The extent and burden of high multimorbidity on older adults in the US: a descriptive analysis of Medicare beneficiaries.

BACKGROUND: The impact of multimorbidity (≥ 2 chronic diseases) on the well-being of older adults is substantial but variable. The burden of multimorbidity varies by the number and kinds of conditions, and timing of onset. The impact varies by age, race, ethnicity, socioeconomic status, and health indicators. Large scale longitudinal surveys linked to medical claims provide unique opportunities to characterize this variability. METHODS: We analyzed Medicare-linked Health and Retirement Study data for respondents 65 and older with 3 or more years of fee-for-service coverage (n = 17,199; 2000-2016). We applied standardized claims algorithms for operationalizing 21 chronic diseases. We compared multimorbidity levels, demographics, and outcomes at baseline and over time and escalation to high multimorbidity levels (≥ 5 conditions). RESULTS: At baseline, 51.2% had no multimorbidity, 36.5% had multimorbidity, and 12.4% had high multimorbidity. Loss of function, cognitive decline, and higher healthcare utilization were up to ten times more prevalent in the high multimorbidity group. Greater rates of high multimorbidity were seen among non-Hispanic Black and Hispanic groups, those with lower wealth, younger birth cohorts, and adults with obesity. Rates of transition to high multimorbidity varied greatly and was highest among Hispanic and respondents with lower education. CONCLUSIONS: The development and progression of multimorbidity in old age is influenced by many factors. Higher levels of multimorbidity are associated with sociodemographic characteristics, suggesting possible mitigation strategies.

Cardiometabolic multimorbidity in Mexican adults: a cross-sectional analysis of a national survey.

Background: Cardiometabolic multimorbidity is a rising phenomenon that has been barely explored in middle-income countries such as Mexico. Objective: This study aimed to estimate the prevalence, associated factors, and patterns of cardiometabolic multimorbidity (2 and 3+ diseases) in Mexican adults (≥20 years old) by age group. Methods: A cross-sectional and secondary analysis of Mexico's National Health and Nutrition Survey 2018-2019 was conducted. Information on eight diseases and other sociodemographic and health/lifestyle characteristics was obtained through self-reporting. Descriptive analyses were performed, and multinomial logistic regression models were calculated to identify the variables associated with cardiometabolic multimorbidity. Factor analysis and latent classes were estimated to determine disease patterns. Results: The prevalence of cardiometabolic multimorbidity for the total population study was 27.6% (13.7% for people with 2 diseases and 13.9% for people with 3+ diseases). By age group, the prevalence of 2+ diseases was 12.5% in the age group of 20-39 years, 35.2% in the age group of 40-59 years, and 44.5% in the age group of 60 years and older. The variables of depressive symptomatology and having functional limitations (1+) were statistically associated with cardiometabolic multimorbidity in almost all age groups. Patterns of cardiometabolic multimorbidity varied among adults in different age groups. Understanding the behavior of cardiometabolic multimorbidity at various stages of adulthood is a resource that could be used to design and implement intervention strategies. Such strategies should correspond to the population's sociodemographic, health, and lifestyle characteristics and the specific disease patterns of each age group.

Cardiovascular comorbidities in psoriatic arthritis: state of the art.

Psoriatic arthritis (PsA) is a complex multi-system immune-mediated condition, characterised by a high comorbidity burden, one of the most prevalent of which is cardiovascular disease (CVD), affecting up to 80% of patients. This narrative review explores the current understanding of cardiovascular comorbidities in PsA, focusing on mechanistic pathways, risk assessment, and the impact of treatment choices on cardiovascular health. Here, we outline the role of inflammatory cytokines, immune system dysregulation, and genetic predispositions in PsA, not only as drivers of musculoskeletal manifestations but also atherosclerosis and endothelial dysfunction, giving rise to cardiovascular pathology. Given these insights, accurately assessing and predicting cardiovascular risk in PsA patients is a critical challenge. This review evaluates traditional risk calculators as well as innovative biomarkers and imaging techniques, emphasising their utility and limitations in capturing the true cardiovascular risk profile of PsA patients. There are multiple complexities surrounding the treatment of PsA in the context of concurrent CVD, and therapeutic choices must carefully balance efficacy in managing PsA symptoms with the potential cardiovascular implications. A multidisciplinary approach, integrating dermatological, rheumatological, and cardiological perspectives, amongst others, to optimise patient outcomes, is key. Overall, a heightened clinical awareness and research focus on cardiovascular comorbidities in PsA is warranted, aiming to refine risk assessment strategies and therapeutic interventions that holistically address the multifaceted needs of patients with PsA.

