Comorbidities of Physical and Psychiatric Syndromes in Later Life

2018 ◽  
Author(s):  
Lydia K. Manning ◽  
Lauren M. Bouchard ◽  
James L. Flanagan
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Negative Impact ◽  
Later Life ◽  
The Body ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Obstructive Pulmonary Disease ◽  
Complex Interactions

There is a great deal of concern about the increasing number of older adults who suffer from chronic disease. These conditions result in persistent health consequences and have an ongoing and long-term negative impact on people and their quality of life. Furthermore, the probability that a person will experience the onset of multiple chronic conditions, known as comorbidities, increases with age. Despite the prevalence of comorbidity in later life, scant research exists regarding specific patterns of disease and the co-occurrence and complex interactions of the chronic conditions most closely associated with aging. It is important to review the body of literature on comorbidities associated with physical and psychiatric syndromes in later life to gain an overview of some of the most commonly seen disorders in older adults: hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, arthritis, depression, and dementia. Specific patterns of disease and the co-occurrence and complex interactions of chronic conditions in later life are explored. In conclusion, we consider the need for a more informed understanding of comorbidity, as well as a related plan for addressing it.

scholarly journals 23Multiple Chronic Conditions: Need for Ongoing Research

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sangeeta Gupta
Keyword(s):  
Chronic Conditions ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Behavioral Risk ◽  
Obstructive Pulmonary Disease ◽  
Ongoing Research ◽  
The Public ◽  
Global Priority ◽  
Control And Prevention ◽  
Ongoing Surveillance

Abstract Background Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC. Methods Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke. Results More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent. Conclusions The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance. Key messages Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.

scholarly journals The Effects of Multiple Chronic Conditions on Adult Patient Readmissions and Hospital Finances: A Management Case Study

2017 ◽  
Vol 54 ◽  
pp. 004695801772959 ◽  
Author(s):  
Michael Mihailoff ◽  
Shreyasi Deb ◽  
James A. Lee ◽  
Joanne Lynn
Keyword(s):  
Chronic Conditions ◽  
Chronic Renal Disease ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
Average Patient ◽  
Patient Readmissions ◽  
Management Case Study

Medicare and other payers have launched initiatives to reduce hospital utilization, especially targeting readmissions within 30 days of discharge. Hospital managers have traditionally contended that hospitals would prosper better by ignoring the penalties for high readmission rates and keeping the beds more full. We aimed to test the financial effects of admissions and readmissions by persons with and without specified chronic conditions in one regional hospital. This is a management case study with a descriptive brief report. This study was conducted at Winchester Memorial Hospital, a general hospital in a largely rural area of Virginia, 2010-2015. The total margin per admission varied by diagnosis, with the average patient diagnosed with chronic obstructive pulmonary disease, heart failure, pneumonia, or chronic renal disease having negative margins. The largest per-patient losses were in diagnostic categories coinciding with the highest readmission rates. The margin declined into substantial losses with an increasing number of chronic conditions, which also corresponded with higher readmission rates. Patients with 5 or more clinical conditions had highest risk of readmission within 30 days (24.8%) and had an average total loss of $865 per admission in 2015. The adverse financial effects worsened between 2010 and 2015. This hospital might improve its finances by investing in strategies to reduce chronic illness hospitalizations, especially those with multiple chronic conditions and high risk of readmission. These findings counter the common claim that the hospital would do better to fill beds rather than to work on efficient utilization. Other hospitals could replicate these analyses to understand their situations.

scholarly journals Living with multimorbidity? The lived experience of multiple chronic conditions in later life

2019 ◽  
Vol 24 (6) ◽  
pp. 701-718 ◽  
Author(s):  
Tom Porter ◽  
Bie Nio Ong ◽  
Tom Sanders
Keyword(s):  
Older People ◽  
Lived Experience ◽  
Chronic Conditions ◽  
Later Life ◽  
Constructivist Grounded Theory ◽  
Multiple Chronic Conditions ◽  
Long Term Conditions ◽  
Depth Interviews ◽  
Multiple Conditions

Multimorbidity is defined biomedically as the co-existence of two or more long-term conditions in an individual. Globally, the number of people living with multiple conditions is increasing, posing stark challenges both to the clinical management of patients and the organisation of health systems. Qualitative literature has begun to address how concurrency affects the self-management of chronic conditions, and the concept of illness prioritisation predominates. In this article, we adopt a phenomenological lens to show how older people with multiple conditions experience illness. This UK study was qualitative and longitudinal in design. Sampling was purposive and drew upon an existing cohort study. In total, 15 older people living with multiple conditions took part in 27 in-depth interviews. The practical stages of analysis were guided by Constructivist Grounded Theory. We argue that the concept of multimorbidity as biomedically imagined has limited relevance to lived experience, while concurrency may also be erroneous. In response, we outline a lived experience of multiple chronic conditions in later life, which highlights differences between clinical and lay assumptions and makes the latter visible.

