Journal of the American Geriatrics Society

Patterns of Chronic Multimorbidity in the Elderly Population

Alessandra Marengoni MD, PhD

From the ^* Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden ^† Stockholm Gerontology Research Center, Stockholm, Sweden ^‡ Geriatric Unit, Civili Hospital, Department of Medical and Surgery Sciences, University of Brescia, Brescia, Italy.

Search for more papers by this author

Debora Rizzuto MS,

Debora Rizzuto MS

Search for more papers by this author

Hui-Xin Wang PhD,

Hui-Xin Wang PhD

Search for more papers by this author

Bengt Winblad MD, PhD,

Bengt Winblad MD, PhD

Search for more papers by this author

Laura Fratiglioni MD, PhD,

Laura Fratiglioni MD, PhD

Search for more papers by this author

Alessandra Marengoni MD, PhD,

Alessandra Marengoni MD, PhD

Search for more papers by this author

Debora Rizzuto MS,

Debora Rizzuto MS

Search for more papers by this author

Hui-Xin Wang PhD,

Hui-Xin Wang PhD

Search for more papers by this author

Bengt Winblad MD, PhD,

Bengt Winblad MD, PhD

Search for more papers by this author

Laura Fratiglioni MD, PhD,

Laura Fratiglioni MD, PhD

Search for more papers by this author

First published: 28 January 2009

https://doi.org/10.1111/j.1532-5415.2008.02109.x

Citations: 291

Address correspondence to Alessandra Marengoni, I Medicina, Spedali Civili. Piazzale Spedali Civili 1. 25123 Brescia, Italy. E-mail: [email protected]

Share a link

Email
Facebook
Twitter
LinkedIn
Reddit
Wechat

Abstract

OBJECTIVES: To describe patterns of comorbidity and multimorbidity in elderly people.

DESIGN: A community-based survey.

SETTING: Data were gathered from the Kungsholmen Project, a urban, community-based prospective cohort in Sweden.

PARTICIPANTS: Adults aged 77 and older living in the community and in institutions of the geographically defined Kungsholmen area of Stockholm (N=1,099).

MEASUREMENTS: Diagnoses based on physicians' examinations and supported by hospital records, drug use, and blood samples. Patterns of comorbidity and multimorbidity were evaluated using four analytical approaches: prevalence figures, conditional count, logistic regression models, and cluster analysis.

RESULTS: Visual impairments and heart failure were the diseases with the highest comorbidity (mean 2.9 and 2.6 co-occurring conditions, respectively), whereas dementia had the lowest (mean 1.4 comorbidities). Heart failure occurred rarely without any comorbidity (0.4%). The observed prevalence of comorbid pairs of conditions exceeded the expected prevalence for several circulatory diseases and for dementia and depression. Logistic regression analyses detected similar comorbid pairs. The cluster analysis revealed five clusters. Two clusters included vascular conditions (circulatory and cardiopulmonary clusters), and another included mental diseases along with musculoskeletal disorders. The last two clusters included only one major disease each (diabetes mellitus and malignancy) together with their most common consequences (visual impairment and anemia, respectively).

CONCLUSION: In persons with multimorbidity, there exists co-occurrence of diseases beyond chance, which clinicians need to take into account in their daily practice. Some pathological mechanisms behind the identified clusters are well known; others need further clarification to identify possible preventative strategies.