Survival Analysis of the Geriatric Population having Multiple Diseases in the Jammu District, J and K, India.

Aging is a complex, multifactorial, and inevitable process, which begins before birth and continues throughout the life. Multimorbidity prevailing among the geriatric population is an important health challenge for most of the developing countries. To examine the effect of gender and increasing age on the survival of the geriatric population suffering from multimorbidity. A cross-sectional study was conducted among the geriatric population of the Jammu district, J and K, using multistage sampling procedure, and the analysis was conducted using the Kaplan-Meier method and survival analysis using software IBM SPSS version 24.0. Our study included 1150 study subjects, of whom 610 (53%) were males and 540 (47%) were females, respectively. It was indicated that the probability for the survival of the study population suffering from morbidity belonging to 60-64 years was higher than the survival of the geriatric population belonging to other age-groups or we can say that survival probability of the geriatric population suffering from morbidities decreases with the increase in age. Also, it was reported that probability for the survival of the female geriatric population suffering from morbidity was slightly higher than the survival of the male geriatric population. Gender had no significant effect on survival of the geriatric population suffering from morbidities, whereas baseline age had a significant effect on the survival of the geriatric population suffering from morbidities as their survival probability decreases with the increase in age.

Association between fatty liver index and cardiometabolic multimorbidity: evidence from the cross-sectional national health and nutrition examination survey.

Background: Metabolic dysfunction associated steatotic liver disease (MASLD) contributes to the cardiometabolic diseases through multiple mechanisms. Fatty liver index (FLI) has been formulated as a non-invasive, convenient, and cost-effective approach to estimate the degree of MASLD. The current study aims to evaluate the correlation between FLI and the prevalent cardiometabolic multimorbidity (CMM), and to assess the usefulness of FLI to improve the detection of the prevalent CMM in the general population. Methods: 26,269 subjects were enrolled from the National Health and Nutrition Examination Survey 1999-2018. FLI was formulated based on triglycerides, body mass index, γ -glutamyltransferase, and waist circumference. CMM was defined as a history of 2 or more of diabetes mellitus, stroke, myocardial infarction. Results: The prevalence of CMM was 10.84%. With adjustment of demographic, anthropometric, laboratory, and medical history covariates, each standard deviation of FLI leaded to a 58.8% risk increase for the prevalent CMM. The fourth quartile of FLI had a 2.424 times risk for the prevalent CMM than the first quartile, and a trend towards higher risk was observed. Smooth curve fitting showed that the risk for prevalent CMM increased proportionally along with the elevation of FLI. Subgroup analysis demonstrated that the correlation was robust in several conventional subpopulations. Receiver-operating characteristic curve analysis revealed an incremental value of FLI for detecting prevalent CMM when adding it to conventional cardiometabolic risk factors (Area under the curve: 0.920 vs. 0.983, P < 0.001). Results from reclassification analysis confirmed the improvement from FLI. Conclusion: Our study demonstrated a positive, linear, and robust correlation between FLI and the prevalent CMM, and our findings implicate the potential usefulness of FLI to improve the detection of prevalent CMM in the general population.

Association of coffee consumption with cardiometabolic multimorbidity: A prospective cohort study in the UK biobank.