scholarly journals The Economic and Mental Health Impact of IAPT: Pragmatic Trial in Three English Regions

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
V Toffolutti ◽  
M McKee ◽  
D M Clark ◽  
D Stuckler
Keyword(s):  
Healthcare Utilization ◽  
Chronic Conditions ◽  
Pragmatic Trial ◽  
Health Impact ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Intention To Treat ◽  
Psychological Therapies ◽  
Cardio Vascular

Abstract Background Improving Access to Psychological Therapies (IAPT) programme is the English’s major initiative for treating anxiety and depression, currently provided to over 1 million people. We tested whether IAPT could reduce healthcare costs and improve employment in persons with long-term chronic conditions. Methods Stepped-wedge design of two cohorts covering 560 patients each with depression and/or anxiety and comorbid long-term physical health conditions, namely diabetes, chronic obstructive pulmonary disease (COPD) and cardio-vascular disease (CVD) from three areas in Thames Valley (Berkshire, Oxfordshire and Buckinghamshire) for the period March 2017 - August 2017. Panels were balanced. Difference-in-difference models were used and intention-to-treat analysis. Results Based on the step-wedge modelling, IAPT treatment decreased costs by £497 (95% CI: -£770 to -£224) total per person (pp) (from £1266 pp before starting the treatment to £768 pp since the treatment started)in the first 3 months. Results also showed a decrease by about 5.55 [95% CI: -6.35, -4.75] (-4.18 [95%CI: -4.91, -3.45]) points per person in the PHQ9 (GAD7). Our results show that IAPT increased the probability to an employment for those who were unemployment by about 7.92% (95% CI: 0.94% to 14.9%). Conclusions IAPT treatment significantly reduced healthcare utilization and costs among persons with chronic conditions. It also significantly increased the probability of employment. Key messages IAPT treatment significantly reduced healthcare utilization and costs among persons with chronic conditions. IAPT was significantly associated with increased probability to find employment for those unemployed.

scholarly journals 1165Multiple Chronic Conditions: Need for Ongoing Research

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sangeeta Gupta
Keyword(s):  
Chronic Conditions ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Behavioral Risk ◽  
Obstructive Pulmonary Disease ◽  
Ongoing Research ◽  
The Public ◽  
Global Priority ◽  
Control And Prevention ◽  
Ongoing Surveillance

Abstract Background Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC. Methods Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke. Results More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent. Conclusions The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance. Key messages Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.

Long-term conditions and severe acute respiratory syndrome SARS-CoV-2 (COVID-19)

2020 ◽  
Vol 25 (5) ◽  
pp. 247-251
Author(s):  
Patricia Robinson
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Nursing Care ◽  
Chronic Conditions ◽  
Severe Infection ◽  
Chronic Obstructive ◽  
Long Term Conditions ◽  
Protection Measures ◽  
Obstructive Pulmonary Disease ◽  
Increased Risk

Observation of infection trends through the course of the ongoing COVID-19 pandemic has indicated that those with certain pre-existing chronic conditions, such as hypertension, chronic obstructive pulmonary disease and obesity, are particularly likely to develop severe infection and experience disastrous sequelae, including near-fatal pneumonia. This article aims to outline how SARS-CoV-2 affects people and to consider why individuals living with long-term conditions are at increased risk from infection caused by this virus. A summary of available clinical guidelines with recommendations is presented, to provide community nurses with the up-to-date information required for protecting individuals living with a number of long-term conditions. Additionally, special measures required are outlined, so that community nurses may reflect on how to best provide nursing care for individuals living with long-term conditions and understand protection measures for individuals at increased risk from severe COVID-19.

scholarly journals ‘You learn to live with all the things that are wrong with you’: gender and the experience of multiple chronic conditions in later life

2012 ◽  
Vol 33 (2) ◽  
pp. 342-360 ◽  
Author(s):  
LAURA HURD CLARKE ◽  
ERICA BENNETT
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Later Life ◽  
Physical Symptoms ◽  
Multiple Chronic Conditions ◽  
Biographical Disruption ◽  
Masculine Norms ◽  
Loss Of Autonomy ◽  
And Gender ◽  
Depth Interviews

