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      Impact of Chronic Conditions and Multimorbidity on the Disability Burden in the Older Population in Belgium

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          Abstract

          The increase in longevity along with a high prevalence of chronic conditions contribute to increased disability burden. Despite the high occurrence of multimorbidity observed in advanced ages, most studies are restricted to the investigation of individual diseases. In this study, we assessed the impact of chronic conditions and multimorbidity on the disability burden in the older population in Belgium.

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          Multimorbidity and Comorbidity of Chronic Diseases among the Senior Australians: Prevalence and Patterns

          M Islam, José M. Valderas, Laurann Yen … (2014)
          Understanding patterns and identifying common clusters of chronic diseases may help policymakers, researchers, and clinicians to understand the needs of the care process better and potentially save both provider and patient time and cost. However, only limited research has been conducted in this area, and ambiguity remains as those limited previous studies used different approaches to identify common clusters and findings may vary with approaches. This study estimates the prevalence of common chronic diseases and examines co-occurrence of diseases using four approaches: (i) identification of the most occurring pairs and triplets of comorbid diseases; performing (ii) cluster analysis of diseases, (iii) principal component analysis, and (iv) latent class analysis. Data were collected using a questionnaire mailed to a cross-sectional sample of senior Australians, with 4574 responses. Eighty-two percent of respondents reported having at least one chronic disease and over 52% reported having at least two chronic diseases. Respondents suffering from any chronic diseases had an average of 2.4 comorbid diseases. Three defined groups of chronic diseases were identified: (i) asthma, bronchitis, arthritis, osteoporosis and depression; (ii) high blood pressure and diabetes; and (iii) cancer, with heart disease and stroke either making a separate group or “attaching” themselves to different groups in different analyses. The groups were largely consistent across the approaches. Stability and sensitivity analyses also supported the consistency of the groups. The consistency of the findings suggests there is co-occurrence of diseases beyond chance, and patterns of co-occurrence are important for clinicians, patients, policymakers and researchers. Further studies are needed to provide a strong evidence base to identify comorbid groups which would benefit from appropriate guidelines for the care and management of patients with particular disease clusters.
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            Assessing the validity of the Global Activity Limitation Indicator in fourteen European countries

            Nicolas Berger, Herman Van Oyen, Emmanuelle Cambois … (2015)
            Background The Global Activity Limitation Indicator (GALI), the measure underlying the European indicator Healthy Life Years (HLY), is widely used to compare population health across countries. However, the comparability of the item has been questioned. This study aims to further validate the GALI in the adult European population. Methods Data from the European Health Interview Survey (EHIS), covering 14 European countries and 152,787 individuals, were used to explore how the GALI was associated with other measures of disability and whether the GALI was consistent or reflected different disability situations in different countries. Results When considering each country separately or all combined, we found that the GALI was significantly associated with measures of activities of daily living, instrumental activity of daily living, and functional limitations (P < 0.001 in all cases). Associations were largest for activity of daily living and lowest though still high for functional limitations. For each measure, the magnitude of the association was similar across most countries. Overall, however, the GALI differed significantly between countries in terms of how it reflected each of the three disability measures (P < 0.001 in all cases). We suspect cross-country differences in the results may be due to variations in: the implementation of the EHIS, the perception of functioning and limitations, and the understanding of the GALI question. Conclusion The study both confirms the relevance of this indicator to measure general activity limitations in the European population and the need for caution when comparing the level of the GALI from one country to another. Electronic supplementary material The online version of this article (doi:10.1186/1471-2288-15-1) contains supplementary material, which is available to authorized users.
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              Association of Diabetes, Comorbidities, and A1C With Functional Disability in Older Adults

              Rita Kalyani, Christopher Saudek, Frederick Brancati … (2010)
              OBJECTIVE To examine the relationship of diabetes and functional disability in older adults and the possible mediating roles of comorbidities and A1C. RESEARCH DESIGN AND METHODS We analyzed data from a nationally representative sample of 6,097 participants aged ≥60 years in the National Health and Nutrition Examination Survey, 1999–2006. Diabetes was defined by self-report. Disability was defined as difficulty performing a physical task. We evaluated disability by grouping 19 physical tasks into five functional groups: lower-extremity mobility (LEM), general physical activities (GPA), activities of daily living (ADL), instrumental activities of daily living (IADL), and leisure and social activities (LSA). RESULTS Older U.S. adults with diabetes had the greatest disability in GPA (prevalence 73.6% [95% CI 70.2–76.9]), followed by LEM (52.2% [48.5–55.9]), IADL (43.6% [40.1–47.2]), ADL (37.2% [33.1–41.3]), and LSA groups (33.8% [30.8–36.9]). Diabetes was associated with two to three times increased odds of disability across functional groups (all P 0.05). CONCLUSIONS Older adults with diabetes have a high prevalence of disabilities with variable associations attributable to comorbidities and A1C. Aggressive management of cardiovascular risk factors and obesity may significantly reduce the burden of disability in this population.
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                Author and article information

                Journal
                Title: The Journals of Gerontology Series A: Biological Sciences and Medical Sciences
                Abbreviated Title: GERONA
                Publisher: Oxford University Press (OUP)
                ISSN (Print): 1079-5006
                ISSN (Electronic): 1758-535X
                Publication date Created: June 14 2016
                Publication date Created: July 2016
                Publication date (Print): July 2016
                Publication date (Electronic): January 16 2016
                Volume: 71
                Issue: 7
                Pages: 903-909
                Article
                DOI: 10.1093/gerona/glv234
                PubMed ID: 26774118
                SO-VID: daff5aec-e188-4be2-b0e3-5b33fe4787fd
                Copyright © © 2016
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