BACKGROUND AND AIMS: Previous observational studies have investigated the association between coffee consumption and single cardiometabolic disease. Yet, the extent to which coffee might confer health advantages to individuals with a singular cardiometabolic disease remains unclear. This study aimed to further investigate the association of coffee consumption and the onset and progression from single cardiometabolic disease to cardiometabolic multimorbidity (CMM). METHODS AND RESULTS: This prospective cohort study included 185,112 participants from the UK Biobank who were enrolled between 2006 and 2010 and followed up until 2020. Coffee consumption was collected using a 24-h dietary questionnaire. CMM was defined as the coexistence of at least two cardiometabolic diseases, including type 2 diabetes (T2D), coronary heart disease (CHD) and stroke. Cox proportional hazards and multi-state models estimated the associations between coffee consumption and CMM. During a median follow-up of 11.4 years, 1585 participants developed CMM. Compared with nonconsumers, coffee consumers had lower risks for the transitions from baseline to single cardiometabolic disease, with the respective lowest hazard ratios and 95% confidence intervals (CIs) for the transitions from baseline to T2D, CHD and stroke after multivariable adjustment being 0.79 (CI, 0.72-0.87), 0.91 (CI, 0.86-0.97) and 0.87 (CI, 0.78-0.96). Coffee consumption resulted in a significant reduction in the risk of the transitions from CHD and stroke to CMM, with the lowest estimates were 0.56 (CI, 0.43-0.73) and 0.60 (CI, 0.43-0.83). Similar associations were observed in unsweetened coffee. Sugar-sweetened coffee was associated with some transitions at low levels of consumption. The associations between artificially sweetened coffee and CMM were less consistent. CONCLUSIONS: Coffee consumption was associated with lower risk for almost all transition phases of CMM development and consistent findings were observed with unsweetened coffee.

The association of a low-inflammatory diet with the trajectory of multimorbidity: a large community-based longitudinal study.

BACKGROUND: A proinflammatory diet has been associated with a risk of individual chronic diseases, however, evidence on the association between inflammatory dietary patterns and the trajectory of chronic disease multimorbidity is sparse. OBJECTIVES: We aimed to investigate the associations of a low-inflammatory diet with the multimorbidity trajectory. METHODS: Within the UK Biobank, 102,424 chronic disease-free participants (mean age 54.7 ± 7.9 y, 54.8% female) were followed up to detect multimorbidity trajectory (annual change in the number of 59 chronic diseases). Baseline inflammatory diet index (IDI) and empirical dietary inflammatory pattern (EDIP) were separately calculated from the weighted sum of 32 posteriori-derived (15 anti-inflammatory) and 18 prior-defined (9 anti-inflammatory) food groups, and tertiled as low-, moderate-, and high-inflammatory diet. Data were analyzed using linear mixed effects model, Cox model, and Laplace regression with adjustment for potential confounders. RESULTS: During the follow-up (median 10.23 y), 15,672 and 35,801 participants developed 1 and 2+ chronic conditions, respectively. Adherence to a low-inflammatory diet was associated with decreased multimorbidity risk (hazard ratio [HRIDI] = 0.84, 95% confidence interval [CI]: 0.81, 0.86; HREDIP = 0.91, 95% CI: 0.89, 0.94) and a slower multimorbidity accumulation (ßIDI = -0.033, 95% CI: -0.036, -0.029; ßEDIP = -0.006, 95% CI: -0.010, -0.003) compared with a high-inflammatory diet, especially in participants aged > 60 y (ßIDI = -0.051, 95% CI: -0.059, -0.042; ßEDIP = -0.020, 95% CI: -0.029, -0.012; both P-interactions < 0.05). The 50th percentile difference (95% CI) of chronic disease-free survival time was prolonged by 0.81 (0.64, 0.97) and 0.49 (0.34, 0.64) y for participants with a low IDI and EDIP, respectively. Higher IDI and EDIP were associated with the development of 4 and 3 multimorbidity clusters (especially for cardiometabolic diseases), respectively. CONCLUSIONS: A low-inflammatory diet is associated with a lower risk and slower accumulation of multimorbidity (especially in participants aged > 60 y). A low-inflammatory diet may prolong chronic disease-free survival time.

Habitual Coffee, Tea, and Caffeine Consumption, Circulating Metabolites, and the Risk of Cardiometabolic Multimorbidity.

