Multimorbidity,
disability and QoL
in older adultsVilnius, Nov 7th 2014
M. João Forjaz, Carmen Rodriguez Blázquez
Institute of Health Carlos III, Spain
This presentation arises from the Joint Action addressing chronic diseases and healthy ageing across the life cycle
(JA-CHRODIS) which has received funding from the European Union, under the framework of the Health Programme
(2008-2013).
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M. João Forjaz
Carmen Rodriguez-Blazquez
Alba Ayala
Jesús de Pedro
Vicente Rodriguez
Nerea Gonzalez; Susana García
Alexandra Prado-Torres
Institute of Health Carlos III
Madrid, Spain
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A simple model
as starting point
Multimorbidity
(MM)
Quality of life
(QoL)
Disability
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Main goals
• What are the characteristics of older adults with
multimorbidity (MM)?
• In patients with MM, what is the impact of chronic health
conditions on QoL?
• What is the role of disability in the relationship between MM
and QoL?
• Methods:
– 5 databases in Spain
– Older adults (65+ years)
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Databases
Databasen
(total)n
(MM)
Data
collectionRepresentation
CadeViMa 862 705 2008 Nationally
Aragón 704 517 2008-2009 Disability study
ELES 707 443 2011 Nationally
Basque
country
2108 1492 2009-2010 Emergency
rooms
ENSE 5896 4995 2012 Nationally
Basque
country Aragón
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Chronic conditions
Conditions common to all
databases:
1. Osteoarticular
2. Asthma
3. Cardiac conditions
4. Diabetes
5. Hypertension (HT)
6. Cancer
7. Neuropsychiatric
conditions:
– Alzheimer’s disease
– Dementia
– Memory problems
– Schizophrenia
– Psychosis
– Mental health problems other
than anxiety and depression
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QoL and disability measures
CadeViMa Aragón ELES Basque C. ENSE
QoL EQ-5D-3L
PWI
EQ-5D-3L PWI SF-12
• physical
• mental
EQ-5D-5L
Disability Barthel
index
WHO-DAS Functional
ability (ad-
hoc measure)
Barthel
index
Functional
ability (ad-
hoc measure)
• EQ-5D, index (EuroQol Group, 1990).
• PWI: Personal Wellbeing Index (Cummins et al., 2006)
• WHO-DAS: World Health Organization Disability Assessment
Schedule 2.0 (WHO, 2010)
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Statistical analysis by database
• Inclusion criteria:
– Age: 65+ years
– Multimorbidity: 2+ chronic health conditions
• Descriptive statistics, prevalences.
• Logistic regression models for the group with “lower QoL”
• Control variables:
– Age
– Gender
– Interaction: Disability status x chronic health conditions
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Preliminary results
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Prevalence of multimorbidity
by database
79.0% 77.7%70.9%
74.2%
84.7%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CadeViMa Aragon ELES BasqueCountry
ENSE
No
Yes
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MM group:
Age (years) and sex (%)
75,16 78,81 74,22 81,07 75,7770,00
72,00
74,00
76,00
78,00
80,00
82,00
84,00
86,00
CadeViMa Aragón ELES BasqueCountry
ENSE
Mean
ag
e ±
SD
(years
)
39,5731,91
39,9
16,69
40,39
60,4368,09
60,1
83,31
59,61
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CadeViMa Aragón ELES BasqueCountry
ENSE
Men Women
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Nº health conditions (MM group)
4,23 3,20 4,08 4,10 5,702,00
3,00
4,00
5,00
6,00
7,00
CadeViMa Aragón ELES BasqueCountry
ENSE
Mean
±
SD
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Chronic health conditions:
Prevalences (%) in MM
0 10 20 30 40 50 60 70
Osteoarticular
Asthma
Cardiac
Diabetes
Hypertension
Cancer
Neuropsychiatric
ENSE Basque Country ELES Aragón CadeViMa
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Disability (%)
26,42
97,28
10
47,1651,25
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CadeViMa Aragón ELES Basque Country ENSE
No
Yes
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Lo
gis
tic r
eg
res
sio
ns
for
“lo
wer
Qo
L”
(OR) CadeViMa Aragón ELES Basque C. ENSE
QoL measure EQ-5D PWI EQ-5D PWI SF-12
physical
SF-12
mental
EQ-5D
Age 1.07 1.05 0.98 1.03
Sex (woman) 1.45 1.50 1.49
Disability 2.47 1.68 10.14 2.96 6.98 2.50 7.96
Osteoarticular 2.36 1.63 3.27
Asthma 2.38
Cardiac (n.a.) 1.35 1.60
Diabetes 1.61
Hypertension
Cancer 2.51
Neuropsychiatric 5.10 1.06 1.66 2.04 3.67
Disability*HT 0.29
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Next steps
• Refine regression models
• Explore interactions
• Write paper
ISCIII campus
Madrid, Spain
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The Joint Action on Chronic Diseases and promoting healthy ageing across the life cycle (JA-CHRODIS)*
* THIS PRESENTATION ARISES FROM THE JOINT ACTION ON
CHRONIC DISEASES AND PROMOTING HEALTHY AGEING
ACROSS THE LIFE CYCLE (JA-CHRODIS) WHICH HAS RECEIVED
FUNDING FROM THE EUROPEAN UNION, IN THE FRAMEWORK
OF THE HEALTH PROGRAMME (2008-2013)
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