scholarly journals Relationship Between Clusters of Chronic Conditions and Disability Trajectories

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 881-881
Author(s):  
Tara Klinedinst ◽  
Lauren Terhorst ◽  
Juleen Rodakowski
Keyword(s):  
Repeated Measures ◽  
Chronic Conditions ◽  
Latent Class ◽  
Functional Mobility ◽  
Multiple Chronic Conditions ◽  
Class Time ◽  
Time Interaction ◽  
Minimal Disease ◽  
Best Fit ◽  
Over Time

Abstract Recent evidence shows that more complex clusters of chronic conditions are associated with poorer health outcomes. Less clear is the extent to which these clusters are associated with different types of disability (basic and instrumental activities of daily living (ADL, IADL) and functional mobility (FM)) over time. This was a longitudinal analysis using the National Health and Aging Trends Study (NHATS) (n = 6,179). Using latent class analysis, we determined the optimal clusters of chronic conditions, then assigned each person to a best-fit class. Next, we used mixed-effects models with repeated measures to examine the effects of group (best-fit class), time (years from baseline), and the group by time interaction on each of the outcomes in separate models over 4 years. We identified 5 chronic condition clusters: “multisystem morbidity” (13.9% of the sample), “diabetes” (39.5%), “osteoporosis” (24.9%), “cardio/stroke/cancer” (4.5%), and “minimal disease” (17.3%). Group by time interaction was not significant for any outcome. For ADL outcome, only time was significant (F3,16249 = 224.72, p < .001). For IADL, both group (F4,5403 = 6.62, p < .001) and time (F3,22622 = 3.87, p = .009) were significant. For FM, both group (F4,5920 = 2.96, p = .02) and time were significant (F3,16381 = 213.41, p < .001). We did not find evidence that any cluster experienced greater increases in disability over time, but all clusters containing multiple chronic conditions had risk of IADL and FM disability. Increased screening for IADL and FM disability could identify early disability and prevent decline.

scholarly journals The Importance of Studying Health Behavior in Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 827-827
Author(s):  
Jaime Hughes ◽  
Susan Hughes ◽  
Mina Raj ◽  
Janet Bettger
Keyword(s):  
Social Support ◽  
Older Adults ◽  
Behavior Change ◽  
Chronic Conditions ◽  
Population Level ◽  
Multiple Chronic Conditions ◽  
Prior Work ◽  
Time Changes ◽  
The Impact ◽  
Over Time

Abstract Behavior change is an inherent aspect of routine geriatric care. However, most research and clinical programs emphasis how to initiate behavior change with less emphasis placed on skills and strategies to maintain behaviors over time, including after an intervention has concluded. This presentation will provide an introduction to the symposium, including a review of prior work and our rationale for studying the critical yet overlooked construct of maintenance in older adults. Several key considerations in our work include the impact of multiple chronic conditions, declines in cognitive and functional capacity over time, changes in environmental context and/or social support, and sustainability of community and population-level programs and services.

scholarly journals CHARACTERIZING THE PATHWAYS UNDERLYING THE ASSOCIATION BETWEEN PSYCHOLOGICAL WELL-BEING AND HEALTH

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S813-S813
Author(s):  
Eric S Kim ◽  
Anthony Ong
Keyword(s):  
Repeated Measures ◽  
Chronic Conditions ◽  
Daily Diary ◽  
Well Being ◽  
Management Approach ◽  
Diary Study ◽  
Response Effort ◽  
Psychological Well Being ◽  
Daily Diary Study ◽  
Over Time

Abstract As populations age, identifying factors that foster the maintenance of health is crucial for improving the health and well-being of older adults. Yet, most psychological, biomedical, and public health efforts have focused on reducing harmful risk factors. While the risk management approach has contributed greatly to prevention and treatment programs, our aging society continues to grapple with the steadily rising tide of chronic conditions. Expanding the focus to include upstream, health-promoting psychosocial assets may help inform a more comprehensive response effort. Mounting research suggests that different dimensions of psychological well-being are uniquely associated with reduced risk of chronic conditions. However, the mechanisms underlying these associations remain understudied. This symposium presents 4 studies evaluating potential mechanisms. The first talk presents research evaluating how a spouse’s level of optimism may be uniquely associated with an individual’s cognitive health over time (above and beyond that own individual’s level of optimism). A second talk, draws upon a multi-burst daily diary study and focuses on affective stress response as a potentially modifiable target that could explain the health benefits of optimism. A third talk evaluates how baseline levels purpose in life might be associated with repeated measures of five key health behaviors over time. A fourth talk discusses results from a longitudinal-burst daily diary study determining the reciprocal relationships among optimism, pain interference, and goal-directed activity among older women who experience pain. Overall, these studies add to the growing research on psychological well-being and physical health by providing evidence around potential biobehavioral pathways.

