Contribution of Multiple Chronic Conditions to Universal Health Outcomes

OBJECTIVES: To determine the relative effect of five chronic conditions on four representative universal health outcomes. DESIGN: Cross‐sectional. SETTING: Cardiovascular Health Study. PARTICIPANTS: Five thousand two hundred and ninety‐eight community‐living participants aged 65 and older. MEASUREME...

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Bibliographic Details
Published in:Journal of the American Geriatrics Society (JAGS) Vol. 59; no. 9; pp. 1686 - 1691
Main Authors: Tinetti, Mary E., McAvay, Gail J., Chang, Sandy S., Newman, Anne B., Fitzpatrick, Annette L., Fried, Terri R., Peduzzi, Peter N.
Format: Journal Article
Language:English
Published: Malden, USA Blackwell Publishing Inc 01.09.2011
Wiley-Blackwell
Wiley Subscription Services, Inc
Subjects:
Activities of daily living
Aged
Biological and medical sciences
Chronic Disease - epidemiology
Chronic illnesses
Chronic obstructive pulmonary disease
Clinical outcomes
Cognition
Cognition Disorders - epidemiology
Cognitive impairment
Comorbidity
Cross-Sectional Studies
Death & dying
Depression - epidemiology
Female
General aspects
Health
Health Status
Heart failure
Heart Failure - epidemiology
Humans
Male
Medical sciences
Mental depression
Miscellaneous
multiple chronic conditions
Older people
Osteoarthritis
Osteoarthritis - epidemiology
Outcome Assessment, Health Care
patient-reported outcomes
Proportional Hazards Models
Public health. Hygiene
Public health. Hygiene-occupational medicine
Pulmonary Disease, Chronic Obstructive - epidemiology
Regression Analysis
Self evaluation
Symptoms
Treatment methods
universal health outcomes
Human
patient-reported outcomes
Prognosis
Chronic disease
Patient
multiple chronic conditions
Concomitant disease
Chronic
Gerontology
Polypathology
Evolution
Elderly
Public health
Geriatrics
universal health outcomes
ISSN:0002-8614, 1532-5415, 1532-5415
Online Access:Get full text
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Summary:OBJECTIVES: To determine the relative effect of five chronic conditions on four representative universal health outcomes. DESIGN: Cross‐sectional. SETTING: Cardiovascular Health Study. PARTICIPANTS: Five thousand two hundred and ninety‐eight community‐living participants aged 65 and older. MEASUREMENTS: Multiple regression and Cox models were used to determine the effect of heart failure (HF), chronic obstructive pulmonary disease (COPD), osteoarthritis, depression, and cognitive impairment on self‐rated health, 12 basic and instrumental activities of daily living (ADLs and IADLs), six‐item symptom burden scale, and death. RESULTS: Each condition adversely affected self‐rated health (P<.001) and ADLs and IADLs (P<.001). For example, persons with HF performed 0.70±0.08 fewer ADLs and IADLs than those without; persons with depression and persons with cognitive impairment performed 0.59±0.04 and 0.58±0.06 fewer activities, respectively, than those without these conditions. Depression, HF, COPD, and osteoarthritis were associated with 1.18±0.04, 0.40±0.08, 0.40±0.05, and 0.57±0.03 more symptoms, respectively, in individuals with these conditions than in those without. HF (hazard ratio (HR)=2.84, 95% confidence interval (CI)=1.97–4.10), COPD (2.62, 95% CI=1.94–3.53), cognitive impairment (2.05, 95% CI=1.47–2.85), and depression (1.47, 95% CI=1.08–2.01) were each associated with death within 2 years. Several paired combinations of conditions had synergistic effects on ADLs and IADLs. For example, individuals with HF plus depression performed 2.0 fewer activities than persons with neither condition, versus the 1.3 fewer activities expected from adding the effects of the two conditions together. CONCLUSION: Universal health outcomes may provide a common metric for measuring the effects of multiple conditions and their treatments. The varying effects of the conditions across universal outcomes could inform care priorities.
Bibliography:ArticleID:JGS3573
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ISSN:0002-8614
1532-5415
1532-5415
DOI:10.1111/j.1532-5415.2011.03573.x