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)