Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Sep 9:9:2235042X19873486.
doi: 10.1177/2235042X19873486. eCollection 2019 Jan-Dec.

Multimorbidity, functional limitations, and outcomes: Interactions in a population-based cohort of older adults

Alanna M Chamberlain  1   2 , Lila J Finney Rutten  1   2 , Debra J Jacobson  1   2 , Chun Fan  1 , Patrick M Wilson  1   2 , Walter A Rocca  1   3 , Véronique L Roger  1   4 , Jennifer L St Sauver  1   2
Affiliations

Multimorbidity, functional limitations, and outcomes: Interactions in a population-based cohort of older adults

Alanna M Chamberlain et al. J Comorb. .

Abstract

Objective: To understand the interaction of multimorbidity and functional limitations in determining health-care utilization and survival in older adults.

Methods: Olmsted County, Minnesota, residents aged 60-89 years in 2005 were categorized into four cohorts based on the presence or absence of multimorbidity (≥3 chronic conditions from a list of 18) and functional limitations (≥1 limitation in an activity of daily living from a list of 9), and were followed through December 31, 2016. Andersen-Gill and Cox regression estimated hazard ratios (HRs) for emergency department (ED) visits, hospitalizations, and death using persons with neither multimorbidity nor functional limitations as the reference (interaction analyses).

Results: Among 13,145 persons, 34% had neither multimorbidity nor functional limitations, 44% had multimorbidity only, 4% had functional limitations only, and 18% had both. Over a median follow-up of 11 years, 5906 ED visits, 2654 hospitalizations, and 4559 deaths occurred. Synergistic interactions on an additive scale of multimorbidity and functional limitations were observed for all outcomes; however, the magnitude of the interactions decreased with advancing age. The HR (95% confidence interval) for death among persons with both multimorbidity and functional limitations was 5.34 (4.40-6.47) at age 60-69, 4.16 (3.59-4.83) at age 70-79, and 2.86 (2.45-3.35) at age 80-89 years.

Conclusion: The risk of ED visits, hospitalizations, and death among persons with both multimorbidity and functional limitations is greater than additive. The magnitude of the interaction was strongest for the youngest age group, highlighting the importance of interventions to prevent and effectively manage multimorbidity and functional limitations early in life.

Keywords: High-need patients; activities of daily living; death; functional limitations; health outcomes; health-care utilization; hospitalization; interactions; multimorbidity.

PubMed Disclaimer

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves in four cohorts defined by functional limitation and multimorbidity status.
Figure 2.
Figure 2.
Mean cumulative hazard function curve for hospitalizations (top panel) and ED visits (bottom panel) in four cohorts defined by functional limitation and multimorbidity status. ED: emergency department.
Figure 3.
Figure 3.
HRs (95% CIs) for death (top panel), hospitalization (middle panel), and ED visits (bottom panel) in four cohorts defined by functional limitation and multimorbidity status. The HRs for death were estimated from a Cox proportional hazards regression model, whereas the HRs for hospitalizations and ED visits were estimated using Andersen–Gill models. HRs were adjusted for age, sex, race, ethnicity, education, and marital status. The cohort of persons with neither multimorbidity nor functional limitations served as the referent cohort. CI: confidence interval.
See this image and copyright information in PMC

References

    1. Ortman JM, Velkoff VA, Hogan H. An aging nation: the older population in the United States. Current Population Reports Washington, DC: US Census Bureau, 2014, pp. 25–1140.
    1. Blumenthal D, Chernof B, Fulmer T, et al. Caring for high-need, high-cost patients—an urgent priority. N Engl J Med 2016; 375: 909–911. - PubMed
    1. Centers for Disease Control and Prevention. The state of aging and health in America 2013. Atlanta: Centers for Disease Control and Prevention, US Department of Health and Human Services, 2013.
    1. Cohen SB. Differentials in the concentration of health expenditures across population subgroups in the U.S., 2013. Rockville: Statistical Brief (Medical Expenditure Panel Survey (US)), 2015.
    1. Mitchell EM. Concentration of health expenditures in the U.S. civilian noninstitutionalized population, 2014. Rockville: Statistical Brief (Medical Expenditure Panel Survey (US)), 2016.

LinkOut - more resources