The Co-Occurrence of Chronic Diseases and Geriatric Syndromes: The Health and Retirement Study

Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-2007, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.57). 03/2009; 57(3):511-6. DOI: 10.1111/j.1532-5415.2008.02150.x
Source: PubMed

ABSTRACT To analyze the co-occurrence, in adults aged 65 and older, of five conditions that are highly prevalent, lead to substantial morbidity, and have evidence-based guidelines for management and well-developed measures of medical care quality.
Secondary data analysis of the 2004 wave of the Health and Retirement Study (HRS).
Nationally representative health interview survey.
Respondents in the 2004 wave of the HRS aged 65 and older.
Self-reported presence of five index conditions (three chronic diseases (coronary artery disease, congestive heart failure, and diabetes mellitus) and two geriatric syndromes (urinary incontinence and injurious falls)) and demographic information (age, sex, race, living situation, net worth, and education).
Eleven thousand one hundred thirteen adults, representing 37.1 million Americans aged 65 and older, were interviewed. Forty-five percent were aged 76 and older, 58% were female, 8% were African American, and 4% resided in a nursing home. Respondents with more conditions were older and more likely to be female, single, and residing in a nursing home (all P<.001). Fifty-six percent had at least one of the five index conditions, and 23% had two or more. Of respondents with one condition, 20% to 55% (depending on the index condition) had two or more additional conditions.
Five common conditions (3 chronic diseases, 2 geriatric syndromes) often co-occur in older adults, suggesting that coordinated management of comorbid conditions, both diseases and geriatric syndromes, is important. Care guidelines and quality indicators, rather than considering one condition at a time, should be developed to address comprehensive and coordinated management of co-occurring diseases and geriatric syndromes.

