tors for physicians caring for older adults with multiple dis-
eases and syndromes; such guidelines and indicators of com-
prehensive clinical quality are now under development.
Finally, from a research standpoint, the co-occurrence
of chronic diseases and geriatric syndromes in the cur-
rent study suggests that they may have shared risk factors.
The pathophysiological relationship between DM and
heart disease is well known, but the pathways relating
chronic diseases to geriatric syndromes have not been
fully explored. Future research investigating the causes of
the ‘‘clustering’’ of diseases and syndromes would have
beneﬁt for prevention, early recognition, and manage-
ment of accumulating comorbid diseases and syndromes.
Such research might lead also to eventual prevention or
attenuation of functional disability and decreased quality
A key strength of this study is its use of HRS data. The
HRS is a nationally representative survey and includes de-
tailed information on chronic diseases and geriatric syn-
dromes. Although the HRS primarily collects self-report
data, it is one of the few nationally representative studies to
contain such extensive information on diseases and geriatric
syndromes. Self-report data may be less reliable for certain
chronic diseases, although research suggests that good
agreement exists between validated evidence of myocardial
infarction, angina pectoris, CHF, and DM and the self-
report of these diseases.
The current study employs cross-sectional analysis, and
causality cannot be determined, although respondents in
the HRS are interviewed every 2 years, making possible
future longitudinal studies to further evaluate the relation-
ship between chronic diseases and geriatric syndromes. In
addition, the prevalence of other common chronic diseases,
such as chronic lung disease or arthritis, and other geriatric
syndromes, such as delirium, were not analyzed. Rather,
diseases and syndromes with well-developed clinical per-
formance indicators, ones on which physicians are now
being measured, were selected to highlight the substantial
co-occurrence of these ﬁve diseases and syndromes. For
most primary care physicians and other providers, these ﬁve
conditions occur commonly in their practices, and these are
the most common conditions for which payers and health
plans are measuring the quality of clinical care. Future re-
search is needed to more fully explore the effect of multiple
other geriatric syndromes on patients with multiple chronic
It has been convincingly argued that medical practice
should evolve to match the changes of an aging population
with a longer life expectancy.
Consistent with that view,
the results from the current study suggest that, as greater
numbers of older adult patients present with multiple co-
occurring diseases and geriatric syndromes, physicians will
be required to provide comprehensive care to address com-
plex health status. Clinical guidelines and measures of
the quality of clinical care must be developed that address
coordinated and comprehensive management of multiple
co-occurring diseases and syndromes rather than focus on
We would like to thank Ms. Zhiyi Tian for her assistance in
Conﬂict of Interest: The editor in chief has reviewed the
conﬂict of interest checklist provided by the authors and has
determined that the authors have no ﬁnancial or any other
kind of personal conﬂicts with this manuscript.
Financial Disclosure: Dr. Lee was supported by the
Veterans Affairs (VA) Special Fellowships Program in Ad-
vanced Geriatrics through the VA Ann Arbor Healthcare
System Geriatric Research, Education and Clinical Center
(GRECC); the John A. Hartford Foundation; and the Uni-
versity of Michigan Claude D. Pepper Older Americans In-
dependence Center. Dr. Cigolle was supported by a Ruth L.
Kirschstein National Research Service Award from the Na-
tional Institute on Aging (NIA; 1F32AG027649-01), the
National Institutes of Health, National Center for Research
Resources K12 Mentored Clinical Scholars Program at the
University of Michigan, the VA Ann Arbor Healthcare Sys-
tem GRECC, and the John A. Hartford Foundation. Dr.
Blaum was supported by NIA Grant R01 AG021493A and
the VA Ann Arbor Healthcare System GRECC. An early
version of this paper was presented as a poster at the Ge-
rontological Society of America’s Annual Scientiﬁc Meeting
in November 2007.
Author Contributions: All authors were involved in
study concept and design, data analyses, interpretation of
data, and preparation of manuscript.
Sponsor’s Role: None.
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CO-OCCURRING DISEASES AND GERIATRIC SYNDROMES 515JAGS MARCH 2009–VOL. 57, NO. 3