Multimorbidity and functional limitation: the role of social relationships

ObjectivesTo examine the relationship between multimorbidity and functional limitation, and how social relationships alter that association.MethodsThis cross-sectional study used data collected by self-reported questionnaires from adults aged 65 years and older living in a rural area in Japan in 2017. This analysis included complete data from 570 residents. Multimorbidity status was defined as having two chronic diseases exist simultaneously in one individual, and the function status was measured by their long-term care needs. Social relationships were assessed by the Index of Social Interaction and divided into high and low levels. Multiple logistic regression analysis was used to examine the association between social relationships and functional limitation and to assess the role of social relationships in this association.ResultsThe logistic regression model indicated that the risk of functional limitation was higher in multimorbidity participants than free-of-multimorbidity participants (OR = 2.55, 95% CI = 1.56–4.16). Compared with participants with no multimorbidity and a high level of social relationships, low level of social relationships increased the risk of functional limitation among participants both with and without multimorbidity, with the OR = 7.71, 95% CI = 3.03–19.69 and OR = 3.28, 95% CI = 1.30–8.27, respectively. However, no significant result was found in participants with multimorbidity and a high level of social relationships (P = 0.365).ConclusionsMultimorbidity was associated with functional limitations. However, this association could be increased by a low level of social relationships and decreased by a high level of social relationships.     

Multimorbidity,functional impairment,and mortality in older patients stable after prior acute myocardial infarction: Insights from the TIGRIS registry

BackgroundData on the association of multimorbidity and functional impairment with cardiovascular (CV) and non‐CV outcomes among older myocardial infarction (MI) patients are limited.HypothesisMultimorbidity and functional impairment among older MI patients are associated with CV and non‐CV mortality.MethodsPatients aged ≥65 years, 1−3 years post‐MI, and enrolled between June 2013 and Novemeber 2014 from 349 sites in 25 countries in the global TIGRIS registry were categorized by age, number of comorbidities, and presence and degree of functional impairment. Functional impairment was calculated using five‐dimension EuroQol based on three domains—mobility, self‐care, and usual activities. The association between age, number of comorbid conditions, and degree of functional impairment with 2‐year incidence of CV and non‐CV death was evaluated using Poisson regression analysis.ResultsOlder age was associated with higher number of comorbidities and functional impairment; after adjustment, increasing age was significantly associated with non‐CV mortality (p = .03) but not CV mortality (p = .38). Greater functional impairment was associated with a higher rate and relatively equal magnitude risk of CV (rate ratios [RR] 1.52, 95% confidence intervals [CI]: 1.29−1.79, per one‐step increase) and non‐CV mortality (RR 1.42, 95% CI: 1.17−1.73). Multimorbidity was more strongly associated with CV mortality (RR 1.52, 95% CI: 1.38−1.67, per additional comorbidity) versus non‐CV mortality (RR 1.29, 95% CI: 1.14−1.47, per additional comorbidity).ConclusionsMultimorbidity and functional impairment are prevalent among older post‐MI patients and are associated with increased CV and non‐CV mortality. These findings highlight the importance of considering comorbid conditions and functional impairment as predictors of risk for adverse outcomes and aspects of medical decision making. Clinical Trial Registration: {"type":"clinical-trial","attrs":{"text":"NCT01866904","term_id":"NCT01866904"}}NCT01866904.     

老年人身体功能与慢性病共病关联的研究

目的 探讨老年人身体功能与慢性病共病的关联。方法 采用中国健康与养老追踪调查数据库(CHARLS)的数据,以2011年基线调查的2452名≥60岁的老年人作为研究对象并追踪到2015年,调查内容包括握力、简易躯体能力(SPPB)、慢性病情况、人口学变量及健康行为变量等。采用SPSS 26.0统计软件进行数据分析。根据数据类型,应用广义估计方程分析身体功能与慢性病共病的关联。结果 老年人慢性病共病患病率呈上升趋势,性别、摔倒、握力和SPPB与老年人慢性病共病患病风险显著相关;女性及发生摔倒的老年人慢性病共病患病风险较高(P＜0.05),握力值低(OR=1.274, 95%CI:1.053～1.542, P=0.013)和SPPB得分低 (OR=1.508, 95%CI:1.119～2.033, P=0.007)的老年人慢性病共病患病风险较高。结论 老年人身体功能与慢性病共病患病风险显著相关,身体功能测量可作为筛查慢性病共病的有效手段,有助于对有较高慢性病共病患病风险的个体进行早期识别和重点防控。     

