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Health and Quality of Life Outcomes
Published in: Health and Quality of Life Outcomes 1/2017

Open Access 01-01-2017 | Research

Multimorbidity associated with functional independence among community-dwelling older people: a cross-sectional study in Southern China

Authors: Xiao-Xiao Wang, Wei-Quan Lin, Xu-Jia Chen, Ying-Yu Lin, Ling-Ling Huang, Sheng-Chao Zhang, Pei-Xi Wang

Published in: Health and Quality of Life Outcomes | Issue 1/2017

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Abstract

Background

Multimorbidity, the coexistence of two or more chronic diseases, is common in older adults. And it may lead to many adverse health outcomes, such as disability. However, data on multimorbidity and its relationship with functional independence are scarce in Asian countries. Therefore, this study aims to investigate the relationship between multimorbidity and functional status among older people in China.

Methods

Based on a cross-sectional survey, the information regarding 2705 older adults, who were of at least 60 years of age, was collected through interviews and analyzed. To assess functional status, we used the Functional Independence Measure (FIM). Exploratory factor analysis was performed to assess correlations among chronic diseases. Several logistic regression models were run in the study.

Results

The presence of two or more chronic conditions and the number of multimorbidity group overlaps were independent risk factors for the loss of functional independence in older adults. Hypertension and chronic pain, emerged as the most prevalent multimorbidity pair, was significantly associated with functional independence (OR = 1.64, 95% CI = 1.25–2.16), followed by the co-occurrence of hypertension and heart diseases with a lower prevalence but a higher OR compared with the former pair (OR = 1.72, 95% CI = 1.15–2.58). Of the five multimorbidity groups used for factor analysis, the bones and pain group (OR = 1.47, 95% CI = 1.23–1.77) and the cardiometabolic group (OR = 1.34, 95% CI = 1.13–1.59) were both found to be significantly correlated with lower functional independence.