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Available from: Pearl Lee, Jul 29, 2014
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    • "To date, only a few studies have investigated the association between multi-morbidity and falls [12-14]. For example, Lee et al. observed substantial co-occurrence of several chronic conditions and falls among 11,000 older adults, and increased prevalence of falling among those with a chronic disease than without [12]. "
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    ABSTRACT: Falls and chronic disease are both important health issues in older adults. The objectives of this study were to quantify the prevalence of falls and multi-morbidity (>=2 chronic conditions) in Canadian older adults; examine associations between falls and number of chronic conditions; and explore whether certain patterns of chronic disease were associated with a greater risk of falling. Data were derived from the Canadian Community Health Survey- Healthy Aging. Primary outcomes from 16,357 community-dwelling adults aged 65 years and over were self-reported falls in the previous 12 months and presence of 13 chronic conditions. Prevalence estimates were calculated with normalized sampling weights, and hierarchical cluster analysis was used to identify clusters based on chronic condition patterns, and tested for association to falls with logistic regression. Overall prevalence of falling and multi-morbidity were 19.8% and 62.0% respectively. Fall risk was significantly greater in individuals with one, two, four, five and six or more chronic conditions relative to those with none (all p < 0.05). A seven-cluster model was selected, including groups with low prevalence of chronic disease, or high prevalence of hypertension and arthritis, visual impairment, hypertension, chronic obstructive pulmonary disease (COPD), diabetes, or heart disease and hypertension. Only the hypertension cluster (Odds Ratio [OR] = 1.2) and COPD cluster (OR = 1.6) were significantly associated with increased falls relative to the low prevalence group. Both the number and pattern of chronic conditions were related to falls. COPD emerged as a significant predictor of falls despite affecting a smaller proportion of respondents. Continued study is warranted to verify this association and determine how to incorporate consideration of chronic disease and multi-morbidity into fall risk assessments.
    BMC Geriatrics 02/2014; 14(1):22. DOI:10.1186/1471-2318-14-22 · 1.68 Impact Factor
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    • "The vast majority of nursing home residents is characterized by the most dramatic results of the pathophysiological modifications and chronic conditions experienced and accumulated during the entire life course. The complexity of nursing home residents is due to the high comorbidity [7,8], the frequent polypharmacy (especially including psychotropic drugs [9]) [10] the presence of major geriatric syndromes (e.g., falls [11]), and the general poor health status (e.g., malnutrition [12]). In particular, it cannot be ignored that the high prevalence of physical disability in this population. "
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    ABSTRACT: Among the most burdensome clinical conditions occurring in older persons, respiratory infections are particularly relevant. In fact, the onset of pneumonias is associated with a significant worsening of the individual's global health status and significant increase of healthcare costs. The clinical and economical negative consequences of pneumonia may be particularly evident among the frailest groups of elders, in particular those living in nursing home. Nevertheless, specific research on incidence and economical effects of pneumonia in nursing homes residents is still scarce. In the present article, we present the rationale, the design and the methods of the "Incidence of pNeumonia and related ConseqUences in nursing home Resident (INCUR) study, specifically aimed at filling some of the gaps currently present in the field.Methods/design: INCUR is an observational longitudinal study recruiting 800 residents across 13 randomly selected nursing homes in France. Multidimensional evaluations of participants are conducted at the baseline, mid-term (at 6 months), and end of the study (at 12 months) visits in order to measure and follow-up their physical function, nutrition, cognition, depression, quality of life, and healthcare costs. Incident pneumonia as well as the onset/recurrence of other major health-related events are monitored during the study follow-up. The INCUR study will provide valuable information about older persons living in nursing homes. Results from INCUR study may constitute the basis for the development of future preventive campaigns against pneumonia and its consequences.
    BMC Public Health 09/2013; 13(1):861. DOI:10.1186/1471-2458-13-861 · 2.26 Impact Factor
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    • "Adults with diabetes have a high prevalence of physical function limitations (11–13) that are associated with decreased physical activity (8). Diabetes is also associated with comorbidities, including geriatric conditions such as falls, cognitive impairment, and chronic pain (14,15). Geriatric conditions themselves are associated with an increased risk for physical function limitations (16). "
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    ABSTRACT: OBJECTIVE To describe the prevalence of physical function limitations among a nationally representative sample of adults with prediabetes.RESEARCH DESIGN AND METHODS We performed a cross-sectional analysis of 5,991 respondents ≥53 years of age from the 2006 wave of the Health and Retirement Study. All respondents self-reported physical function limitations and comorbidities (chronic diseases and geriatric conditions). Respondents with prediabetes reported no diabetes and had a measured glycosylated hemoglobin (HbA1c) of 5.7-6.4%. Descriptive analyses and logistic regressions were used to compare respondents with prediabetes versus diabetes (diabetes history or HbA1c ≥6.5%) or normoglycemia (no diabetes history and HbA1c <5.7%).RESULTSTwenty-eight percent of respondents ≥53 years of age had prediabetes; 32% had mobility limitations (walking several blocks and/or climbing a flight of stairs); 56% had lower-extremity limitations (getting up from a chair and/or stooping, kneeling, or crouching); and 33% had upper-extremity limitations (pushing or pulling heavy objects and/or lifting >10 lb). Respondents with diabetes had the highest prevalence of comorbidities and physical function limitations, followed by those with prediabetes, and then normoglycemia (P < 0.05). Compared with respondents with normoglycemia, respondents with prediabetes had a higher odds of having functional limitations that affected mobility (odds ratio [OR], 1.48), the lower extremities (1.35), and the upper extremities (1.37) (all P < 0.01). The higher odds of having lower-extremity limitations remained after adjusting for age, sex, and body mass index (1.21, P < 0.05).CONCLUSIONS Comorbidities and physical function limitations are prevalent among middle-aged and older adults with prediabetes. Effective lifestyle interventions to prevent diabetes must accommodate physical function limitations.
    Diabetes care 06/2013; 36(10). DOI:10.2337/dc13-0412 · 8.42 Impact Factor
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