Original Article
Coexisting chronic conditions in the older population: Variation by health indicators

https://doi.org/10.1016/j.ejim.2016.02.014Get rights and content

Highlights

  • There is variability in the indicators used to describe health in older persons.

  • Multimorbidity, polypharmacy, comorbidity index and complex problems were described.

  • 40% of people 60 + years did not meet the criteria for any of the 4 health indicators.

  • Among the others, prevalence of chronic conditions varied greatly by indicator used.

  • Different indicators are needed to capture health complexity in older adults.

Abstract

Background

This study analyzes the prevalence and patterns of coexisting chronic conditions in older adults.

Design

Cross-sectional.

Participant and setting

A sample of 3363 people ≥ 60 years living in Stockholm were examined from March 2001 through August 2004.

Measurements

Chronic conditions were measured with: 1) multimorbidity (≥ 2 concurrent chronic diseases); 2) the Cumulative Illness Rating Scale, 3) polypharmacy (≥ 5 prescribed drugs), and 4) complex health problems (chronic diseases and/or symptoms along with cognitive and/or functional limitations).

Results

A total of 55.6% of 60–74 year olds and 13.4% of those ≥ 85 years did not have chronic conditions according to the four indicators. Multimorbidity and polypharmacy were the most prevalent indicators: 38% aged 60–74 and 76% aged ≥ 85 had multimorbidity; 24.3% aged 60–74 and 59% aged ≥ 85 had polypharmacy. Prevalence of chronic conditions as indicated by the comorbidity index and complex health problems ranged from 16.5% and 1.5% in the 60–74 year olds to 38% and 36% in the 85 + year olds, respectively. Prevalence of participants with 4 indicators was low, varying from 1.6% in those aged 60–74 to 14.9% in those aged ≥ 85 years. Older age was associated with higher odds of each of the 4 indicators; being a woman, with all indicators but multimorbidity; and lower educational level, only with complex health problems.

Conclusions

Prevalence of coexisting chronic conditions varies greatly by health indicator used. Variation increases when age, sex, and educational level are taken into account. These findings underscore the need of different indicators to capture health complexity in older adults.

Introduction

Despite 30 years of intensive research in the field of geriatrics, it is only in the last few years that clinicians and health care planners have started to consider the need for a “geriatric approach” when examining the health status of older adults [1]. Health care systems are currently challenged by the increasing number of people over 65 years and the aging of older populations, and the challenge will grow in coming decades. Because of the high prevalence of chronic disorders in those of advanced age, older people are already the main users of health care services and account for the majority of health care spending [2], [3]. For these reasons, promoting health, preventing diseases and disability, and optimizing care have become major goals in most industrialized countries. To achieve these goals, we need to develop instruments that can help researchers and clinicians capture the complexity of health status in older people [4].

Researchers have found that the main characteristics of older people's health are a high prevalence of disabling chronic diseases (such as heart failure, stroke, and dementia) and the co-occurrence of such chronic diseases in the same person [5], [6]. To date, studies have used a variety of indicators to describe the multiple health problems of older people; indicators have been chosen on the basis of the studies' aims, the information available, and the sample setting. We have identified 4 health indicators that have been frequently used in epidemiological, clinical, or care science research [6]: multimorbidity, polypharmacy, cumulative indexes, and complex health problems. Multimorbidity is characterized by the concurrent presence of chronic diseases. This definition is mostly used in epidemiological studies and includes both individuals who, with the help of medications, may live relatively unaffected by disease burden and those who face severe functional loss. Multimorbidity was recently recognized as the “most common chronic condition in the elderly” [7]. Polypharmacy, defined on the basis of the number of drugs a person uses, has also been used as a good indicator of coexisting chronic diseases. Like those with multimorbidity, people with polypharmacy may live independently and actively or may be affected by severe and disabling conditions. Cumulative indices, on the other hand, evaluate both the number and severity of coexisting chronic conditions. These indices have mainly been used in clinical studies that aimed to identify people at risk for adverse health outcomes and who might benefit from specific interventions. The most commonly used indices are the Charlson Comorbidity Index [8], the Index of Coexistent Diseases [9], and the Cumulative Illness Rating Scale [10]. Finally, Meinow et al. have proposed an indicator of complex health problems that takes into account not only the cumulative effect of coexisting diseases, but also other factors, such as somatic symptoms and cognitive and/or functional impairment. This indicator has mainly been used to identify older people who need not only medical, but also social services, usually provided by a number of health care professionals [11].

Given the large variability in the indicators used to describe the coexistence of chronic conditions, we applied 4 indicators to the same community-based population, aged 60 years and over, to 1) estimate the prevalence of coexisting chronic conditions in older adults and 2) verify to the extent to which the different indicators overlap or identify people of different health statuses and consequently different health care needs.

Section snippets

Study population

The study population was drawn from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K). SNAC-K is one of 4 subprojects in a national survey established by the Swedish Ministry for Social Affairs that aims to monitor and evaluate the eldercare system in Sweden [12]. The study population consists of a random sample of people 60 years and older living at home and in institutions in the Kungholmen area of central Stockholm. Baseline examinations were carried out from March 2001

Results

The study population consisted of 3155 people. The majority were women (64.3%; 95%CI 62.7–66.0). The youngest participants were 60 years old, and the oldest was 104. The distribution of age, sex, and level of education is reported in Table 1. More than 80% of the population had a high school or university education. On average, the women were older than the men (75.9 vs. 71.7 years, p < 0.001), and more women than men had a low level (2–7 years) of education (18.8% vs. 14.3%, p < 0.001).

Almost 40% of

Discussion

The major findings of this study highlight the heterogeneity of the health status of older adults and the need to use multiple indicators to better identify people with different medical and care needs. However, it is important to note that a large proportion (almost 40%) of people 60 + years do not meet the criteria for any of the 4 health indicators. This suggests that a large proportion of older adults still have good health, as they are affected at most by 1 chronic disease of slight/moderate

Sponsor's role

The funders had no role in the study design, the data collection and analysis, the decision to publish, or the preparation of the manuscript.

The Swedish National study on Aging and Care, SNAC (www.snac.org) is financially supported by the Ministry of Health and Social Affairs, Sweden, (Regeringsbeslut 2015-03-19) the participating County Councils and Municipalities, and the Swedish Research Council (VR) (521-2013-8676). In addition, this study was supported by specific grants from the Swedish

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgments

The authors do not have any conflict of interest to disclose.

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