REFERENCES

1 Gijsen R, Hoeymans N, Schellevis FG et al. Causes and consequences of comorbidity: A review. J Clin Epidemiol 2001; 54: 661–674.
CASPubMedWeb of Science®Google Scholar
2 Feinstein AR. The pretherapeutic classification of comorbidity in chronic disease. J Chronic Dis 1970; 23: 455–468.
10.1016/0021-9681(70)90054-8
CASPubMedWeb of Science®Google Scholar
3 Van Den Akker M, Buntinx F, Knottnerus JA. Comorbidity or multimorbidity: What's in a name? A review of literature. Eur J Gen Pract 1996; 2: 65–70.
Google Scholar
4 Batstra L, Bos EH, Neeleman J. Quantifying psychiatric comorbidity: Lessons from chronic disease epidemiology. Soc Psychiatry Psychiatr Epidemiol 2002; 37: 105–111.
CASPubMedWeb of Science®Google Scholar
5 Guralnik JM. Assessing the impact of comorbidity in the older population. Ann Epidemiol 1996; 6: 376–380.
10.1016/S1047-2797(96)00060-9
CASPubMedWeb of Science®Google Scholar
6 Verbrugge LM, Lepkowski JM, Imanaka Y. Comorbidity and its impact on disability. Milbank Q 1989; 67: 450–484.
10.2307/3350223
CASPubMedWeb of Science®Google Scholar
7 Fried LP, Bandeen-Roche K, Kasper JD et al. Association of comorbidity with disability in older women: The Women's Health and Aging Study. J Clin Epidemiol 1999; 52: 27–37.
CASPubMedWeb of Science®Google Scholar
8 Van Den Akker M, Buntinx F, Metsemakers JF et al. Multimorbidity in general practice: Prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 1998; 51: 367–375.
CASPubMedWeb of Science®Google Scholar
9 John R, Kerby DS, Hagan Hennessy C. Patterns and impact of comorbidity and multimorbidity among community-resident American Indian elders. Gerontologist 2003; 43: 649–660.
10.1093/geront/43.5.649
PubMedWeb of Science®Google Scholar
10 Fratiglioni L, Viitanen M, Backman L et al. Occurrence of dementia in advanced age: The study design of the Kungsholmen Project. Neuroepidemiology 1992; 11: 29–36.
Web of Science®Google Scholar
11 Timmreck TC, Cole GE, James G et al. Health education and health promotion: A look at the jungle of supportive fields, philosophies and theoretical foundations. Health Educ 1987; 18: 23–28.
CASGoogle Scholar
12 World Health Organization. Guidelines for ATC Classification. WHO Collaborating Centre for Drug Statistics Methodology, Norway and Nordic Councils on Medicines, Sweden: 1990.
Google Scholar
13 World Health Organization. International Classification of Diseases, Injuries, and Causes of Death. Ninth Revision (ICD-9). Geneva, Switzerland: World Health Organization, 1987.
Google Scholar
14 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. Washington, DC: American Psychiatric Association, 1994, pp 133–158.
Google Scholar
15 Åsberg M, Montgomery SA, Perris C et al. A comprehensive psychopathological rating scale. Acta Psychiatr Scand 1978; 271: 5–27.
10.1111/j.1600-0447.1978.tb02357.x
CASPubMedWeb of Science®Google Scholar
16 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 3rd Ed., Revised. Washington, DC: American Psychiatric Association, 1987, pp 97–163.
Google Scholar
17 World Health Organization. Nutritional anemias. Report of a WHO scientific group. Geneva, Switzerland, 1968, Technical Report Series No. 405.
Google Scholar
18 Marengoni A, Winblad B, Karp A et al. Prevalence of chronic diseases and multimorbidity in the old population: Differential distribution by age, gender and socio-economic status. Am J Public Health 2008; 98: 1198–1200.
PubMedWeb of Science®Google Scholar
19 Wolff JL, Starfield B, Anderson G. Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 2002; 162: 2269–2276.
10.1001/archinte.162.20.2269
PubMedWeb of Science®Google Scholar
20 Weiss CO, Boyd CM, Yu Q et al. Patterns of prevalent major chronic disease among older adults in the United States. JAMA 2007; 298: 1160–1162.
10.1001/jama.298.10.1160-b
CASPubMedWeb of Science®Google Scholar
21 Lyketsos CG, Toone L, Tschanz J et al. Population-based study of medical comorbidity in early dementia and “cognitive impairment, no dementia (CIND)”: Association with functional and cognitive impairment: The Cache County Study. Am J Geriatr Psychiatry 2005; 13: 656–664.
PubMedWeb of Science®Google Scholar
22 Sanderson M, Wang J, Davis DR et al. Co-morbidity associated with dementia. Am J Alzheimers Dis Other Dem 2002; 17: 73–78.
10.1177/153331750201700210
PubMedGoogle Scholar
23 Sin DD, Paul Man SF. Why are patients with chronic obstructive pulmonary disease at increased risk of cardiovascular diseases? Circulation 2003; 107: 1514–1519.
10.1161/01.CIR.0000056767.69054.B3
PubMedWeb of Science®Google Scholar
24 Singh S, Duggal J, Molnar J et al. Impact of subclinical thyroid disorders on coronary heart disease, cardiovascular and all-cause mortality: A meta-analysis. Int J Cardiol 2008; 125: 41–48.
PubMedWeb of Science®Google Scholar
25 Berger AK, Fratiglioni L, Forsell Y et al. The occurrence of depressive symptoms in the preclinical phase of AD. A population-based study. Neurology 1999; 53: 1998–2002.
10.1212/WNL.53.9.1998
CASPubMedWeb of Science®Google Scholar
26 Sheridan PL, Hausdorff JM. The role of higher-level cognitive function in gait: Executive dysfunction contributes to fall risk in Alzheimer's disease. Dement Geriatr Cogn Disord 2007; 24: 125–137.
PubMedWeb of Science®Google Scholar
27 Guo Z, Viitanen M, Winblad B et al. Low blood pressure and incidence of dementia in a very old sample: Dependent on initial cognition. J Am Geriatr Soc 1999; 47: 723–726.
CASPubMedWeb of Science®Google Scholar
28 Qiu C, Winblad B, Fastbom J et al. Combined effect of APOE genotype, blood pressure, and antihypertensive drug use on incident AD. Neurology 2003; 61: 655–660.
10.1212/WNL.61.5.655
PubMedWeb of Science®Google Scholar
29 Xu H, Wang R, Zhang YW et al. Estrogen, beta-amyloid metabolism/trafficking, and Alzheimer's disease. Ann NY Acad Sci 2006; 1089: 324–342.
10.1196/annals.1386.036
CASPubMedWeb of Science®Google Scholar
30 Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med 1998; 338: 1516–1520.
10.1056/NEJM199805213382106
CASPubMedWeb of Science®Google Scholar
31 Boyd CM, Darer J, Boult C et al. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA 2005; 294: 716–724.
CASPubMedWeb of Science®Google Scholar

Citing Literature

Volume57, Issue2

February 2009

Pages 225-230

Patterns of Chronic Multimorbidity in the Elderly Population

Abstract

REFERENCES

Citing Literature

References

Information

About Wiley Online Library

Help & Support

Opportunities

Connect with Wiley

Patterns of Chronic Multimorbidity in the Elderly Population

Abstract

REFERENCES

Citing Literature

References

Related

Information