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multimorbidity older persons

Angela Koverech, Valeriano Soldati, Vittoria Polidori, Leda Marina Pomes, Luana Lionetto, Matilde Capi, Andrea Negro, Maurizio Simmaco, Paolo Martelletti
The ageing of the world population has resulted in an increase in the number of older patients with multimorbid conditions receiving multiple therapies. This emerging clinical scenario poses new challenges, which are mostly related to the increased incidence of adverse effects. This translates into poor clinical care, reduced cost-effectiveness of drug therapies, and social isolation of multimorbid patients due to reduced autonomy. A strategy to address these emerging challenges could involve the personalization of therapies based on the clinical, molecular, and genetic characterization of multimorbid patients...
August 2, 2018: International Journal of Environmental Research and Public Health
Norlela Mohd Hussin, Suzana Shahar, Normah Che Din, Devinder Kaur Ajit Singh, Ai-Vyrn Chin, Rosdinom Razali, Mohd Azahadi Omar
BACKGROUND: Multimorbidity in older adults needs to be assessed as it is a risk factor for disability, cognitive decline, and mortality. AIMS: A community-based longitudinal study was performed to determine the incidence and to identify possible predictors of multimorbidity among multiethnic older adults population in Malaysia. METHODS: Comprehensive interview-based questionnaires were administered among 729 participants aged 60 years and above...
July 30, 2018: Aging Clinical and Experimental Research
Iñaki Martín Lesende, Luis Ignacio Mendibil Crespo, Sonia Castaño Manzanares, Anne-Sophie Denise Otter, Irati Garaizar Bilbao, Jakobe Pisón Rodríguez, Ion Negrete Pérez, Iraide Sarduy Azcoaga, María Jesús de la Rua Fernández
OBJECTIVE: To analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity. DESIGN AND SETTING: Prospective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals. PARTICIPANTS: Of the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by 'Adjusted Clinical Groups') and 86 were newly included (patients who met Ollero's criteria and with ≥1 hospital admission the previous year)...
July 28, 2018: BMJ Open
Amelie Lindh Mazya, Peter Garvin, Anne W Ekdahl
BACKGROUND: Multimorbidity and frailty are often associated and Comprehensive Geriatric Assessment (CGA) is considered the gold standard of care for these patients. AIMS: This study aimed to evaluate the effect of outpatient Comprehensive Geriatric Assessment (CGA) on frailty in community-dwelling older people with multimorbidity and high health care utilization. METHODS: The Ambulatory Geriatric Assessment-Frailty Intervention Trial (AGe-FIT) was a randomized controlled trial (intervention group, n = 208, control group n = 174) with a follow-up period of 24 months...
July 23, 2018: Aging Clinical and Experimental Research
Luke Mondor, Deborah Cohen, Anum Irfan Khan, Walter P Wodchis
BACKGROUND: The burden of multimorbidity is a growing clinical and health system problem that is known to be associated with socioeconomic status, yet our understanding of the underlying determinants of inequalities in multimorbidity and longitudinal trends in measured disparities remains limited. METHODS: We included all adult respondents from four cycles of the Canadian Community Health Survey (CCHS) (between 2005 to 2011/12), linked at the individual-level to health administrative data in Ontario, Canada (pooled n = 113,627)...
June 26, 2018: International Journal for Equity in Health
Sophie C E van Blijswijk, Jeanet W Blom, Anton J M de Craen, Wendy P J den Elzen, Jacobijn Gussekloo
BACKGROUND: A first step to offer community-dwelling older persons proactive care is to identify those at risk of functional decline within a year. This study investigates the predictive value of registered information, questionnaire and GP-opinion on functional decline. METHODS: In this cohort study, embedded within the ISCOPE-trial, participants (≥75 years) completed the ISCOPE-screening questionnaire on four health domains. GPs gave their opinion on vulnerability of participants...
June 11, 2018: BMC Geriatrics
V I Starodubov, A N Edeleva, T P Sabgayda
The article compares the prevalence of pathological changes in different organs and systems among city and rural residents of the next ages: elderly (60-74 years for men and 55-74 years for women), senile (75-84 years) and advanced (85 years and older) ages. The results of the continuous survey of all persons of the retirement age of one urban (7 809 people) and two rural areas (14 749) of the Nizhny Novgorod region were analyzed. The region is comparatively homogeneous in terms of the national composition of the population...
