Patterns of multimorbidity in elderly veterans

Abstract

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.

Figure 1

Prevalence of common conditions in (A) male and (B) female veterans according to age group. P < .001 for differences in disease prevalence according to age group for all conditions in men and for all conditions in women except epilepsy; gastroesophageal reflux disease, peptic ulcer disease, and dyspepsia (GERD/PUD); and chronic obstructive pulmonary disease (COPD) and asthma. CHD = coronary heart disease; PAD = peripheral arterial disease, CVA = cerebrovascular accident; BPH = benign prostatic hypertrophy; CRI = chronic renal insufficiency.