CONTEXT: Cardiometabolic multimorbidity (CM) is an increasing public health concern. Previous observational studies have suggested inverse associations between coffee, tea, and caffeine intake and risks of individual cardiometabolic diseases; however, their associations with CM and related biological markers are unknown. METHODS: This prospective study involved 172 315 (for caffeine analysis) and 188 091 (tea and coffee analysis) participants free of any cardiometabolic diseases at baseline from the UK Biobank; 168 metabolites were measured among 88 204 and 96 393 participants. CM was defined as the coexistence of at least 2 of the following conditions: type 2 diabetes, coronary heart disease, and stroke. RESULTS: Nonlinear inverse associations of coffee, tea, and caffeine intake with the risk of new-onset CM were observed. Compared with nonconsumers or consumers of less than 100 mg caffeine per day, consumers of moderate amount of coffee (3 drinks/d) or caffeine (200-300 mg/d) had the lowest risk for new-onset CM, with respective hazard ratios (95% CIs) of 0.519 (0.417-0.647) and 0.593 (0.499-0.704). Multistate models revealed that moderate coffee or caffeine intake was inversely associated with risks of almost all developmental stages of CM, including transitions from a disease-free state to single cardiometabolic diseases and subsequently to CM. A total of 80 to 97 metabolites, such as lipid components within very low-density lipoprotein, histidine, and glycoprotein acetyls, were identified to be associated with both coffee, tea, or caffeine intake and incident CM. CONCLUSION: Habitual coffee or caffeine intake, especially at a moderate level, was associated with a lower risk of new-onset CM and could play important roles in almost all transition phases of CM development. Future studies are warranted to validate the implicated metabolic biomarkers underlying the relation between coffee, tea, and caffeine intake and CM.

Determinants of multimorbidity among elderly population in maharashtra, India: Logistic regression analysis.

BACKGROUND: Population aging is an emerging global trend. Because of decreasing fertility rates and improved healthcare, the lifespan of elderly population increased. Consequently, proportion of elderly population is increasing at an alarming rate. This is accompanied by an increased recognition of the occurrence of multimorbidity and associated mortality risks. So, the purpose of this study was to determine the prevalence and predictors of multimorbidity among elderly population in Maharashtra with its variation among socio-demographic spectrum, functional health and health behaviors. MATERIALS AND METHODS: Sample of elderly population aged > 60 years were selected to examine multimorbidity and its associated risk factors. Statistical methods such as Chi-square test were used to show the association between multimorbidity and other covariates. Binary logistic regression analysis was used to understand the effects of predictor variables on multimorbidity. Receiver Operating Characteristic (ROC) Curve Analysis was carried out to improve the performance of the classification model by using a modified cut-off probability value. Z scores were calculated to compare model performance in training data and test data. RESULTS: The prevalence of multimorbidity in Maharashtra in training data and test data was found to be 32.8% and 32.9%. Residence, living arrangement, MPCE Quintile, marital status, work status, education, tobacco consumption, physical activity, Instrumental Activities of Daily Living (IADL), Activities of Daily Living (ADL) and self-rated health of elderly population were important determinants that exert a significant adverse effect on multimorbidity. CONCLUSION: Prediction percentages indicate that appropriate actions should be undertaken to ensure good quality of life for all the elderly in Maharashtra.

Prevalence of and Factors Associated with Treatment Burden and Medication Adherence Among Primary Care Patients with Multimorbidity in Jeddah, Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: Multimorbidity, the coexistence of multiple chronic conditions, presents significant challenges in treatment management and medication adherence. This study investigates the burden of multimorbidity and factors influencing treatment adherence among primary care patients in Jeddah, Saudi Arabia. METHODS: A cross-sectional study was conducted from November to December 2023, including 422 participants selected via stratified random sampling from 12 primary healthcare centers in Jeddah. Participants were adults aged 18 years or older with two or more confirmed long-term medical conditions. The Multimorbidity Treatment Burden Questionnaire (MTBQ) and General Medication Adherence Scale (GMAS) were used to measure treatment burden and medication adherence, respectively. Demographic variables were assessed for their influence on these outcomes. RESULTS: High treatment burden was reported by 55% of participants, while 21% reported medium burden, 15% experienced low burden and 9% no burden. Medication adherence was partial in 69% of participants, with 13% reporting high adherence, 13% good adherence, and 5% poor adherence. Statistically significant differences in MTBQ scores were observed based on marital status, education level, residence, occupation, and income. GMAS scores varied statistically significantly with marital status, education level, residence, occupation, income, and previous self-care education session attendance and MTBQ scores, with those having high burden reporting the lowest adherence scores. CONCLUSIONS: Demographic factors, including marital status, education level, residence, occupation, and income, significantly influence multimorbidity treatment burden and medication adherence. A higher treatment burden was associated with lower adherence. Targeted interventions addressing these factors could improve treatment outcomes for patients with multiple chronic conditions.

Epidemiology of multimorbidity in Nepal: A systematic review and meta-analysis.