scholarly journals 4228 A latent class analysis of seriously ill adults with multiple chronic conditions receiving palliative care

2020 ◽  
Vol 4 (s1) ◽  
pp. 104-104
Author(s):  
Komal Murali ◽  
Gary Yu ◽  
John D. Merriman ◽  
Abraham A. Brody
Keyword(s):  
Palliative Care ◽  
Latent Class Analysis ◽  
Mortality Risk ◽  
Chronic Conditions ◽  
Latent Class ◽  
Metastatic Cancer ◽  
Multiple Chronic Conditions ◽  
Latent Subgroups ◽  
Ill Adults ◽  
Seriously Ill

OBJECTIVES/GOALS: The purpose of this secondary data analysis was to identify latent subgroups of seriously ill adults based on multiple chronic conditions and mortality risk using the CCI. This study was conducted by performing a secondary analysis of data from a randomized controlled trial of seriously ill patients receiving palliative care. METHODS/STUDY POPULATION: A cross-sectional analysis of baseline CCI data was conducted. 381 seriously ill adults receiving palliative care were in the original study. Latent subgroups were identified based on the CCI by conducting a latent class analysis in MPlus. The LCA was modeled on each of the 19 disease items as binary latent predictor variables, an additional binary variable representing presence of any disease not accounted for by the CCI, and a final categorical variable representing the total CCI score divided based on clinically significant cutoffs including zero, low (> = 1-<2), moderate (> = 2-<5), and high CCI (> = 5). RESULTS/ANTICIPATED RESULTS: Three distinct latent subgroups were identified based on the CCI. Latent subgroup 1 included those with a low-moderate CCI consisting of MCC and non-Metastatic Cancers (n = 178), with 45% of this group having chronic obstructive pulmonary disease. The second two subgroups included individuals with a high CCI or a score greater than or equal to 5. Latent subgroup 2 (n = 64) was comprised of individuals with MCC and non-metastatic cancer. Latent subgroup 3 (n = 139) included individuals with metastatic cancer. DISCUSSION/SIGNIFICANCE OF IMPACT: In a sample of seriously ill adults with MCC, latent subgroups were identified consisting of individuals with low, moderate, or high CCI. The low to moderate CCI group consists of individuals with chronic conditions including COPD, congestive heart failure, myocardial infarction, cardiovascular disease. There were two subgroups with high CCI scores and the differentiating factor between the two subgroups was the presence of metastatic cancer in latent subgroup 3. The identification of latent subgroups sets the groundwork for further analyses to compare differences in symptom burden, quality of life, and functional status between groups. The findings have the potential to inform future studies seeking to better characterize seriously adults with MCC based on their disease burden and mortality risk.

Multimorbidity patterns and their association with survival in a large national cohort of older veterans with multiple myeloma.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 8033-8033
Author(s):  
Nathanael Fillmore ◽  
Clark DuMontier ◽  
David Cheng ◽  
Diana Cirstea ◽  
Sarvari Yellapragada ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Substance Use ◽  
Lung Disease ◽  
Chronic Lung Disease ◽  
Chronic Conditions ◽  
Latent Class ◽  
Triplet Chemotherapy ◽  
National Cohort ◽  
Minimal Disease ◽  
The Impact