The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community‐based,longitudinal study

Objective. We aimed to disentangle the effect of chronic multimorbidity and disability on 3‐year functional decline and survival in the elderly. Design. Prospective cohort study with a mean of follow‐up of 2.8 years. Setting. Swedish elderly persons from the Kungsholmen Project (1987–2000). Subjects. A total of 1099 subjects, 77–100 years old, living in the community and institutions. Main outcome measurements. Medical diagnoses (based on clinical examination, drug use, medical records and blood tests), and functional assessment (according to Katz Index) at baseline were investigated in relation to functional decline and death occurring during follow‐up. Results. At baseline, 12.1% of participants had disability, and 52.3% were affected by multimorbidity. During follow‐up, 363 persons died and 85 worsened in functioning. The number of chronic conditions incrementally increased the risk of functional decline [hazard ratio (HR) increased from 1.5 in subjects with one disease to 6.2 in persons with 4+ diseases]. However, this was not the case for mortality, as the HR of death was the same for people with one disease as well as 4+ diseases (HR = 2.3). Baseline disability had the highest impact on survival, independently of number of diseases [HR = 8.1; 95% confidence interval (CI) = 4.8–13.7 in subjects with one disease and HR = 7.7; 95% CI = 4.7–12.6 in those with 2+ diseases]. Conclusions. In the elderly subjects, chronic disability rather than multimorbidity emerged as the strongest negative prognostic factor for functionality and survival.     

Cognitive impairment,depressive symptoms,and functional decline in older people

OBJECTIVES: Although cognitive impairment and depressive symptoms are associated with functional decline, it is not understood how these risk factors act together to affect the risk of functional decline. The purpose of this study is to determine the relative contributions of cognitive impairment and depressive symptoms on decline in activity of daily living (ADL) function over 2 years in an older cohort. DESIGN: Prospective cohort study. SETTING: A U.S. national prospective cohort study of older people, Asset and Health Dynamics in the Oldest Old. PARTICIPANTS: Five thousand six hundred ninety-seven participants (mean age 77, 64% women, 86% white) followed from 1993 to 1995. MEASUREMENTS: Cognitive impairment and depressive symptoms were defined as the poorest scores: 1.5 standard deviations below the mean on a cognitive scale or 1.5 standard deviations above the mean on validated depression scales. Risk of functional decline in participants with depressive symptoms, cognitive impairment, and both, compared with neither risk factor, were calculated and stratified by baseline dependence. Analyses were adjusted for demographics and comorbidity. RESULTS: Eight percent (n = 450) of subjects declined in ADL function. In participants who were independent in all ADLs at baseline, the relative risk (RR) of 2-year functional decline was 2.3 (95% confidence interval (CI) = 1.7-3.1) for participants with cognitive impairment, 1.9 (95% CI = 1.3-2.6) for participants with depressive symptoms, and 2.4 (95% CI = 1.4-3.7) for participants with cognitive impairment and depressive symptoms. In participants who were dependent in one or more ADLs at baseline, RR of 2-year functional decline was 1.9 (95% CI = 1.2-2.8) for participants with cognitive impairment, 0.6 (95% CI = 0.3-1.3) for participants with depressive symptoms, and 1.5 (95% CI = 0.8-2.6) for participants with cognitive impairment and depressive symptoms. CONCLUSIONS: In participants with no ADL dependence at baseline, cognitive impairment and depressive symptoms are risk factors for decline, but that, in participants with dependence in ADL at baseline, cognitive impairment, but not depressive symptoms, is a risk factor for additional decline.