Conclusions

Multimorbidity was common among older people in Southern China. Studying the relationship between multimorbidity and functional status could be useful to find potential correlations among chronic diseases. Additionally, it may also be meaningful to identify multimorbidity combinations, posing an increased risk of loss of functional independence, and further improve functional status in older adults with comorbidities.
Literature
1.
Van den Akker M, Buntix F, Knottnerus J. Comorbidity or multimor-bidity: what’s in a name? a review of literature. Eur J Gen Pract. 1996;2:65–70.CrossRef
2.
WHO. The world health report 2008. In: Primary Health Care (Now more than ever). New York: The World Health Report; 2008.
3.
Violan C, Foguet-Boreu Q, Flores-Mateo G, Salisbury C, Blom J, Freitag M, et al. Prevalence, determinants and patterns of multimorbidity in primary care: a systematic review of observational studies. PLoS One. 2014;9(7):e102149.CrossRefPubMedPubMedCentral
4.
Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9.CrossRefPubMed
5.
6.
7.
Bahler C, Huber CA, Brungger B, Reich O. Multimorbidity, health care utilization and costs in an elderly community-dwelling population: a claims data based observational study. BMC Health Serv Res. 2015;15:23.CrossRefPubMedPubMedCentral
8.
Garin N, Olaya B, Moneta MV, Miret M, Lobo A, Ayuso-Mateos JL, et al. Impact of multimorbidity on disability and quality of life in the Spanish older population. PLoS One. 2014;9(11):e111498.CrossRefPubMedPubMedCentral
9.
Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA. Health-related quality of life and healthcare utilization in multimorbidity: results of a cross-sectional survey. Qual Life Res. 2013;22(4):791–9.CrossRefPubMed
10.
Marventano S, Ayala A, Gonzalez N, Rodriguez-Blazquez C, Garcia-Gutierrez S, Forjaz MJ, et al. Multimorbidity and functional status in community-dwelling older adults. Eur J Intern Med. 2014;25(7):610–6.CrossRefPubMed
11.
Rauch A, Cieza A, Stucki G. How to apply the international classification of functioning, disability and health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil Med. 2008;44(3):329–42.PubMed
12.
Laan W, Bleijenberg N, Drubbel I, Numans ME, de Wit NJ, Schuurmans MJ. Factors associated with increasing functional decline in multimorbid independently living older people. Maturitas. 2013;75(3):276–81.CrossRefPubMed
13.
Piernik-Yoder B, Ketchum N. Rehabilitation outcomes of stroke patients with and without diabetes. Arch Phys Med Rehabil. 2013;94(8):1508–12.CrossRefPubMed
14.
den Ouden ME, Schuurmans MJ, Mueller-Schotte S, Brand JS, van der Schouw YT. Domains contributing to disability in activities of daily living. J Am Med Dir Assoc. 2013;14(1):18–24.CrossRef
15.
Fried LP, Guralnik JM. Disability in older adults: evidence regarding significance, etiology, and risk. J Am Geriatr Soc. 1997;45(1):92–100.CrossRefPubMed
16.
Fried LP, Bandeen-Roche K, Kasper JD, Guralnik JM. Association of comorbidity with disability in older women: the Women’s health and aging study. J Clin Epidemiol. 1999;52(1):27–37.CrossRefPubMed
17.
Koroukian SM, Warner DF, Owusu C, Given CW. Multimorbidity redefined: prospective health outcomes and the cumulative effect of co-occurring conditions. Prev Chronic Dis. 2015;12:E55.PubMedPubMedCentral
18.
Wang HH, Wang JJ, Wong SY, Wong MC, Li FJ, Wang PX, et al. Epidemiology of multimorbidity in China and implications for the healthcare system: cross-sectional survey among 162,464 community household residents in southern China. BMC Med. 2014;12:188.CrossRefPubMedPubMedCentral
19.
Yoo KB, Park EC, Jang SY, Kwon JA, Kim SJ, Cho KH, et al. Association between employment status change and depression in Korean adults. BMJ Open. 2016;6(3):e008570.CrossRefPubMedPubMedCentral
20.
21.
Smith AW, Reeve BB, Bellizzi KM, Harlan LC, Klabunde CN, Amsellem M, et al. Cancer, comorbidities, and health-related quality of life of older adults. Health Care Financ Rev. 2008;29(4):41–56.PubMedPubMedCentral
22.
Abhaya G, Almas R. Measurement scales used in elderly care. 1st ed. Boca Raton: CRC Press; 2008.
23.
Long WB, Sacco WJ, Coombes SS, Copes WS, Bullock A, Melville JK. Determining normative standards for functional independence measure transitions in rehabilitation. Arch Phys Med Rehabil. 1994;75(2):144–8.PubMed
24.
Schafer I, von Leitner EC, Schon G, Koller D, Hansen H, Kolonko T, et al. Multimorbidity patterns in the elderly: a new approach of disease clustering identifies complex interrelations between chronic conditions. PLoS One. 2010;5(12):e15941.CrossRefPubMedPubMedCentral
25.
Hinkle JL, McClaran J, Davies J, Ng D. Reliability and validity of the adult alpha functional independence measure instruments in England. J Neurosici Nurs. 2010;42(1):12–8.CrossRef
26.
Ottenbacher KJ, Mann WC, Granger CV, Tomita M, Hurren D, Charvat B. Inter-rater agreement and stability of functional assessment in the community-based elderly. Arch Phys Med Rehabil. 1994;75(12):1297–301.PubMed
27.
