TY - JOUR
T1 - Prospective disability in different combinations of somatic and mental multimorbidity
AU - Quiñones, Ana R.
AU - Markwardt, Sheila
AU - Thielke, Stephen
AU - Rostant, Ola
AU - Vásquez, Elizabeth
AU - Botoseneanu, Anda
N1 - Publisher Copyright:
© The Author(s) 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights
PY - 2018/3/1
Y1 - 2018/3/1
N2 - Background: Multimorbidity (multiple co-occurring chronic conditions) may be an important contributor to disability and poor health-related quality of life. The functional consequences of specific combinations of somatic and mental health conditions are unclear. Methods: Nationally representative prospective cohort study using the National Health and Aging Trends Study data of Medicare beneficiaries. We included 4,017 participants aged 65 years or older interviewed in 2013 and 2014. The primary outcome was prospective activities of daily living (ADL)-instrumental ADL (IADL) index (range = 0-11) assessed in 2014. All other measures were assessed in 2013. Chronic conditions included heart disease, hypertension, stroke, diabetes, arthritis, lung disease, osteoporosis, cancer, depression, and cognitive impairment. Analyses were adjusted for age, sex, education, race/ethnicity, body mass index, and baseline ADL-IADL. Results: Thirty-four percent of multimorbidity combinations included depression, cognitive impairment, or both. Relative to multimorbidity combinations of exclusively somatic conditions, combinations that included both depression and cognitive impairment were associated with 1.34 times greater ADL-IADL in adjusted models (95% confidence interval [CI]: 1.09, 1.64). Relative to combinations of both depression and cognitive impairment, combinations of cognitive impairment and somatic conditions were associated with 0.84 times lower ADL-IADL in adjusted models (95% CI: 0.74, 0.96); combinations of depression and somatic conditions were associated with 0.72 times lower ADL-IADL in adjusted models (95% CI: 0.62, 0.85). Conclusions: Depression and/or cognitive impairment was identified in one-third of older adults with multimorbidity, and these combinations were associated with substantially greater prospective disability than combinations comprised exclusively of somatic conditions. This argues for identifying and managing mental health conditions that co-occur with somatic conditions.
AB - Background: Multimorbidity (multiple co-occurring chronic conditions) may be an important contributor to disability and poor health-related quality of life. The functional consequences of specific combinations of somatic and mental health conditions are unclear. Methods: Nationally representative prospective cohort study using the National Health and Aging Trends Study data of Medicare beneficiaries. We included 4,017 participants aged 65 years or older interviewed in 2013 and 2014. The primary outcome was prospective activities of daily living (ADL)-instrumental ADL (IADL) index (range = 0-11) assessed in 2014. All other measures were assessed in 2013. Chronic conditions included heart disease, hypertension, stroke, diabetes, arthritis, lung disease, osteoporosis, cancer, depression, and cognitive impairment. Analyses were adjusted for age, sex, education, race/ethnicity, body mass index, and baseline ADL-IADL. Results: Thirty-four percent of multimorbidity combinations included depression, cognitive impairment, or both. Relative to multimorbidity combinations of exclusively somatic conditions, combinations that included both depression and cognitive impairment were associated with 1.34 times greater ADL-IADL in adjusted models (95% confidence interval [CI]: 1.09, 1.64). Relative to combinations of both depression and cognitive impairment, combinations of cognitive impairment and somatic conditions were associated with 0.84 times lower ADL-IADL in adjusted models (95% CI: 0.74, 0.96); combinations of depression and somatic conditions were associated with 0.72 times lower ADL-IADL in adjusted models (95% CI: 0.62, 0.85). Conclusions: Depression and/or cognitive impairment was identified in one-third of older adults with multimorbidity, and these combinations were associated with substantially greater prospective disability than combinations comprised exclusively of somatic conditions. This argues for identifying and managing mental health conditions that co-occur with somatic conditions.
KW - Chronic disease combinations
KW - Comorbidity
KW - Disability
KW - Multimorbidity
KW - Multiple chronic conditions
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U2 - 10.1093/gerona/glx100
DO - 10.1093/gerona/glx100
M3 - Article
C2 - 28541396
AN - SCOPUS:85044603001
SN - 1079-5006
VL - 73
SP - 204
EP - 210
JO - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
JF - Journals of Gerontology - Series A Biological Sciences and Medical Sciences
IS - 2
ER -