8033 Background: The majority of older adults carry two or more chronic conditions (multimorbidity). Although comorbidity in multiple myeloma (MM) has often been described with comorbidity counts, the impact of multimorbidity clusters has yet to be investigated. Methods: In a national cohort of 7815 patients aged ≥60 years diagnosed with and treated for MM in Veterans Affairs Healthcare System, we extracted 53 chronic conditions from claims in the 3 years preceding diagnosis using the Centers of Medicare and Medicaid Services-defined chronic and disabling conditions. We performed latent class analysis to identify patterns of multimorbidity that coexisted with MM at diagnosis. We then assessed whether these multimorbidity patterns were associated with survival in 5992 non-transplanted patients initially treated with either doublet or triplet chemotherapy regimens, adjusting for MM stage, sociodemographic factors, and prognostic lab values. Results: Mean follow up time was 3.1 years (SD, 2.6). We identified 6 multimorbidity clusters at the time of MM diagnosis: minimal disease (1302 patients, 16.7%), cardiovascular disease (2011, 25.7%), diabetes and complications (1820, 23.3%), psychiatric and substance use disorders (931, 11.9%), chronic lung disease (759, 9.7%), and multisystem impairment (992, 12.7%). In patients initially treated with doublet or triplet chemotherapy, survival varied across multimorbidity patterns (p < 0.001); patients with minimal disease had the best survival (median survival [MS] = 4.5 years, 5-year survival = 47.5%), and patients with multisystem impairment had the worst (MS = 2.4 years, 5-year survival = 24.3%). After adjustment for covariates, patients with clusters of chronic lung disease (HR = 1.40 [1.22-1.60]), psychiatric and substance use (HR = 1.57 [1.37-1.79]), and multisystem impairment (HR = 1.71 [1.50-1.94]) had higher hazards of death than patients with minimal disease. Conclusions: We found higher-impact and lower-impact multimorbidity clusters among older veterans with newly-diagnosed MM treated with chemotherapy. Unique combinations of chronic diseases may interact with MM itself to drive differences in mortality.

scholarly journals Hand stereotypies

Neurology ◽  
2019 ◽  
Vol 92 (22) ◽  
pp. e2594-e2603 ◽  
Author(s):  
Jennifer L. Stallworth ◽  
Marisela E. Dy ◽  
Caroline B. Buchanan ◽  
Chin-Fu Chen ◽  
Alexandra E. Scott ◽  
...  
Keyword(s):  
Natural History ◽  
Repeated Measures ◽  
Clinical Care ◽  
Hand Function ◽  
Nonparametric Tests ◽  
Clinical Severity ◽  
Categorical Variables ◽  
Logistic Regression Models ◽  
Time Interaction ◽  
Over Time

ObjectiveTo characterize hand stereotypies (HS) in a large cohort of participants with Rett syndrome (RTT).MethodsData from 1,123 girls and women enrolled in the RTT Natural History Study were gathered. Standard tests for continuous and categorical variables were used at baseline. For longitudinal data, we used repeated-measures linear and logistic regression models and nonparametric tests.ResultsHS were reported in 922 participants with classic RTT (100%), 73 with atypical severe RTT (97.3%), 74 with atypical mild RTT (96.1%), and 17 females with MECP2 mutations without RTT (34.7%). Individuals with RTT who had classic presentation or severe MECP2 mutations had higher frequency and earlier onset of HS. Heterogeneity of HS types was confirmed, but variety decreased over time. At baseline, almost half of the participants with RTT had hand mouthing, which like clapping/tapping, decreased over time. These 2 HS types were more frequently reported than wringing/washing. Increased HS severity (prevalence and frequency) was associated with worsened measures of hand function. Number and type of HS were not related to hand function. Overall clinical severity was worse with decreased hand function but only weakly related to any HS characteristic. While hand function decreased over time, prevalence and frequency of HS remained relatively unchanged and high.ConclusionsNearly all individuals with RTT have severe and multiple types of HS, with mouthing and clapping/tapping decreasing over time. Interaction between HS frequency and hand function is complex. Understanding the natural history of HS in RTT could assist in clinical care and evaluation of new interventions.

scholarly journals Prevalence and patterns of multimorbidity in Australian baby boomers: the Busselton healthy ageing study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michael L. Hunter ◽  
Matthew W. Knuiman ◽  
Bill Musk ◽  
Jennie Hui ◽  
Kevin Murray ◽  
...  
Keyword(s):  
General Population ◽  
Bowel Disease ◽  
Chronic Conditions ◽  
Latent Class ◽  
Myocardial Infarct ◽  
Healthy Ageing ◽  
Multiple Chronic Conditions ◽  
Middle Aged ◽  
Ageing Study ◽  
Middle Aged Adults