Background: Multimorbidity is rising in low-and middle-income countries such as Nepal, yet the research has not gained pace in this field. We aimed to systematically review the existing multimorbidity literature in Nepal and estimate the prevalence and map its risk factors and consequences. Methods: We reviewed data collated from PubMed, Embase and CINAHL by including original studies that reported prevalence of multimorbidity in Nepal. The quality of included studies was assessed using the Appraisal Tool for Cross-sectional Studies. The summary of the review is presented both qualitatively as well as through meta-analysis to give pooled prevalence. We prospectively registered in PROSPERO (CRD42024499598). Results: We identified 423 studies out of which seven were included in this review. All studies were conducted in a community setting except one which was hospital based. The prevalence reported across various studies ranged from 13.96% to 70.1%. The pooled prevalence of multimorbidity was observed to be 25.05% (95% CI: 16.99 to 34.09). The number of conditions used to assess multimorbidity ranged from four to nine. The major risk factors identified were increasing age, urban residence, and lower literacy rates. Conclusion: A wide variance in the prevalence of multimorbidity was observed. Moreover, multimorbidity assessment tool/conditions considered for assessing multimorbidity were heterogeneous.

Sex Differences in the Associations Between Chronic Diseases and Insomnia Symptoms Among Older Adults in India.

Background: Sleep problems are a critical issue in the aging population, affecting quality of life, cognitive efficiency, and contributing to adverse health outcomes. The coexistence of multiple diseases is common among older adults, particularly women. This study examines the associations between specific chronic diseases, multimorbidity, and insomnia symptoms among older Indian men and women, with a focus on the interaction of sex in these associations. Methods: Data were drawn from 31,464 individuals aged 60 and older in the Longitudinal Ageing Study in India, Wave-1 (2017-18). Insomnia symptoms were assessed using four questions adapted from the Jenkins Sleep Scale (JSS-4), covering difficulty falling asleep, waking up, waking too early, and feeling unrested during the day. Multivariable logistic regression models, stratified by sex, were used to analyze the associations between chronic diseases and insomnia symptoms. Results: Older women had a higher prevalence of insomnia symptoms than men (44.73% vs 37.15%). Hypertension was associated with higher odds of insomnia in both men (AOR: 1.20) and women (AOR: 1.36). Women with diabetes had lower odds of insomnia (AOR: 0.80), while this association was not significant in men. Neurological or psychiatric disorders, stroke, and bone and joint diseases were linked to higher odds of insomnia in both sexes. Chronic lung disease was associated with insomnia in men (AOR: 1.65), but not in women. Additionally, having three or more chronic diseases significantly increased the odds of insomnia in both men (AOR: 2.43) and women (AOR: 2.01). Conclusion: Hypertension, bone and joint diseases, lung diseases, stroke, neurological or psychiatric disorders, and multimorbidity are linked to insomnia symptoms in older Indian adults. Disease-specific management and routine insomnia screening are crucial for promoting healthy aging in this vulnerable population.

Independent and joint associations of cardiometabolic multimorbidity and depression on cognitive function: findings from multi-regional cohorts and generalisation from community to clinic.

