,以65岁及以上的老年人为研究对象,描述不同体重状态老年人群的多病共存现状,使用广义线性模型分别分析体重状态与疾病数量以及多病共存的关系,使用关联规则分析不同体重状态下的疾病组合情况。结果 共44 631名调查对象纳入分析。与正常体重人群相比,超重（β = 0.13,95%CI:0.09～0.18）及肥胖人群（β = 0.29,95%CI:0.22～0.35）所患疾病数更多,超重（OR = 1.17,95%CI:1.09～1.26）及肥胖人群（OR = 1.37,95%CI:1.23～1.53）多病共存患病风险更高。在65～79岁年龄组,功能损伤类疾病（牙齿缺损、感觉损伤及认知损伤）组合在低体重老年人群的出现频次高,关联强度大;心血管代谢类疾病（高血压、心脏疾病、卒中及糖尿病）组合在正常体重、超重以及肥胖老年人群的出现频次高;在80～94岁以及95岁以上年龄组,不论体重状态,功能损伤类疾病（牙齿缺损、感觉损伤及认知损伤）组合在老年人群的出现频次高。结论 我国老年人群多病共存现状严峻,在不同年龄段中,多病共存患病风险以及疾病组合在不同体重状态下存在差异。充分了解不同体重状态下多病共存的差异,有助于针对性地开展多病共存的管理与干预,为老年人群健康的精准管理提供依据。     

The impact of multimorbidity on grip strength in adults age 50 and older: Data from the health and retirement survey (HRS)

BackgroundMultimorbidity, 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.MethodsA 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).ResultsAs 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.ConclusionMultimorbidity 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.     

Healthy life-expectancy and multimorbidity among older adults: Do inequality and poverty matter?

Multimorbidity among older adults increases with age. There are large socioeconomic differences across states in Brazil. We believe that estimates of healthy life expectancy differ according to poverty and income inequality status. The objective of the study is to describe patterns of life expectancy with multimorbidity with distinct levels of poverty and inequality in Brazil. We constructed life tables for Brazilian states and estimated the prevalence of multimorbidity for populations aged 60 and over, and divided the states into three groups according to poverty and inequality status and compare them. The group with high poverty and inequality lives fewer years with multimorbidity than the group with lower poverty and inequality. We believe this approach can be used to compare estimates between populations and to identify health inequalities within the country that require attention, optimizing resources, and planning interventions to improve population health, mainly through primary health care.     

Multimorbidity and Health-Related Quality of Life in Old Age: Role of Functional Dependence and Depressive Symptoms

ObjectivesTo examine the associations of multimorbidity patterns with health-related quality of life (HRQL) in rural-dwelling older adults in China, and to explore to what extent their associations were mediated by functional dependence and depressive symptoms.DesignPopulation-based cross-sectional study.Setting and participants1497 participants (age ≥60 years; 66.4% women) in the 2014-2016 examination of the Confucius Hometown Aging Project who were living in a rural community near Qufu, Shandong, China.MeasuresData on demographics, lifestyles, chronic health conditions, and use of medications were collected through interviews, clinical examinations, and laboratory tests. Multimorbidity was defined as co-occurrence of ≥2 chronic diseases in the same person. The 15-item Geriatric Depression Scale (GDS-15) was used to assess depressive symptoms, and EQ-5D-3L was used to assess HRQL.ResultsMultimorbidity was present in 83.8% of the participants (women vs men: 85.5% vs 80.6%, P = .015). Exploratory factor analysis identified 4 patterns of multimorbidity, that is, patterns of cardiovascular-degenerative, respiratory, neurologic-thyroid, and metabolic-cognitive-cerebrovascular diseases. The neurologic-thyroid disease pattern did not show a significant association with HRQL. The 3 other patterns were associated with poor HRQL and had a diverse impact on different dimensions of HRQL. Mediation analysis suggested that functional dependence and the presence of depressive symptoms could mediate 24.8% and 21.8%, respectively, of the association between the number of chronic diseases and poor HRQL.Conclusions/ImplicationsMultimorbidity is associated with poor HRQL in older adults, in which functional dependence and depressive symptoms partly mediate their associations. Prevention and proper management of dependence and depressive symptoms in older people with multimorbidity may help maintain and improve quality of life.     