Abstract Background and objective Chronic medical conditions accumulate within individuals with age. However, knowledge concerning the trends, patterns and determinants of multimorbidity remains limited. This study assessed the prevalence and patterns of multimorbidity using extensive individual phenotyping in a general population of Australian middle-aged adults. Methods Participants (n = 5029, 55% female), born between 1946 and 1964 and attending the cross-sectional phase of the Busselton Healthy Ageing Study (BHAS) between 2010 and 2015, were studied. Prevalence of 21 chronic conditions was estimated using clinical measurement, validated instrument scores and/or self-reported doctor-diagnosis. Non-random patterns of multimorbidity were explored using observed/expected (O/E) prevalence ratios and latent class analysis (LCA). Variables associated with numbers of conditions and class of multimorbidity were investigated. Results The individual prevalence of 21 chronic conditions ranged from 2 to 54% and multimorbidity was common with 73% of the cohort having 2 or more chronic conditions. (mean ± SD 2.75 ± 1.84, median = 2.00, range 0–13). The prevalence of multimorbidity increased with age, obesity, physical inactivity, tobacco smoking and family history of asthma, diabetes, myocardial infarct or cancer. There were 13 pairs and 27 triplets of conditions identified with a prevalence > 1.5% and O/E > 1.5. Of the triplets, arthritis (> 50%), bowel disease (> 33%) and depression-anxiety (> 33%) were observed most commonly. LCA modelling identified 4 statistically and clinically distinct classes of multimorbidity labelled as: 1) “Healthy” (70%) with average of 1.95 conditions; 2) “Respiratory and Atopy” (11%, 3.65 conditions); 3) “Non-cardiometabolic” (14%, 4.77 conditions), and 4) “Cardiometabolic” (5%, 6.32 conditions). Predictors of multimorbidity class membership differed between classes and differed from predictors of number of co-occurring conditions. Conclusion Multimorbidity is common among middle-aged adults from a general population. Some conditions associated with ageing such as arthritis, bowel disease and depression-anxiety co-occur in clinically distinct patterns and at higher prevalence than expected by chance. These findings may inform further studies into shared biological and environmental causes of co-occurring conditions of ageing. Recognition of distinct patterns of multimorbidity may aid in a holistic approach to care management in individuals presenting with multiple chronic conditions, while also guiding health resource allocation in ageing populations.

scholarly journals Multimorbidity disease clusters in Aboriginal and non-Aboriginal Caucasian populations in Canada

2014 ◽  
Vol 34 (4) ◽  
pp. 218-225 ◽  
Author(s):  
JP Kuwornu ◽  
LM Lix ◽  
S Shooshtari
Keyword(s):  
Chronic Diseases ◽  
Chronic Conditions ◽  
Latent Class ◽  
Canadian Community Health Survey ◽  
Disease Clusters ◽  
Prevalence Estimates ◽  
Community Health Survey ◽  
Caucasian Origin ◽  
Best Fit ◽  
Lca Results

Introduction Patterns of multimorbidity, the co-occurrence of two or more chronic diseases, may not be constant across populations. Our study objectives were to compare prevalence estimates of multimorbidity in the Aboriginal population in Canada and a matched non-Aboriginal Caucasian population and identify the chronic diseases that cluster in these groups. Methods We used data from the 2005 Canadian Community Health Survey (CCHS) to identify adult (≥ 18 years) respondents who self-identified as Aboriginal or non-Aboriginal Caucasian origin and reported having 2 or more of the 15 most prevalent chronic conditions measured in the CCHS. Aboriginal respondents who met these criteria were matched on sex and age to non-Aboriginal Caucasian respondents. Analyses were stratified by age (18–54 years and ≥ 55 years). Prevalence was estimated using survey weights. Latent class analysis (LCA) was used to identify disease clusters. Results A total of 1642 Aboriginal respondents were matched to the same number of non-Aboriginal Caucasian respondents. Overall, 38.9% (95% CI: 36.5%–41.3%) of Aboriginal respondents had two or more chronic conditions compared to 30.7% (95% CI: 28.9%–32.6%) of non-Aboriginal respondents. Comparisons of LCA results revealed that three or four clusters provided the best fit to the data. There were similarities in the diseases that tended to co-occur amongst older groups in both populations, but differences existed between the populations amongst the younger groups. Conclusion We found a small group of younger Aboriginal respondents who had complex co-occurring chronic diseases; these individuals may especially benefit from disease management programs.