Background: Cardiometabolic multimorbidity (CMM) and depression are often co-occurring in older adults and associated with neurodegenerative outcomes. The present study aimed to estimate the independent and joint associations of CMM and depression on cognitive function in multi-regional cohorts, and to validate the generalizability of the findings in additional settings, including clinical. Methods: Data harmonization was performed across 14 longitudinal cohort studies within the Cohort Studies of Memory in an International Consortium (COSMIC) group, spanning North America, South America, Europe, Africa, Asia, and Australia. Three external validation studies with distinct settings were employed for generalization. Participants were eligible for inclusion if they had data for CMM and were free of dementia at baseline. Baseline CMM was defined as: 1) CMM 5, ≥2 among hypertension, hyperlipidemia, diabetes, stroke, and heart disease and 2) CMM 3 (aligned with previous studies), ≥2 among diabetes, stroke, and heart disease. Baseline depression was primarily characterized by binary classification of depressive symptom measurements, employing the Geriatric Depression Scale and the Center for Epidemiological Studies-Depression scale. Global cognition was standardized as z-scores through harmonizing multiple cognitive measures. Longitudinal cognition was calculated as changes in global cognitive z-scores. A pooled individual participant data (IPD) analysis was utilized to estimate the independent and joint associations of CMM and depression on cognitive outcomes in COSMIC studies, both cross-sectionally and longitudinally. Repeated analyses were performed in three external validation studies. Findings: Of the 32,931 older adults in the 14 COSMIC cohorts, we included 30,382 participants with complete data on baseline CMM, depression, and cognitive assessments for cross-sectional analyses. Among them, 22,599 who had at least 1 follow-up cognitive assessment were included in the longitudinal analyses. The three external studies for validation had 1964 participants from 3 multi-ethnic Asian older adult cohorts in different settings (community-based, memory clinic, and post-stroke study). In COSMIC studies, each of CMM and depression was independently associated with cross-sectional and longitudinal cognitive function, without significant interactions between them (Ps > 0.05). Participants with both CMM and depression had lower cross-sectional cognitive performance (e.g. ß = -0.207, 95% CI = (-0.255, -0.159) for CMM5 (+)/depression (+)) and a faster rate of cognitive decline (e.g. ß = -0.040, 95% CI = (-0.047, -0.034) for CMM5 (+)/depression (+)), compared with those without either condition. These associations remained consistent after additional adjustment for APOE genotype and were robust in two-step random-effects IPD analyses. The findings regarding the joint association of CMM and depression on cognitive function were reproduced in the three external validation studies. Interpretation: Our findings highlighted the importance of investigating age-related co-morbidities in a multi-dimensional perspective. Targeting both cardiometabolic and psychological conditions to prevent cognitive decline could enhance effectiveness. Funding: Natural Science Foundation of China and National Institute on Aging/National Institutes of Health.

Association between polypharmacy and 2-year outcomes among Chinese older inpatients: a multi-center cohort study.

BACKGROUND: The escalating global prevalence of polypharmacy presents a growing challenge to public health. In light of this issue, the primary objective of our study was to investigate the status of polypharmacy and its association with clinical outcomes in a large sample of hospitalized older patients aged 65 years and over. METHODS: A two-year prospective cohort study was carried out at six tertiary-level hospitals in China. Polypharmacy was defined as the prescription of 5 or more different medications daily, including over-the-counter and non-prescription medications. Baseline polypharmacy, multimorbidity, and other variables were collected when at admission, and 2-year outcomes were recorded by telephone follow-up. We used multivariate logistic regression analysis to examine the associations between polypharmacy and 2-year outcomes. RESULTS: The overall response rate was 87.2% and 8713 participants were included in the final analysis. The mean age was 72.40 years (SD = 5.72), and women accounted for 42.2%. The prevalence of polypharmacy among older Chinese inpatients is 23.6%. After adjusting for age, sex, education, marriage status, body mass index, baseline frailty, handgrip strength, cognitive impairment, and the Charlson comorbidity index, polypharmacy is significantly associated with frailty aggravation (OR 1.432, 95% CI 1.258-1.631) and mortality (OR 1.365, 95% CI 1.174-1.592), while inversely associated with readmission (OR 0.870, 95% CI 0.764-0.989). Polypharmacy was associated with a 35.6% increase in the risk of falls (1.356, 95%CI 1.064-1.716). This association weakened after adjustment for multimorbidity to 27.3% (OR 1.273, 95%CI 0.992-1.622). CONCLUSIONS: Polypharmacy was prevalent among older inpatients and was a risk factor for 2-year frailty aggravation and mortality. These results highlight the importance of optimizing medication use in older adults to minimize the risks associated with polypharmacy. Further research and implementing strategies are warranted to enhance the quality of care and safety for older individuals exposed to polypharmacy. TRIAL REGISTRATION: Chinese Clinical Trial Registry, ChiCTR1800017682, registered 09/08/2018.

Association between Dietary Patterns and Cardiometabolic Multimorbidity among Chinese Rural Older Adults.

BACKGROUND: The global population is aging rapidly, leading to an increase in the prevalence of cardiometabolic multimorbidity (CMM). This study aims to investigate the association between dietary patterns and CMM among Chinese rural older adults. METHODS: The sample was selected using a multi-stage cluster random sampling method and a total of 3331 rural older adults were ultimately included. Multivariate logistic regression analysis was used to examine the association between the latent dietary patterns and CMM. RESULTS: The prevalence of CMM among rural older adults was 44.64%. This study identified four potential categories: "Low Consumption of All Foods Dietary Pattern (C1)", "High Dairy, Egg, and Red Meat Consumption, Low Vegetable and High-Salt Consumption Dietary Pattern (C2)", "High Egg, Vegetable, and Grain Consumption, Low Dairy and White Meat Consumption Dietary Pattern (C3)" and "High Meat and Fish Consumption, Low Dairy and High-Salt Consumption Dietary Pattern (C4)". Individuals with a C3 dietary pattern (OR, 0.80; 95% CI, 0.66-0.98; p = 0.028) and a C4 dietary pattern (OR, 0.70; 95% CI, 0.51-0.97; p = 0.034) significantly reduced the prevalence of CMM compared with the C1 dietary pattern. CONCLUSIONS: Rural older adults have diverse dietary patterns, and healthy dietary patterns may reduce the risk of CMM.

