In a recent study, both baseline and new multiple chronic conditions (MCCs) led to worse health in older patients—more limitations in activities of daily living (ADLs) and diminished health-related quality of life (HRQOL).
Physicians should consider addressing classes of MCCs by using interventions designed to reduce their emergence (eg, physical activity, reductions in smoking rates, and improved and coordinated access to health care services), the authors suggested.
The US Department of Health and Human Services defines MCCs as the presence of 2 or more chronic conditions, such as hypertension, arthritis, diabetes mellitus, asthma, and depression. The prevalence of MCCs is high among older adults, with 62% of adults older than 65 years reporting having at least 2 chronic conditions.
Barile and associates assessed longitudinal associations between MCCs and limitations in ADLs on HRQOL among adults older than 65 years. They used data on 27,334 patients from the Medicare Health Outcomes Survey to test the following hypotheses:
• The number of MCCs at baseline is associated with more ADL limitations at follow-up.
• ADL limitations at follow-up are associated with changes in HRQOL.
• MCCs at baseline and at follow-up are both directly and indirectly associated with changes in HRQOL.
The analyses also controlled for numerous potential confounding medical conditions and behaviors, including chronic low back pain, cancer treatment, and smoking status.
A 6-item ADL limitations measure was used to assess patients’ level of functioning at baseline and follow-up.
The study findings supported all 3 of the hypotheses. The numbers of chronic conditions at baseline and the 2-year follow-up were independently associated with more limitations in ADLs at 2-year follow-up. More limitations in ADLs at 2-year follow-up were associated with worse HRQOL during the follow-up period. The association between MCCs and indices of HRQOL was mediated by changes in limitations in ADLs.
The relationships between MCCs, functional limitations, and HRQOL are complex ones that likely change over time and are reciprocal in nature, the authors noted.
They concluded that both previous and incident MCCs affect both ADLs and HRQOL and therefore intervening on MCCs at any point probably will improve both current and subsequent ADLs and HRQOL. They noted that because MCCs at baseline and new MCCs during follow-up were strongly associated with subsequent increases in limitations in ADLs, prevention efforts to reduce the likelihood of new MCCs developing in older adults could forestall increases in ADL limitations.
The findings support the need for physicians to monitor and try to reduce the number of MCCs their patients experience to facilitate optimal function and HRQOL among older adults, according to the authors. They should recognize the need for better care coordination, particularly for patients with MCCs, to ensure that conditions are treated, prevent the acquisition of new conditions, and limit the burden of disease.
The study was published on September 26 in the CDC’s Preventing Chronic Disease.