Study On Multimorbidity And It’s Association With Functional Status Among Community-dwelling Older People

ObjectivesThe present study aimed to investigate the prevalence of multimorbidity and the functional status among community-dwelling older adults aged 60 years and above,to analyze the multimorbidity patterns and explore how those multimorbidity patterns affect the functional status and so as to screen multimorbid patients at risk of losing functional independence,which in order to provide the scientific theoretical basis for the health intervention and prevention of patients with multimorbidity.MethodsBased on a cross-sectional community health surveys in Shenzhen,China,the sample of the study consisted of 2705 older adults,aged over 60 years old dwelling in the community.The general condition questionnaire(including the social demographic such as age,gender,marital status and health and lifestyle characteristics such as smoking,drinking,exercise),the information on chronic diseases(hypertension,chronic pain,diabetes mellitus,et al),physical examination(height,weight,et al)were extracted from the survey questionnaire.The Functional Independence Measure(FIM)was used to assess the functional status.Epi Data 3.1 was used to establish the database.SPSS 17.0 and SPSS Modeler 14.1 were applied to conduct the statistical analysis.Descriptive statistics were used to describe the general information data,the prevalence of chronic diseases and multimorbidity,and the scores of FIM.Means and standard deviations were calculated for continuous variables,whereas frequency and percentage were presented for categorical variables.Association rule based on the Apriori algorithm and exploratory factor analysis were performed to excavate the multimorbidity patterns.Chi-square and several non-conditional dichotomous logistic regression models were run in the study and used to explore the main factors influencing the functional status of the elderly people and the effects of different chronic disease multimorbidity patterns on the functional status.All the statistical tests were two-tailed,with the level of significance was set at 0.05.Results1.Of the total 2705 older adults,aged 60 years and above,with an average age of(69.24±7.58)years,1644 aged 60~69 years(60.8%),736 aged 70~79 years(27.2%)and 325 aged 80 years or above(12.0%);1131(41.8%)were men and 1574(58.2%)were women;2666(98.6%)were Han ethnic group;2074 participates(76.7%)got married;1401(51.8%)received an education of primary school or lower;133(4.9%)still were employed;1477(54.6%)reported good individual economic condition;361(13.3%)were smoker,387(14.3%)were drinker;1245(46.0%)had regular exercise.There were 1331(49.2%)older adults with normal body mass index.2.There were 1335 older adults with two or more chronic diseases and the prevalence of multimorbidity was 49.4%.Among them,44.0% had two chronic diseases,27.6% had three chronic diseases,15.0% had four chronic diseases and 13.7% had five or more chronic diseases.3.Based on the association rule analysis,the paired multimorbidity patterns including chronic pain and hypertension(13.3%),diabetes mellitus and hypertension(10.1%),hyperlipidemia and hypertension(8.5%),bone diseases and hypertension(7.4%),bone diseases and chronic pain(6.2%),heart diseases and hypertension(6.1%)and so on.Based on the factor analysis,we detected six multimorbidity groups,including bones and pain group(15.5%),neuropsychiatric-stroke group(0.5%),the cardiovascular and metabolic group(16.3%),lung and cancer group(1.4%),eyes-gallbladder-kidney diseases group(1.4%)and obesity-anxiety group(0.3%).4.Of the 2705 older adults,there were 225(8.3%)with functional dependence.The results of chi-square showed that the functional status of older adults had statistical difference in age,marital status,the education level,employment status,smoking,drinking,regular exercise and the number of chronic diseases(P<0.05).Multivariate logistic regression analysis showed that age,the education level,regular exercise and the number of chronic diseases independently predicted functional dependence in elderly people(P<0.05).5.Among the paired multimorbidity patterns based the association rule analysis,the results of univariate analysis showed that chronic pain and hypertension,diabetes mellitus and hypertension,bone diseases and hypertension,heart diseases and hypertension were the influential factors of functional dependence for older adults(P<0.05).Multivariate logistic regression analysis showed that only chronic pain and hypertension had an independent risk of functional dependence in elderly people(P=0.022).6.Among the multimorbidity groups based on factor analysis,the results of univariate analysis showed that neuropsychiatric-stroke group and obesity-anxiety group were the influential factors of functional dependence for older adults(P<0.05).Multivariate logistic regression analysis showed that only neuropsychiatric-stroke group had an independent risk of functional dependence in elderly people(P=0.007).Conclusions1.The prevalence of multimorbidity in older adults was high and the status of multimorbidity was not optimistic.2.The functional status of older adults was not good.High age and with two or more chronic diseases were the risk factors of functional dependency;high educational level and regular exercise were its protective factors.3.Among the paired multimorbidity patterns,chronic pain and hypertension were common,and identified as having a significant risk of functional dependence.Of the six multimorbidity groups,the bones and pain group as well as the cardiovascular and metabolic group were common,while neuropsychiatricstroke group was identified as having a significant risk of reduced functional independence.