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. 2025 Apr;73(4):1168-1178.
doi: 10.1111/jgs.19336. Epub 2025 Jan 22.

Network Analyses to Explore Comorbidities Among Older Adults Living With Dementia

Samuel Quan  1   2 , Barret A Monchka  3 , Philip D St John  1   4 , Malcolm B Doupe  2   4 , Maxime Turgeon  5 , Lisa M Lix  2   3
Affiliations

Network Analyses to Explore Comorbidities Among Older Adults Living With Dementia

Samuel Quan et al. J Am Geriatr Soc. 2025 Apr.

Abstract

Background: Older persons living with dementia (PLWD) often have multiple other chronic health conditions (i.e., comorbidities). Network analyses can describe complex profiles of chronic health conditions through graphical displays grounded in empirical data. Our study compared patterns of chronic health conditions among PLWD residing in and outside of long-term care (LTC) settings.

Methods: Population-based administrative data, including outpatient physician claims, inpatient records, pharmaceutical records, and LTC records, for the study were from the Canadian province of Manitoba. We included PLWD, ages ≥ 67 years, with two or more other chronic health conditions, who resided in Manitoba from 2017 to 2020. A total of 138 chronic health conditions were ascertained using a modification of the open-source Clinical Classification Software. Networks defined by nodes (health conditions) and edges (associations between nodes) were stratified by residence location (in versus outside LTC). Network properties were described, including: density (ratio of number of edges to number of potential edges), and modularity (associations between and within clusters of health conditions), and the median and interquartile range (IQR) for node degree (number of associations per node).

Results: The population comprised 19,672 PLWD, of which 17,534 (89.1%) had two or more chronic health conditions. The median number of co-occurring conditions was similar among PLWD in LTC (median: 6, IQR: 3-10) versus outside LTC (median: 7, IQR: 4-10). Network properties were similar for PLWD and multiple comorbidities residing in versus outside LTC, including node degree (median 11 vs. 12), density (0.15 vs. 0.14), and modularity (0.18 vs. 0.26).

Conclusions: Multiple chronic diseases characterize PLWD residing in and outside of LTC. Using network analyses, chronic diseases among PLWD do not form easily distinguishable groups or patterns. This suggests the need for comprehensive clinical assessments, individualized approaches for disease management, and highlights the importance of person-specific care.

Keywords: administrative data; dementia; multimorbidity; network analysis.

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Conflict of interest statement

There are no relevant conflicts of interest declared among the authors. The research was conducted while S.Q. was a resident physician in the Geriatric Medicine and the Clinician Investigator Program at the University of Manitoba. As a resident physician, S.Q. received a salary as an employee of the Manitoba provincial health authority, Shared Health. S.Q. received scholarships from the Canadian Institutes of Health Research (CIHR) Canada Graduate Scholarship (Master's), Tri‐Agency Top‐Up Award (Faculty of Graduate Studies, University of Manitoba), Dr. Hector Ma Award (Department of Internal Medicine, University of Manitoba), Evelyn Shapiro Award (University of Manitoba). S.Q. received travel awards and funding through the University of Manitoba, CIHR, and the Canadian Geriatrics Society to present research findings at various conferences. B.A.M. declares no conflicts of interest. P.D.St.J. receives research funding from CIHR. P.D.St.J. is a member of the board of Age and Opportunity (unremunerated) and has received speaking fees from McMaster University and the Regional Geriatric Program of Eastern Ontario. P.D.St.J. has received consulting fees from the Toronto Rehab Institute (University of Toronto, University Health Network). M.B.D. receives research funding from CIHR, the Norwegian Research Council, and Manitoba Health Seniors and Long‐Term Care. M.T. receives funding from the Natural Sciences and Engineering Research Council of Canada (NSERC) and New Frontiers in Research Fund. L.M.L. receives research funding from CIHR, National Institutes of Health (NIH), and The Arthritis Society.

Figures

FIGURE 1
FIGURE 1
Study flow diagram.
FIGURE 2
FIGURE 2
Network depicting all statistically significant (p < αFDR) pairwise associations between chronic health conditions among persons living with dementia and multiple comorbidities who resided in long‐term care.
FIGURE 3
FIGURE 3
Network depicting all statistically significant (p < αFDR) pairwise comparisons between chronic health conditions among persons living with dementia and multiple comorbidities who resided outside of long‐term care.
See this image and copyright information in PMC

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