Treatment burden in multimorbidity: an integrative review.

BACKGROUND: People living with multimorbidity experience increased treatment burden, which can result in poor health outcomes. Despite previous efforts to grasp the concept of treatment burden, the treatment burden of people living with multimorbidity has not been thoroughly explored, which may limit our understanding of treatment burden in this population. This study aimed to identify the components, contributing factors, and health outcomes of treatment burden in people with multiple diseases to develop an integrated map of treatment burden experienced by people living with multimorbidity. The second aim of this study is to identify the treatment burden instruments used to evaluate people living with multimorbidity and assess the comprehensiveness of the instruments. METHODS: This integrative review was conducted using the electronic databases MEDLINE, EMBASE, CINAHL, and reference lists of articles through May 2023. All empirical studies published in English were included if they explored treatment burden among adult people living with multimorbidity. Data extraction using a predetermined template was performed. RESULTS: Thirty studies were included in this review. Treatment burden consisted of four healthcare tasks and the social, emotional, and financial impacts that these tasks imposed on people living with multimorbidity. The context of multimorbidity, individual's circumstances, and how available internal and external resources affected treatment burden. We explored that an increase in treatment burden resulted in non-adherence to treatment, disease progression, poor health status and quality of life, and caregiver burden. Three instruments were used to measure treatment burden in living with multimorbidity. The levels of comprehensiveness of the instruments regarding healthcare tasks and impacts varied. However, none of the items addressed the healthcare task of ongoing prioritization of the tasks. CONCLUSIONS: We developed an integrated map illustrating the relationships between treatment burden, the context of multimorbidity, people's resources, and the health outcomes. None of the existing measures included an item asking about the ongoing process of setting priorities among the various healthcare tasks, which highlights the need for improved measures. Our findings provide a deeper understanding of treatment burden in multimorbidity, but more research for refinement is needed. Future studies are also needed to develop strategies to comprehensively capture both the healthcare tasks and impacts for people living with multimorbidity and to decrease treatment burden using a holistic approach to improve relevant outcomes. TRIAL REGISTRATION: DOI: https://doi.org/10.17605/OSF.IO/UF46V.

Physiotherapists' Treatment Strategies and Delineation of Areas of Responsibility for People With Musculoskeletal Conditions and Comorbidities in Private Physiotherapy Practice: A Qualitative Study.

BACKGROUND: Patients with multiple chronic conditions, for example, musculoskeletal conditions and comorbidities, often receive inadequate and sometimes even contradictory care. Physiotherapists are well qualified to manage patients with musculoskeletal conditions and comorbidities due to their education and experience with rehabilitation; however, it is unknown which challenges they face when treating these patients. AIM: To identify challenges, treatment strategies, and delineations of areas of responsibility among physiotherapists working in private physiotherapy practice when treating people with musculoskeletal conditions and comorbidities. METHODS: Qualitative study using focus group discussions and participant observations of 13 physiotherapists working in Danish private physiotherapy clinics. Grounded theory was applied to guide the analysis. RESULTS: Two major themes emerged from the focus groups and the observations (1) The necessity of adapting management to the patients and their treatment trajectory; (2) The dilemma of overall responsibility for coordinating care. The physiotherapists described different elements of adapting their management, including being challenged on time, taking extra care of the patient, and having to adjust to a fluctuating course of treatment. The dilemma in coordinating care concerned whether the responsibility should lie with the physiotherapist, other healthcare professionals, or the patients, and whether to treat only the condition on the referral or to treat all the conditions the patient had. CONCLUSION: Physiotherapists use adapted strategies for diagnosing and treating patients with musculoskeletal conditions and comorbidities and are uncertain about the overall responsibility for coordinating care and whether they should focus on the index condition alone or also the other comorbidities the patient has.