2018: Advances in Gerontology, Uspekhi Gerontologii
Catia Cillóniz, Diana Rodríguez-Hurtado, Antoni Torres
Community-acquired pneumonia (CAP) can occur at any time of life, but its incidence and risk of death are linked to increasing age. CAP in the elderly is a major health problem associated with high rates of readmission, morbidity, and mortality. Since the clinical presentation of pneumonia in the elderly may be atypical, clinicians should suspect pneumonia in older patients presenting symptoms such as falls and altered mental status, fatigue, lethargy, delirium, anorexia, in order to avoid the complications associated with delayed diagnosis and therapy...
April 30, 2018: Medical Sciences: Open Access Journal
Stéphane Deparis, Alessandra Pascale, Pierpaolo Tommasi, Spyros Kotoulas
This paper describes an application of Bayesian Networks to mo-del persons with multimorbidity using measurements of vital signs and lifestyle assessments. The model was developed as part of a project on the use of wearable and home sensors and tablet applications to help persons with multimorbidity and their carers manage their conditions in daily life. The training data was extracted from TILDA, an open dataset collected from a longitudinal health study of the older Irish population. A categorical BN structure was learnt using a score-based approach, with constraints on the ordering of variables...
2018: Studies in Health Technology and Informatics
Gokce Banu Laleci Erturkmen, Mustafa Yuksel, Bunyamin Sarigul, Mikael Lilja, Rong Chen, Theodoros N Arvanitis
Older age is associated with an increased accumulation of multiple chronic conditions. The clinical management of patients suffering from multiple chronic conditions is very complex, disconnected and time-consuming with the traditional care settings. Integrated care is a means to address the growing demand for improved patient experience and health outcomes of multimorbid and long-term care patients. Care planning is a prevalent approach of integrated care, where the aim is to deliver more personalized and targeted care creating shared care plans by clearly articulating the role of each provider and patient in the care process...
2018: Studies in Health Technology and Informatics
Gustavo Daniel Lopardo, Diego Fridman, Enrique Raimondo, Henry Albornoz, Ana Lopardo, Homero Bagnulo, Daniel Goleniuk, Manuelita Sanabria, Daniel Stamboulian
OBJECTIVE: To determine the incidence rate and mortality of community-acquired pneumonia (CAP) in adults in three cities in Latin America during a 3-year period. DESIGN: Prospective population-based surveillance study. SETTING: Healthcare facilities (outpatient centres and hospitals) in the cities of General Roca (Argentina), Rivera (Uruguay) and Concepción (Paraguay). PARTICIPANTS: 2302 adults aged 18 years and older with CAP were prospectively enrolled between January 2012 and March 2015...
April 10, 2018: BMJ Open
Jori Fleisher, William Barbosa, Meghan M Sweeney, Sarah E Oyler, Amy C Lemen, Arash Fazl, Mia Ko, Talia Meisel, Naomi Friede, Geraldine Dacpano, Rebecca M Gilbert, Alessandro Di Rocco, Joshua Chodosh
Parkinson's disease (PD) is a complex, multisymptom, neurodegenerative disease affecting primarily older adults. With progression, many individuals become homebound and removed from coordinated, expert care, resulting in excess morbidity, mortality, and healthcare expenditures in acute care settings and institutions. Home visit care models have achieved the triple aim of improving individual and population health while reducing costs in many frail, community-dwelling geriatric cohorts. This study details a novel, interdisciplinary home visit program specifically designed for individuals with PD and related disorders and their family caregivers built upon best practice principles in the care of multimorbid older adults...
April 2, 2018: Journal of the American Geriatrics Society
Aleksandra Jarling, Ingela Rydström, Marie Ernsth-Bravell, Maria Nyström, Ann-Charlotte Dalheim-Englund
AIM AND OBJECTIVE: To describe the meaning of the phenomenon home care from the perspective of older persons who live alone with multimorbidity. BACKGROUND: In line with worldwide changing demographics, conditions for older people in need of home care are changing. In Sweden there is a stay-in-place policy and older people are expected to live and be cared for in their own home as long as possible. Home care, instituted by different laws, is a challenge affecting the older person when the private home becomes a workplace...