Hu X, Huang J, Lv Y, Li G, Peng X. Status of prevalence study on multimorbidity of chronic disease in China: systematic review. Geriatr Gerontol Int. 2015;15(1):1–10.CrossRefPubMed
28.
Agur K, McLean G, Hunt K, Guthrie B, Mercer SW. How does sex influence multimorbidity? secondary analysis of a large nationally representative dataset. Int J Environ Res Public Health. 2016;13(4):391.CrossRefPubMedPubMedCentral
29.
30.
Finkelstein JS, Brockwell SE, Mehta V, Greendale GA, Sowers MR, Ettinger B, et al. Bone mineral density changes during the menopause transition in a multiethnic cohort of women. J Clin Endocrinol Metab. 2008;93(3):861–8.CrossRefPubMed
31.
Abramson BL, Melvin RG. Cardiovascular risk in women: focus on hypertension. Can J Cardiol. 2014;30(5):553–9.CrossRefPubMed
32.
Rodrigues MA, Facchini LA, Thume E, Maia F. Gender and incidence of functional disability in the elderly: a systematic review. Cad Saude Publica. 2009;25 Suppl 3:S464–76.CrossRefPubMed
33.
CostaeSilva Mdo D, Guimaraes HA, Trindade Filho EM, Andreoni S, Ramos LR. Factors associated with functional loss in the elderly living in the city of Maceio, Northeastern Brazil. Rev Saude Publica. 2011;45(6):1137–44.CrossRef
34.
Nagarkar A, Kashikar Y. Predictors of functional disability with focus on activities of daily living: a community based follow-up study in older adults in India. Arch Gerontol Geriatr. 2017;69:151–5.CrossRefPubMed
35.
Alexandre Tda S, Corona LP, Nunes DP, Santos JL, Duarte YA, Lebrao ML. Gender differences in incidence and determinants of disability in activities of daily living among elderly individuals: SABE study. Arch Gerontol Geriatr. 2012;55(2):431–7.CrossRefPubMed
36.
Nascimento Cde M, Ribeiro AQ, Cotta RM, Acurcio Fde A, Peixoto SV, Priore SE, et al. Factors associated with functional ability in Brazilian elderly. Arch Gerontol Geriatr. 2012;54(2):e89–94.CrossRefPubMed
37.
Li D, Lv J, Liu F, Liu P, Yang X, Feng Y, et al. Hypertension burden and control in mainland China: analysis of nationwide data 2003–2012. Int J Cardiol. 2015;184:637–44.CrossRefPubMed
38.
39.
Kokubo Y, Matsumoto C. Hypertension Is a Risk Factor for Several Types of Heart Disease: Review of Prospective Studies. Adv Exp Med Biol. 2016. doi:10.​1007/​5584_​2016_​99.
40.
Chamberlain AM, St Sauver JL, Gerber Y, Manemann SM, Boyd CM, Dunlay SM, et al. Multimorbidity in heart failure: a community perspective. Am J Med. 2015;128(1):38–45.CrossRefPubMed
41.
Olsen RB, Bruehl S, Nielsen CS, Rosseland LA, Eggen AE, Stubhaug A. Hypertension prevalence and diminished blood pressure-related hypoalgesia in individuals reporting chronic pain in a general population: the Tromso study. Pain. 2013;154(2):257–62.CrossRefPubMed
42.
Nunes BP, Camargo-Figuera FA, Guttier M, de Oliveira PD, Munhoz TN, Matijasevich A, et al. Multimorbidity in adults from a southern Brazilian city: occurrence and patterns. Int J Public Health. 2016;61(9):1013–20.CrossRefPubMed
43.
Kirchberger I, Meisinger C, Heier M, Zimmermann AK, Thorand B, Autenrieth CS, et al. Patterns of multimorbidity in the aged population. Results from the KORA-Age study. PLoS One. 2012;7(1):e30556.CrossRefPubMedPubMedCentral
44.
Komatsu M, Nezu S, Tomioka K, Hazaki K, Harano A, Morikawa M, et al. Factors associated with activities of daily living (ADL) in independently living elderly persons in a community: a baseline examination of a large scale cohort study, Fujiwara-kyo study. Nihon Eiseigaku Zasshi. 2013;68(1):22–32.CrossRefPubMed
45.
Krein SL, Heisler M, Piette JD, Butchart A, Kerr EA. Overcoming the influence of chronic pain on older patients’ difficulty with recommended self-management activities. Gerontologist. 2007;47(1):61–8.CrossRefPubMed
46.
Connolly D, Garvey J, McKee G. Factors associated with ADL/IADL disability in community dwelling older adults in the Irish longitudinal study on ageing (TILDA). Disabil Rehabil. 2017;39(8):809–16.
47.
Wang ZH, Wang LH, Li YC, Zhang M, Hu N, Wang LM. Current status of diabetes, hypertension and dyslipidemia among older Chinese adults in 2010. Zhonghua Yu Fang Yi Xue Za Zhi. 2012;46(10):922–6.PubMed
48.
Tseng LN, Tseng YH, Jiang YD, Chang CH, Chung CH, Lin BJ, et al. Prevalence of hypertension and dyslipidemia and their associations with micro- and macrovascular diseases in patients with diabetes in Taiwan: an analysis of nationwide data for 2000–2009. J Formos Med Assoc. 2012;111(11):625–36.CrossRefPubMed
49.
Lu J, Wang L, Li M, Xu Y, Jiang Y, Wang W, et al. Metabolic Syndrome among Adults in China - The 2010 China Noncommunicable Disease Surveillance. J Clin Endocrinol Metab.2017;102(2):507–15.
Metadata
Title
Multimorbidity associated with functional independence among community-dwelling older people: a cross-sectional study in Southern China
Authors
Xiao-Xiao Wang
Wei-Quan Lin
Xu-Jia Chen
Ying-Yu Lin
Ling-Ling Huang
Sheng-Chao Zhang
Pei-Xi Wang
Publication date
01-01-2017
Publisher
BioMed Central
Published in
Health and Quality of Life Outcomes / Issue 1/2017
Electronic ISSN: 1477-7525
DOI
https://doi.org/10.1186/s12955-017-0635-7

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