scholarly journals Defining multimorbidity and its impact in older United States Veterans newly treated for multiple myeloma

2021 ◽  
Author(s):  
Nathanael Fillmore ◽  
Clark DuMontier ◽  
Cenk Yildirim ◽  
Jennifer La ◽  
Mara M Epstein ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Multiple Myeloma ◽  
Chronic Conditions ◽  
Latent Class ◽  
Disease Risk ◽  
Demographic Variables ◽  
Emergency Department Visits ◽  
Multiple Chronic Conditions ◽  
Comorbidity Index

Abstract Background Traditional count-based measures of comorbidity are unlikely to capture the complexity of multiple chronic conditions (multimorbidity) in older adults with cancer. We aimed to define patterns of multimorbidity and their impact in older United States Veterans with multiple myeloma (MM). Methods We measured 66 chronic conditions in 5,076 Veterans age ≥ 65 years newly-treated for MM in the national Veterans Affairs healthcare system from 2004 to 2017. Latent class analysis (LCA) was used to identify patterns of multimorbidity among these conditions. These patterns were then assessed for their association with overall survival, our primary outcome. Secondary outcomes included emergency department visits and hospitalizations. Results Five patterns of multimorbidity emerged from the LCA, and survival varied across these patterns (log-rank two-sided p &lt; .001). Older Veterans with cardiovascular and metabolic disease (30.9%, hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.21 to 1.45); psychiatric and substance use disorders (9.7%, HR = 1.58, 95% CI = 1.39 to 1.79); chronic lung disease (15.9%, HR = 1.69, 95% CI = 1.53 to 1.87); and multisystem impairment (13.8%, HR = 2.25, 95% CI = 2.03 to 2.50) had higher mortality compared to Veterans with minimal comorbidity (29.7%, reference). Associations with mortality were maintained after adjustment for socio-demographic variables, measures of disease risk, and the count-based Charlson Comorbidity Index. Multimorbidity patterns were also associated with emergency department visits and hospitalizations. Conclusions Our findings demonstrate the need to move beyond count-based measures of comorbidity and consider cancer in the context of multiple chronic conditions.

Validating Four Standard Scales in Spiritually Practicing and Nonpracticing Samples Using Propensity Score Matching

2008 ◽  
Vol 24 (3) ◽  
pp. 165-173 ◽  
Author(s):  
Niko Kohls ◽  
Harald Walach
Keyword(s):  
Propensity Score ◽  
Propensity Score Matching ◽  
Repeated Measures ◽  
Propensity Scores ◽  
Total Sample ◽  
Experimental Manipulation ◽  
Brief Symptom Inventory ◽  
Time Interaction ◽  
Social Support Scale ◽  
Lower Test

Validation studies of standard scales in the particular sample that one is studying are essential for accurate conclusions. We investigated the differences in answering patterns of the Brief-Symptom-Inventory (BSI), Transpersonal Trust Scale (TPV), Sense of Coherence Questionnaire (SOC), and a Social Support Scale (F-SoZu) for a matched sample of spiritually practicing (SP) and nonpracticing (NSP) individuals at two measurement points (t1, t2). Applying a sample matching procedure based on propensity scores, we selected two sociodemographically balanced subsamples of N = 120 out of a total sample of N = 431. Employing repeated measures ANOVAs, we found an intersample difference in means only for TPV and an intrasample difference for F-SoZu. Additionally, a group × time interaction effect was found for TPV. While Cronbach’s α was acceptable and comparable for both samples, a significantly lower test-rest-reliability for the BSI was found in the SP sample (rSP = .62; rNSP = .78). Thus, when researching the effects of spiritual practice, one should not only look at differences in means but also consider time stability. We recommend propensity score matching as an alternative for randomization in variables that defy experimental manipulation such as spirituality.

Opportunities to optimize ehealth technology for patients with multiple chronic conditions

2013 ◽  
Author(s):  
Donna M. Zulman ◽  
Emily Jenchura ◽  
Danielle Cohen ◽  
Eleanor Lewis ◽  
Steven M. Asch
Keyword(s):  
Chronic Conditions ◽  
Multiple Chronic Conditions
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