Abstract:
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BACKGROUND: The population is aging and multimorbidity is
becoming a common problem in the elderly. OBJECTIVE: To explore
the effect of multimorbidity patterns on mortality for all
causes at 3- and 5-year follow-up periods. MATERIALS AND
METHODS: A prospective community-based cohort (2009-2014)
embedded within a randomized clinical trial was conducted in
seven primary health care centers, including 328 subjects aged
85 years at baseline. Sociodemographic variables, sensory
status, cardiovascular risk factors, comorbidity, and geriatric
tests were analyzed. Multimorbidity patterns were defined as
combinations of two or three of 16 specific chronic conditions
in the same individual. RESULTS: Of the total sample, the median
and interquartile range value of conditions was 4 (3-5). The
individual morbidities significantly associated with death were
chronic obstructive pulmonary disease (COPD; hazard ratio [HR]:
2.47; 95% confidence interval [CI]: 1.3; 4.7), atrial
fibrillation (AF; HR: 2.41; 95% CI: 1.3; 4.3), and malignancy
(HR: 1.9; 95% CI: 1.0; 3.6) at 3-year follow-up; whereas
dementia (HR: 2.04; 95% CI: 1.3; 3.2), malignancy (HR: 1.84; 95%
CI: 1.2; 2.8), and COPD (HR: 1.77; 95% CI: 1.1; 2.8) were the
most associated with mortality at 5-year follow-up, after
adjusting using Barthel functional index (BI). The two
multimorbidity patterns most associated with death were AF,
chronic kidney disease (CKD), and visual impairment (HR: 4.19;
95% CI: 2.2; 8.2) at 3-year follow-up as well as hypertension,
CKD, and malignancy (HR: 3.24; 95% CI: 1.8; 5.8) at 5 years,
after adjusting using BI. CONCLUSION: Multimorbidity as specific
combinations of chronic conditions showed an effect on
mortality, which would be higher than the risk attributable to
individual morbidities. The most important predicting pattern
for mortality was the combination of AF, CKD, and visual
impairment after 3 years. These findings suggest that a new
approach is required to target multimorbidity in octogenarians. |