Self-management across chronic diseases: Targeting education and support needs

ObjectivesAmong Canadian adults with chronic disease: 1) to identify groups that differ in self-management task frequency and self-efficacy; 2) to compare group characteristics and preferences for self-management support.MethodsUsing data from an online survey, cluster analysis was used to identify groups that differed in self-management task frequency and self-efficacy. Multivariable regression was used to explore relationships with patient characteristics and preferences.ResultsCluster analysis (n = 247) revealed three groups:Vulnerable Self-Managers (n = 55), with the highest task frequency and lowest self-efficacy; Confident Self-Managers (n = 73), with the lowest task frequency and highest self-efficacy; and Moderate Needs Self-Managers (n = 119), with intermediate task frequency and self-efficacy. Vulnerable Self-Managers, when compared with the Confident group, were more often: on illness-related employment disability or unemployed; less well educated; diagnosed with emotional problems or hypertension, and had greater multimorbidity. They participated less often in self-management programs, and differed in support preferences.ConclusionsKnowing the characteristics of vulnerable self-managers can help in targeting those in greater need for self-management support that matches their preferences.Practice ImplicationsDifferent approaches are needed to support self-management in the vulnerable population.     

Características de la provisión del servicio de gestión de casos en el entorno comunitario en Andalucía a partir del registro RANGECOM

ObjectiveTo describe the characteristics of case management in terms of population served, interventions, use of services and outcomes such as mortality, readmissions, pressure ulcers, falls, drug problems and institutionalization.MethodFollow-up study of a cohort, from the RANGECOM Multicentric Registry of Andalusia. The study population were patients included in the case management services of Health Centres and their family caregivers.ResultsData from 835 patients with a mean age of 76.8 years (SD: 12.1), 50.24% women, are presented. They had an important comorbidity (Charlson 3.1, SD: 2.5) and high dependence (Barthel 37.5, SD: 31.4). Sixty-two point two percent of the interventions deployed by the case managers were grouped into three domains: behavioural (26.0%), health system (20.2%) and safety (14.1%). Mortality was 34.4% and hospital admissions 38.1%. Patients with more hospital readmissions had more visits to the Emergency Department (OR: 1.41; 95% CI: 1.22-1.63), more telephone interventions by case managers (OR: 1.12; 95% CI: 1.02-1.24) and imaging tests (OR: 1.37; 95% CI: 1.17-1.60), together with greater caregiver burden (OR: 1.31; 95% CI: 1.08-1.59), the presence of medical devices at home (OR: 1.69; 95% CI: 1.00-2.87) and received less “Case Management” intervention.ConclusionsThe patients who absorb the demand of case management nurses present high complexity, for which they deploy behavioural interventions, navigation through the health system and clinical safety.     

Childhood adversity: A gateway to multimorbidity in older age?

BackgroundMultimorbidity, or co-occurrence of several chronic diseases, has major consequences in terms of function, quality of life and mortality. Recent advances suggest that the aetiology of multimorbidity includes a life-long process. The purpose of this study was to determine the association between childhood adversity and multimorbidity in community-dwelling older adults, and to investigate variation in participants born immediately before, during and at the end of the Second World War.MethodsParticipants were 4731 community-dwelling older adults who enrolled in the Lausanne cohort 65+ study (Switzerland) at age 65–70 years in 2004/2009/2014. A baseline questionnaire provided several indicators of childhood adversity including premature birth, food restrictions, child labour, family economic environment, serious illness/accident, and stressful life events. Multimorbidity at age 67–72 years was defined as ≥2 active chronic diseases at the 2-year follow-up questionnaire.ResultsAll childhood adversity indicators except premature birth were significantly associated with multimorbidity. Odds ratio (OR) ranged from 1.23 (P = 0.034) for poor family economic environment to 1.74 (P < 0.001) for stressful life events. In a multivariable model adjusted for socioeconomic status, health behaviours and stressful life events in adulthood (>16 years), a history of serious illness/accident (OR = 1.45; P < 0.001) and stressful life events (OR = 1.42; P = 0.001) in childhood remained significantly associated with multimorbidity. Comparisons between cohorts indicated substantial variations in the prevalence of childhood adversity indicators but similar associations with multimorbidity.ConclusionThere was an independent association between childhood adversity and multimorbidity after age 65. This study encourages a comprehensive life-course perspective to better understand and potentially prevent multimorbidity.