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multimorbidity older persons

Sonal Singh, Susan Zieman, Alan S Go, Stephen P Fortmann, Nanette K Wenger, Jerome L Fleg, Barbara Radziszewska, Neil J Stone, Sophia Zoungas, Jerry H Gurwitz
OBJECTIVES: To determine the efficacy and safety of statins for primary prevention of atherosclerotic cardiovascular disease (ASCVD) events in older adults, especially those aged 80 and older and with multimorbidity. METHODS: The National Institute on Aging and the National Heart, Lung and Blood Institute convened A multidisciplinary expert panel from July 31 to August 1, 2017, to review existing evidence, identify knowledge gaps, and consider whether statin safety and efficacy data in persons aged 75 and older without ASCVD are sufficient; whether existing data can inform the feasibility, design, and implementation of future statin trials in older adults; and clinical trial options and designs to address knowledge gaps...
October 2, 2018: Journal of the American Geriatrics Society
Marie Todd
The population is ageing but many older people are living with chronic multimorbidity, which has a significant impact of all aspects of quality of life. Many of the common chronic conditions suffered by older people either precipitate or compound chronic oedema, which means a wide range of skills and in-depth knowledge is required to deliver holistic care that does not interfere with other treatment modalities. This patient group often presents with highly complex coexisting issues that require highly specialist assessment and management in collaboration with other professionals...
October 1, 2018: British Journal of Community Nursing
Kirsten Moore
Our successes in improving life expectancy has led to increased years of life lived with multimorbidity and dementia with increased support needs. Much of the support given to frail older people is provided by family and informal support networks with significant impact on their physical, psychological, and financial well-being. Demographic and societal changes are reducing the capacity of family to offer this care. Formal home-based, center-based, and long-term/residential/nursing home care services are predominately provided by untrained care staff working under supervision from nursing staff...
September 2018: International Psychogeriatrics
Carlotta M Jarach, Matteo Cesari
It is repeatedly advocated in the medical literature the need of reshaping the care process in order to better address the unmet clinical needs of the highly vulnerable and complex ageing population. In the past twenty years, frailty has assumed the role of an arising and independent geriatric condition, different from disability and multimorbidity. Frailty is highly prevalent in older persons. The proper management of frailty relies on the accurate collection and interpretation of a wide spectrum of information about the health status of the individual...
September 13, 2018: Minerva Medica
Irene G M Wijers, Alba Ayala, Carmen Rodriguez-Blazquez, Angel Rodriguez-Laso, Vicente Rodriguez-Rodriguez, Maria João Forjaz
Purpose of the Study: The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire in which participants rate the disease burden caused by a number of medical conditions. This paper studies the measurement properties of the DBMA, using Rasch analysis. Design and Methods: We used data of 1,400 community-dwelling adults aged 50 years and older participating in the Ageing in Spain Longitudinal Study, Pilot Survey (ELES-PS). Test of fit to the Rasch model, reliability, unidimensionality, response dependency, category structure, scale targeting, and differential item functioning (DIF) were studied in an iterative way...
September 14, 2018: Gerontologist
Alexandra B Ryborg Joensson, Ann Dorrit Guassora, Morten Freil, Susanne Reventlow
Objectives Adherence to treatment has proven to require the involvement of patients in treatment and care planning. This process involves incorporating patient knowledge, or knowledge about the patients' everyday life, into the clinical encounter. This article explores the disclosure practices of such knowledge from older adults with multimorbidity. Methods This was an 18-month qualitative study among 14 older adults with multimorbidity living in Denmark. A thematic analysis was applied, focusing on perceptions of patient knowledge and disclosure practices among the participating patients...
September 13, 2018: Chronic Illness
Jean Scholz Mellum, Donna S Martsolf, Greer Glazer, Barbara Tobias, Grant Martsolf
As the number of older adults with multimorbidity increases, care coordination programs are being designed to streamline the complex care older adults receive from multiple providers by improving health and reducing unnecessary costs. Well-coordinated care requires actions by both patients and providers. Yet little attention is paid to the what older adults do to manage their own care alongside a formal Care Coordination Program (CCP). This paper presents a qualitative descriptive study that explored what actions older adults took on their own to manage their care...
September 6, 2018: Geriatric Nursing
Maureen Markle-Reid, Jenny Ploeg, Ruta Valaitis, Wendy Duggleby, Kathryn Fisher, Kimberly Fraser, Rebecca Ganann, Lauren E Griffith, Andrea Gruneir, Carrie McAiney, Allison Williams
Background: The goal of the Aging, Community and Health Research Unit (ACHRU) is to promote optimal aging at home for older adults with multimorbidity (≥2 chronic conditions) and to support their family/friend caregivers. This protocol paper reports the rationale and plan for this patient-oriented, cross-jurisdictional research program. Objectives: The objectives of the ACHRU research program are (i) to codesign integrated and person-centered interventions with older adults, family/friend caregivers, and providers; (ii) to examine the feasibility of newly designed interventions; (iii) to determine the intervention effectiveness on Triple Aim outcomes: health, patient/caregiver experience, and cost; (iv) to examine intervention context and implementation barriers and facilitators; (v) to use diverse integrated knowledge translation (IKT) strategies to engage knowledge users to support scalability and sustainability of effective interventions; and (vi) to build patient-oriented research capacity...
2018: Journal of Comorbidity
He Chen, Mengling Cheng, Yu Zhuang, Joanna B Broad
AIM: The knowledge on multimorbidity and its impact on healthcare systems is lacking in low- and middle-income countries. We aimed to estimate the prevalence of multimorbidity, and analyze the health service use of middle-aged and older persons with multimorbidity in urban China. METHODS: Study participants included 3737 urban residents aged ≥45 years from the China Health and Retirement Longitudinal Study 2011. A total of 16 pre-specified self-reported chronic conditions were used to measure multimorbidity, which was defined as having two or more conditions...
September 4, 2018: Geriatrics & Gerontology International
Quoc Dinh Nguyen, Chenkai Wu, Michelle C Odden, Dae Hyun Kim
Background: Frailty and multimorbidity are independent prognostic factors for mortality, but their interaction has not been fully explored. We investigated the importance of multimorbidity patterns in older adults with the same level of frailty phenotype. Methods: In a cohort of 7197 community-dwelling adults 65 years and older, physical frailty status (robust, pre-frail, frail) was defined using shrinking, exhaustion, inactivity, slowness, and weakness. Latent class analysis was used to identify individuals with multimorbidity patterns based on 10 self-reported chronic conditions...
August 31, 2018: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
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
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