March 30, 2018: International Journal of Older People Nursing
Janko Janković, Sladjana Šiljak, Jelena Marinković, Bojan Kovač, Slavenka Janković
This study aimed to assess possible differences in health services utilization among people living with noncommunicable diseases (NCDs) in the Republic of Srpska (RS), Bosnia and Herzegovina, with special reference to NCD multimorbidity. In addition, the relationship between self-perceived health and health care utilization was assessed. Data were retrieved from the 2010 National Health Survey. A cross-sectional study design was used. A total of 4,673 persons aged 18 years and older were identified in the households, of which 4,128 were interviewed...
January 1, 2018: International Journal of Health Services: Planning, Administration, Evaluation
David O Riordan, Carole Elodie Aubert, Kieran A Walsh, Anette Van Dorland, Nicolas Rodondi, Robert S Du Puy, Rosalinde K E Poortvliet, Jacobijn Gussekloo, Carol Sinnott, Stephen Byrne, Rose Galvin, J Wouter Jukema, Simon P Mooijaart, Christine Baumgartner, Vera McCarthy, Elaine K Walsh, Tinh-Hai Collet, Olaf M Dekkers, Manuel R Blum, Patricia M Kearney
OBJECTIVES: To estimate and compare the prevalence and type of potentially inappropriate prescribing (PIP) and potential prescribing omissions (PPOs) among community-dwelling older adults (≥65 years) enrolled to a clinical trial in three European countries. DESIGN: A secondary analysis of the Thyroid Hormone Replacement for Subclinical Hypothyroidism Trial dataset. PARTICIPANTS: A subset of 48/80 PIP and 22/34 PPOs indicators from the Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment (STOPP/START) V2 criteria were applied to prescribed medication data for 532/737 trial participants in Ireland, Switzerland and the Netherlands...
March 22, 2018: BMJ Open
Jochanan E Naschitz
Guidelines of arterial hypertension treatment based on individualised expected outcomes are not available for frail older persons. In this paper, we review the evidence, concerning management of arterial blood pressure (BP) in frail older patients. We focused on the best affordable methods for BP measurement; the age-related optimum BP; specific BP goals in agreement with the patients' general heath, frailty status, orthostatic and postprandial hypotension; balancing the benefits against risks of antihypertensive treatment...
June 2018: Postgraduate Medical Journal
Manasi Murthy Mittinty, Amy Marshall, Gillian Harvey
INTRODUCTION: According to the 2013 WHO Global Forum on Innovation for Ageing Populations, disabilities and morbidities associated with ageing could be minimised by accessing preventive care. One way of improving the management of multimorbidity in the older population is through the provision of 'integrated care'. Although integrated care means different things to different people, it typically symbolises continuity in care, thus preventing older patients' from falling through gaps in the health care system...
March 8, 2018: BMJ Open
Inge Renne, Robbert Jj Gobbens
Objective: The aim of this cross-sectional study was to determine the associations between frailty and multimorbidity on the one hand and quality of life on the other in community-dwelling older people. Methods: A questionnaire was sent to all people aged 70 years and older belonging to a general practice in the Netherlands; 241 persons completed the questionnaire (response rate 47.5%). For determining multimorbidity, nine chronic diseases were examined by self-report...
2018: Clinical Interventions in Aging
Rafael Aguiar Maciel, Helena Moreira Klück, Madeleine Durand, Eduardo Sprinz
OBJECTIVES: At present, data are limited on the comorbidity profiles associated with aging people with HIV in the developing world, where most such people live. The aim of this study was to compare the disease burden between older HIV-positive subjects and HIV-negative matched controls in Brazil. METHODS: This was a cross-sectional analysis of the South Brazilian HIV Cohort. Individuals aged 50 years and older were enrolled at Hospital de Clínicas de Porto Alegre and matched with HIV-negative controls from the primary practice unit of the same hospital...
May 2018: International Journal of Infectious Diseases: IJID
Su Miin Ong, Yvonne Mei Fong Lim, Sheamini Sivasampu, Ee Ming Khoo
BACKGROUND: Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics...
February 23, 2018: BMC Geriatrics
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