ABSTRACTThis article examines how older adults experience the physical and social realities of having multiple chronic conditions in later life. Drawing on data from in-depth interviews with 16 men and 19 women aged 73+ who had between three and 14 chronic conditions, we address the following research questions: (a) What is it like to have multiple chronic conditions in later life? (b) How do older men and women ‘learn to live’ with the physical and social realities of multiple morbidities? (c) How are older adults’ experiences of illness influenced by age and gender norms? Our participants experienced their physical symptoms and the concomitant limitations to their activities to be a source of personal disruption. However, they normalised their illnesses and made social comparisons in order to achieve a sense of biographical flow in distinctly gendered ways. Forthright in their frustration over their loss of autonomy and physicality but resigned and stoic, the men's stories reflected masculine norms of control, invulnerability, physical prowess, self-reliance and toughness. The women were dismayed by their bodies’ altered appearances and concerned about how their illnesses might affect their significant others, thereby responding to feminine norms of selflessness, sensitivity to others and nurturance. We discuss the findings in relation to the competing concepts of biographical disruption and biographical flow, as well as successful ageing discourses.

The prognostic blood biomarker proadrenomedullin for outcome prediction in patients with chronic obstructive pulmonary disease (COPD): a qualitative clinical review

2015 ◽  
Vol 53 (4) ◽  
Author(s):  
Philipp Schuetz ◽  
Robert J. Marlowe ◽  
Beat Mueller
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Cardiopulmonary Exercise Testing ◽  
The Body ◽  
Biologically Active ◽  
Metabolic Effects ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Blood Biomarker

AbstractPlasma proadrenomedullin (ProADM) is a blood biomarker that may aid in multidimensional risk assessment of patients with chronic obstructive pulmonary disease (COPD). Co-secreted 1:1 with adrenomedullin (ADM), ProADM is a less biologically active, more chemically stable surrogate for this pluripotent regulatory peptide, which due to biological and ex vivo physical characteristics is difficult to reliably directly quantify. Upregulated by hypoxia, inflammatory cytokines, bacterial products, and shear stress and expressed widely in pulmonary cells and ubiquitously throughout the body, ADM exerts or mediates vasodilatory, natriuretic, diuretic, antioxidative, anti-inflammatory, antimicrobial, and metabolic effects. Observational data from four separate studies totaling 1366 patients suggest that as a single factor, ProADM is a significant independent, and accurate, long-term all-cause mortality predictor in COPD. This body of work also suggests that combined with different groups of demographic/clinical variables, ProADM provides significant incremental long-term mortality prediction power relative to the groups of variables alone. Additionally, the literature contains indications that ProADM may be a global cardiopulmonary stress marker, potentially supplying prognostic information when cardiopulmonary exercise testing results such as 6-min walk distance are unavailable due to time or other resource constraints or to a patient’s advanced disease. Prospective, randomized, controlled interventional studies are needed to demonstrate whether ProADM use in risk-based guidance of site-of-care, monitoring, and treatment decisions improves clinical, quality-of-life, or pharmacoeconomic outcomes in patients with COPD.

scholarly journals How Do People With COPD Value Different Activities? An Adapted Meta-Ethnography of Qualitative Research

2016 ◽  
Vol 27 (1) ◽  
pp. 37-50 ◽  
Author(s):  
Antje Lindenmeyer ◽  
Sheila M. Greenfield ◽  
Charlotte Greenfield ◽  
Kate Jolly
Keyword(s):  
Daily Living ◽  
The Body ◽  
Chronic Obstructive ◽  
Sense Of Control ◽  
Personal Integrity ◽  
Obstructive Pulmonary Disease ◽  
Gendered Roles ◽  
Key Aspects ◽  
And Control

Chronic Obstructive Pulmonary Disease (COPD) is a long-term condition where activities of daily living (ADLs) may be very restricted; people with COPD need to prioritize what is important to them. We conducted a meta-ethnography to understand which ADLs are valued and why, systematically searching for articles including experiences of ADLs and organizing themes from the articles into five linked concepts: (a) caring for the body, (b) caring for the personal environment, (c) moving between spaces, (d) interacting with others, and (e) selfhood across time. In addition, we identified three key aspects of personal integrity: effectiveness, connectedness, and control. We found that ADLs were valued if they increased integrity; however, this process was also informed by gendered roles and social values. People whose sense of control depended on effectiveness often found accepting help very difficult to bear; therefore, redefining control as situational and relational may help enjoyment of activities that are possible.

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