Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway

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Abstract

Background

With increasing age, having multiple chronic conditions is the norm. It is of importance to study how co-existence of diseases affects functioning and mortality among older persons. Complex multimorbidity may be defined as three or more conditions affecting at least three different organ systems. The aim of this study was to investigate how complex multimorbidity affects activities of daily living and mortality amongst older Norwegians.

Methods

Participants were 60–69-year-olds at baseline in the Nord-Trøndelag Health Study 1995-1997 (HUNT2) n = 9058. Multinomial logistic regression models were used to investigate the association between complex multimorbidity in HUNT2, basic and instrumental activities of daily living in HUNT3 (2006–2008) and mortality during follow-up ( n = 5819/5836). Risk ratios (RR) and risk differences (RD) in percentage points (pp) with 95% confidence intervals (CI) were reported.

Results

47.8% of 60–69-year-olds met the criteria of complex multimorbidity at baseline (HUNT2). Having complex multimorbidity was strongly associated with the need for assistance in IADL in HUNT3 11 years later (RR = 1.80 (1.58–2.04) and RD = 8.7 (6.8–10.5) pp) and moderately associated with mortality during the follow-up time (RR = 1.22 (1.12–1.33) and RD = 5.1 (2.9–7.3) pp). Complex multimorbidity was to a lesser extent associated with basic activities of daily living 11 years later (RR = 1.24 (0.85–1.83) and RD = 0.4 (− 0.3–1.1) pp).

Conclusions

This is the first study to show an association between complex multimorbidity and activities of daily living. Complex multimorbidity should receive more attention in order to prevent future disability amongst older persons.

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Most cited references 39

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The disablement process

Lois Verbrugge, Alan Jette (1994)

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Multimorbidity in older adults.

M Salive (2013)

Multimorbidity, the coexistence of 2 or more chronic conditions, has become prevalent among older adults as mortality rates have declined and the population has aged. We examined population-based administrative claims data indicating specific health service delivery to nearly 31 million Medicare fee-for-service beneficiaries for 15 prevalent chronic conditions. A total of 67% had multimorbidity, which increased with age, from 50% for persons under age 65 years to 62% for those aged 65-74 years and 81.5% for those aged ≥85 years. A systematic review identified 16 other prevalence studies conducted in community samples that included older adults, with median prevalence of 63% and a mode of 67%. Prevalence differences between studies are probably due to methodological biases; no studies were comparable. Key methodological issues arise from elements of the case definition, including type and number of chronic conditions included, ascertainment methods, and source population. Standardized methods for measuring multimorbidity are needed to enable public health surveillance and prevention. Multimorbidity is associated with elevated risk of death, disability, poor functional status, poor quality of life, and adverse drug events. Additional research is needed to develop an understanding of causal pathways and to further develop and test potential clinical and population interventions targeting multimorbidity. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2013.

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Is Open Access

Measuring population ageing: an analysis of the Global Burden of Disease Study 2017

Angela Y Chang, Vegard F. Skirbekk, Stefanos Tyrovolas … (2019)

Summary Background Traditional metrics for population health ageing tend not to differentiate between extending life expectancy and adding healthy years. A population ageing metric that reflects both longevity and health status, incorporates a comprehensive range of diseases, and allows for comparisons across countries and time is required to understand the progression of ageing and to inform policies. Methods Using the Global Burden of Diseases, Injuries, and Risk Factors Study 2017, we developed a metric that reflects age-related morbidity and mortality at the population level. First, we identified a set of age-related diseases, defined as diseases with incidence rates among the adult population increasing quadratically with age, and measured their age-related burden, defined as the sum of disability-adjusted life-years (DALYs) of these diseases among adults. Second, we estimated age-standardised age-related health burden across 195 countries between 1990 and 2017. Using global average 65-year-olds as the reference population, we calculated the equivalent age in terms of age-related disease burden for all countries. Third, we analysed how the changes in age-related burden during the study period relate to different factors with a decomposition analysis. Finally, we describe how countries with similar levels of overall age-related burden experience different onsets of ageing. We represent the uncertainty of our estimates by calculating uncertainty intervals (UI) from 1000 draw-level estimates for each disease, country, year, and age. Findings 92 diseases were identified as age related, accounting for 51·3% (95% UI 48·5–53·9) of all global burden among adults in 2017. Across the Socio-demographic Index (SDI), the rate of age-related burden ranged from 137·8 DALYs (128·9–148·3) per 1000 adults in high SDI countries to 265·9 DALYs (251·0–280·1) in low SDI countries. The equivalent age to average 65-year-olds globally spanned from 76·1 years (75·6–76·7) in Japan to 45·6 years (42·6–48·2) in Papua New Guinea. Age-standardised age-related disease rates have decreased over time across all SDI levels and regions between 1990 and 2017, mainly due to decreases in age-related case fatality and disease severity. Even among countries with similar age-standardised death rates, large differences in the onset and patterns of accumulating age-related burden exist. Interpretation The new metric facilitates the shift from thinking not just about chronological age but the health status and disease severity of ageing populations. Our findings could provide inputs into policymaking by identifying key drivers of variation in the ageing burden and resources required for addressing the burden. Funding National Institute on Aging of the National Institutes of Health.

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Author and article information

Contributors

Siri H. Storeng:

ORCID: http://orcid.org/0000-0003-3637-3741

siri.h.storeng@ntnu.no

Journal

Journal ID (nlm-ta): BMC Geriatr

Journal ID (iso-abbrev): BMC Geriatr

Title: BMC Geriatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2318

Publication date (Electronic): 21 January 2020

Publication date PMC-release: 21 January 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 21

Affiliations

[1 ]ISNI 0000 0001 1516 2393, GRID grid.5947.f, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, , Norwegian University of Science and Technology, NTNU, ; Trondheim, Norway

[2 ]ISNI 0000 0001 1516 2393, GRID grid.5947.f, HUNT Research Centre, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, , Norwegian University of Science and Technology, ; NTNU, Levanger, Norway

[3 ]GRID grid.465487.c, Faculty of Nursing and Health Sciences, , Nord University, ; Levanger, Norway

[4 ]Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway

Author information

Siri H. Storeng http://orcid.org/0000-0003-3637-3741

Article

Publisher ID: 1425

DOI: 10.1186/s12877-020-1425-3

PMC ID: 6974981

PubMed ID: 31964341

SO-VID: 609b6ece-ee46-460e-b829-0d4221e54152

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 5 October 2019

Date accepted : 13 January 2020

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100009123, Norges Teknisk-Naturvitenskapelige Universitet;

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ScienceOpen disciplines: Geriatric medicine

Keywords: activities of daily living,aged,complex multimorbidity,hunt study,norway

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ScienceOpen disciplines: Geriatric medicine

Keywords: activities of daily living, aged, complex multimorbidity, hunt study, norway

Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: the HUNT Study, Norway

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Most cited references 39

The disablement process

Multimorbidity in older adults.

Measuring population ageing: an analysis of the Global Burden of Disease Study 2017

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