Patterns of Multimorbidity in Elderly Veterans

• Autores: Michael A. Steinman, Sei J. Lee, W. John Boscardin, Yinghui Miao, Kathy Z. Fung, Janice B. Schwartz, Kelly L. Moore
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 60, Nº. 10, 2012, págs. 1872-1880
• Idioma: inglés
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• Resumen

  • Objectives: To determine patterns of co-occurring diseases in older adults and the extent to which these patterns vary between the young-old and the old-old.

    Design: Observational study.

    Setting: Department of Veterans Affairs.

    Participants: Veterans aged 65 years and older (1.9 million male, mean age 76 ± 7; 39,000 female, mean age 77 ± 8) with two or more visits to Department of Veterans Affairs (VA) or Medicare settings in 2007 and 2008.

    Measurements: The presence of 23 common conditions was assessed using hospital discharge diagnoses and outpatient encounter diagnoses from the VA and Medicare.

    Results: The mean number of chronic conditions (out of 23 possible) was 5.5 ± 2.6 for men and 5.1 ± 2.6 for women. The prevalence of most conditions increased with advancing age, although diabetes mellitus and hyperlipidemia were 11% to 13% less prevalent in men and women aged 85 and older than in those aged 65 to 74 (P < .001 for each). In men, the most common three-way combination of conditions was hypertension, hyperlipidemia, and coronary heart disease, which together were present in 37% of men. For women, the most common combination was hypertension, hyperlipidemia, and arthritis, which co-occurred in 25% of women. Reflecting their high population prevalence, hypertension and hyperlipidemia were both present in 9 of the 15 most common three-way disease combinations in men and in 11 of the 15 most common combinations in women. The prevalence of many disease combinations varied substantially between young-old and old-old adults.

    Conclusions: Specific combinations of diseases are highly prevalent in older adults and inform the development of guidelines that account for the simultaneous presence of multiple chronic conditions.