Patients with Multiple Illnesses

Approximately one-third of all individuals have multiple chronic conditions (MCCs) worldwide. Certain disorders tend to cluster together often, with correlations, such as depression and stroke, Alzheimer’s illness and infectious diseases such as HIV/AIDS and tuberculosis coupled and diabetes and cardiovascular diseases. The prevalence of MCC is highly variable according to the definition used and the number of conditions included in the study. In the United States, it was reported to be 23.1%. While other studies report MCC as high as 80% among elder population. The patient hardship encompasses a decline in standards of living, costly expenditures, adherence to multiple medications, incapacity to work, symptoms management, and a significant financial load on caregivers. This significant load from MCCs is expected to rise further. At the current time, the presence of more than one disease causes the patients to take multiple drugs, further prescribing may be indicated for the side effects of the used drugs. Furthermore, new conditions can be misdiagnosed and mistaken as side effects of the drugs the patients is taking. Strategies for treatments include establishing agreement on MCC taxonomy, putting more emphasis on MCC research, focusing on primary prevention to reduce morbidity, and shifting healthcare institutions and policies to a multiple-condition paradigm.

Processing speed is affected by early impairment in kidney function in the general elder population

Background Chronic kidney disease, cardiovascular disease, and cognitive dysfunction are common in the elder population. There is evidence of a connection between these conditions, possibly by a shared vascular pathogenesis. Processing speed is commonly impaired in cerebrovascular disease. Methods The data was obtained from the population based study “Good aging in Skåne” (GÅS), and included 905 individuals (mean age = 68 years). We investigated the impact of impaired kidney function at baseline on the development of dementia, MCI, and impairment in specific cognitive domains at follow up 6 years later, using logistic regression models. Impaired kidney function was defined as GFR < 60 ml/min/1,73 m2. GFR was estimated from creatinine and cystatin C, using the CKD-EPI formula. Function in the cognitive domains learning and memory, language, complex attention, executive function, perceptual-motor, as well as meta-memory, and global cognitive function, was assessed using a neuropsychological test battery consisting of 12 tests. We compared the test results from follow up, with the results obtained at baseline, using linear regression models in order to assess changes in performance in cognitive domains. Results At follow up, 14 and 158 participants had developed dementia and MCI, respectively. We did not find evidence that moderately impaired eGFR at baseline increased the odds of dementia or MCI. A decline in processing speed was associated with impaired kidney function. Conclusions The effect on processing speed could represent early vascular implications on cognition. Even at moderately impaired kidney function, overview of cardiovascular risk factors could potentially prevent further cognitive impairment.

Sarcopenia, Obesity, and Cardiometabolic Risk Factors Among the Elder Population in Taiwan

Background: Sarcopenia and obesity have become important public health and clinical issues worldwide, especially in an aging society like Taiwan. The aim of this study was to evaluate the cardiometabolic risk factors among the different weight status and grip strength status among elder individuals in Taiwan.Methods: We administered a series of community-based health surveys among the elder population in Chiayi County, Taiwan, from 2017 to 2019. Anthropometric characteristics, handgrip strength, and cardiometabolic risk profiles were measured using standard methods. History of chronic diseases was also asked. The questionnaires, including questions regarding any history of chronic diseases, were administered to the subjects under the assistance of a research technician.Results: This study recruited 3739 subjects (1600 males and 2139 females). The non-obese group had lower blood glucose (BG) levels compared to the obese group (100.3 ± 32.2 mg/dl vs 109.1 ± 34.3 mg/dl for the male subjects; 102.8 ± 32.1 mg/dl vs. 112.5 ± 40.3 mg/dl for the female subjects). The grip strength was negatively associated with BG in both sexes (β = −0.357, p < 0.001 for the male subjects male and β = −0.385, p < 0.05 for the female subjects). Relationship between the grip strength and the risk of cardiometabolic disease showed that for every 1 kg increase in the grip strength, there was a 4.1% and 4.5% decrease in the risk for developing diabetes in male and female subjects, respectively (OR = 0.959, 95% CI = 0.940–0.979 for males and OR = 0.955, 95% CI = 0.932–0.978 for females).Conclusions: A higher handgrip strength is associated with a lower BG level and lower risk for developing diabetes mellitus among elder population in Taiwan. Health promotion studies to increase muscle mass along with early rehabilitation programs should focus on the obese and sarcopenic population to prevent cardiometabolic comorbidities.

Statistical Assessment of Ambient Assistive Techniques by Elders to Enhance Their Well Being From Fall Events

The importance of fall detection techniques in the developing and developed nations due to the increase in elder population has been discussed in many studies. Their results encouraged many researchers and industries to design new assistive living products to enhance the wellbeing of elders. Meanwhile, no previous researches discussed the importance to involve the elders in their design. Due to this, the elders have less awareness and adaption towards those techniques. In this paper, elders were given a questionnaire to find out their attitude and awareness towards various ambient assistive techniques concerning fall detection. Results revealed that most of the elders see that presence of fall detection is very important. Moreover, there were significant differences between ambient assistive techniques. The study findings assess their nature and adaptability level by the elder and are important to researchers and industries for the design and implementation of ambient assistive techniques in the future.

Fairness evaluation for the elder population in China

Background: Population aging and the increasing burden of non-communicable diseases are increasingly a strain on health systems. The World Health Organization (WHO) uses fairness of health financing as one of the criteria for assessing health system performance. The Chinese government has undertaken taken a series of health reforms to reduce the pace of disease transition towards non-communicable diseases (NCDs), as well as protecting people from catastrophic health expenditures. The aim of this study was to assess the fairness of health financing among the elderly with different health conditions in China. Methods: The data source was the WHO Study on global AGEing and adult health (SAGE) Wave 1, a national weighted data collected from adults older than 50 years. In this study, 10099 respondents were included for analysis. Chi-square and partial proportional odds model test were applied to assess the distribution of socioeconomic and health behavior factors among different chronic conditions. Fairness of health financing analysis was used to evaluate how the burden of health financing is distributed according to the household ability to pay (ATP). Dominance tests were applied for comparing different ways of health financing among health conditions. Results: More than half of the elderly had at least one chronic condition, and around 20% people suffered from multi-morbidity. Several socioeconomic as well as health behavior factors were found associated with developing NCDs. Out-of-pocket payment dominated other health finance sources in all three chronic conditions with a regressive pattern. Even though mandatory insurance had covered more than 70% of the elder population in China, due to the relative lower proportion reimbursement for chronic diseases, people still had to pay a lot for seeking healthcare.Conclusion: When reimbursement for chronic diseases is relatively low, high mandatory insurance coverage does not ensure fairness of health financing. The Chinese health system should be developed further in order to meet the needs of elderly with different chronic conditions.