Extreme temperature events, functional dependency, and cardiometabolic multimorbidity: Insights from a national cohort study in China.

BACKGROUND: Extreme temperature events (ETEs), including heatwaves and cold spells, are attracting increasing attention because of their impacts on human health. However, the association between ETEs and cardiometabolic multimorbidity (CMM) and the role of functional dependency in this relationship remain unclear. METHODS: A prospective cohort study was conducted using data from the China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2020, considering 12 definitions each for heatwaves and cold spells, and three levels of functional dependency. Mixed Cox models with time-varying variables were used to comprehensively assess the independent and combined effects of ETEs and functional dependency on CMM. Additionally, subgroup analyses were conducted to investigate whether the relationship between ETEs and CMM was modified by the baseline characteristics. RESULTS: Heatwave and cold spell exposures were associated with an increased risk of CMM (HR range: 1.028-1.102 and 1.046-1.187, respectively). Compared to participants with normal functional abilities, the risk of CMM increased with higher levels of functional dependency (HR range: 1.938-2.185). ETEs exposure and functional dependency are jointly associated with CMM risk. Participants with high-intensity ETEs exposure and high functional dependency had the greatest risk of developing CMM. Participants aged 60 and above were more susceptible to the effects of ETEs on CMM. Additionally, urban residents and those in northern regions were more vulnerable to heatwaves. CONCLUSION: Both ETEs exposure and functional dependency increase the risk of developing CMM. Participants with functional dependency exposed to high-intensity ETEs faced the highest risk of developing CMM. These findings highlight the significant impact of ETEs on CMM and the importance of protecting vulnerable populations during periods of extreme temperature.

Pharmacologic Treatment of Hypertension in Older Adults.

The authors conducted a review of pharmacologic therapy in older adults with hypertension. They reviewed the evidence supporting their use in older adults, understanding the physiologic changes and potential adverse drug effects associated with aging and antihypertensive medication use, exploring guideline recommendations for antihypertensive use in older adults, and evaluating the associated risks and benefits of specific classes of antihypertensive medications.

Chronic low-grade inflammation associated with higher risk and earlier onset of cardiometabolic multimorbidity in middle-aged and older adults: a population-based cohort study.

Evidence regarding the role of chronic low-grade inflammation in the progression of cardiometabolic diseases (CMDs) and cardiometabolic multimorbidity (CMM) is currently limited. This prospective cohort study, utilising data from the UK Biobank, included 273,804 adults aged 40-69 years initially free of CMD at baseline. CMM was defined as the coexistence of two or more CMDs, such as coronary artery disease, type 2 diabetes mellitus, hypertension and stroke. The aggregated inflammation score (INFLA-score), incorporating C-reactive protein, white blood cell count, platelet count and granulocyte-to-lymphocyte ratio, quantified chronic low-grade inflammation. Absolute risks (ARs), hazard ratios (HRs) and 95% confidence intervals (CIs) assessed the association of increased INFLA-score with the risk of CMMs and CMDs. The accelerated failure time model explored the effect of INFLA-score on the time to CMM onset, and a restricted cubic spline characterised the dose-dependent relationship between INFLA-score and CMM risk. After a median follow-up of 166.37 months, 13,755 cases of CMM were identified. In quartiles with increasing INFLA-score levels, CMM ARs were 4.41%, 4.49%, 5.04% and 6.01%, respectively; HR increased by 2%, 15% and 36%, respectively, compared to the lowest quartile. The INFLA-score and CMM risk relationship was nonlinear (P for nonlinear < 0.001), exhibiting a significant risk trend change at a score of 9. For INFLA-score < 9, CMM risk increased by 1.9% for each 1-point increase; for INFLA-score ≥ 9, the risk increased by 5.9% for each 1-point increase. Additionally, a higher INFLA-score was associated with an earlier onset of CMM (P < 0.001). Compared to the first INFLA-score quartile, the AFT model revealed adjusted median times to CMM occurrence were 2.92, 6.10 and 13.19 months earlier in the second, third and fourth quartile groups, respectively. Chronic low-grade inflammation is associated with a higher risk of cardiometabolic multimorbidity and earlier onset among middle-aged and older adults. Monitoring and screening the INFLA-score in adults without CMDs may improve early prevention of CMM.