Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 693
Filtrar
1.
Epidemiol Health ; 42: e2020001, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32028546

RESUMO

OBJECTIVES: The incidence of multimorbidity (MM) and its correlates among older adults remain poorly understood. This study aimed to examine the socio-demographic and lifestyle factors associated with MM in New Zealand. METHODS: People aged 55-70 years were invited to participate in a population-based cohort study, the Health Work and Retirement Study, in 2006. Those who accepted the invitation and completed the baseline questionnaire were followed up on a biennial basis. Data on socio-demographic factors, health and lifestyle behaviours, and diagnoses of chronic diseases were obtained from baseline and 6 waves of follow-up. Generalised estimating equations (GEE) adjusted for both time-constant and time-varying factors were used to model factors associated with the onset of MM. RESULTS: A total of 1,673 participants (with 0 or 1 chronic condition) contributed to an overall 8,616 person-years of observation. There were 590 new cases of MM over 10 years of follow-up, corresponding to an overall incidence of 68.5 per 1,000 person-years. The results of the age- and sex-adjusted GEE analysis showed that age, ethnicity, living alone, obesity, hypertension, and having 1 chronic condition at baseline were significant predictors of MM onset. Higher education, income, physical activity, and regular alcohol consumption were protective factors. In a fully adjusted model, marital status (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.01 to 1.37; p=0.039), hypertension (OR, 1.23; 95% CI, 1.02 to 1.48; p=0.032) and having 1 chronic condition at baseline (OR, 2.92; 95% CI, 2.33 to 3.67; p<0.001) remained significant. CONCLUSIONS: The higher incidence of MM among Maori people, socioeconomically disadvantaged groups, those with low physical activity, and obese individuals highlights the importance of targeted prevention strategies.


Assuntos
Multimorbidade , Idoso , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Fatores de Risco , Fatores Socioeconômicos
2.
Mayo Clin Proc ; 94(12): 2381-2382, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806094
3.
Mayo Clin Proc ; 94(12): 2427-2436, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31668449

RESUMO

OBJECTIVES: To analyze the relationship between atrial fibrillation (AF) and Charlson comorbidity index (CCI) in a population-based cohort study over a long-term follow-up period, in relation to oral anticoagulant (OAC) prescriptions and outcomes. PATIENTS AND METHODS: We used data from the administrative health databases of Lombardy. All patients with AF and age 40 years and older and who were admitted to the hospital in 2002 were considered for analysis and followed up to 2014. AF diagnosis and CCI were established according to codes from the International Classification of Diseases, Ninth Revision. RESULTS: In 2002, 24,040 patients were admitted with a diagnosis of AF. CCI was higher in patients with AF than in those without AF (1.8±2.1 vs 0.2±0.9; P<.001). Over 12 years of follow-up, AF was associated with an increased risk of higher CCI (beta coefficient, 1.69; 95% CI, 1.67-1.70). In patients with AF, CCI was inversely associated with OAC prescription at baseline (P<.001) and at the end of the follow-up (P=.03). Patients with AF and a high CCI (≥4) had a higher cumulative incidence of stroke, major bleeding, and all-cause death (all P<.001), compared with those with low CCI (range, 0-3). Adjusted Cox regression analysis revealed that time-dependent continuous CCI was associated with an increased risk for stroke, major bleeding, and all-cause death (all P<.001). CONCLUSIONS: In hospitalized patients, AF is associated with an increase in CCI that is inversely associated with OAC prescriptions during follow-up. CCI is independently associated with an increased risk of stroke, major bleeding, and all-cause death.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/epidemiologia , Multimorbidade , Administração Oral , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Esquema de Medicação , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
4.
BMC Health Serv Res ; 19(1): 795, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690308

RESUMO

BACKGROUND: Half of the older persons in high-income counties are affected with multimorbidity and the prevalence increases with older age. To cope with both the complexity of multimorbidity and the ageing population health care systems needs to adapt to the aging population and improve the coordination of long-term services. The objectives of this review were to synthezise how older people with multimorbidity experiences integrations of health care services and to identify barriers towards continuity of care when multimorbid. METHODS: A systematic literature search was conducted in February 2018 by in Scopus, Embase, Cinahl, and Medline using the PRISMA guidelines. INCLUSION CRITERIA: studies exploring patients' point of view, ≥65 and multi-morbid. Quality assessment was conducted using COREQ. Thematic synthesis was done. RESULTS: Two thousand thirty studies were identified, with 75 studies eligible for full text, resulting in 9 included articles, of generally accepted quality. Integration of health care services was successful when the patients felt listened to on all the aspects of being individuals with multimorbidity and when they obtained help from a care coordinator to prioritize their appointments. However, they felt frustrated when they did not have easy access to their health providers, when they were not listened to, and when they felt they were discharged too early. These frustrations were also identified as barriers to continuity of care. CONCLUSIONS: Health care systems needs to adapt to people with multimorbidity and find solutions on ways to create flexible systems that are able to help older patients with multimorbidity, meet their individual needs and their desire to be involved in decisions regarding their care. A Care coordinator may be a solution.


Assuntos
Atitude Frente a Saúde , Prestação Integrada de Cuidados de Saúde , Multimorbidade , Idoso , Humanos
5.
BMC Public Health ; 19(1): 1361, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651286

RESUMO

BACKGROUND: Cardiometabolic multimorbidity (CM) is defined as having a diagnosis of at least two of stroke, heart disease, or diabetes, and is an emerging health concern, but the prevalence of CM at a population level in Canada is unknown. The objectives of this study were to quantify the: 1) prevalence of CM in Canada; and 2) association between CM and lifestyle behaviours (e.g., physical activity, consumption of fruits and vegetables, and stress). METHODS: Using data from the 2016 Canadian Community Health Survey, we estimated the overall and group prevalence of CM in individuals aged ≥50 years (n = 13,226,748). Multiple logistic regression was used to quantify the association between CM and lifestyle behaviours compared to a group without cardiometabolic conditions. RESULTS: The overall prevalence of CM was 3.5% (467,749 individuals). Twenty-two percent (398,755) of people with diabetes reported having another cardiometabolic condition and thus CM, while the same was true for 32.2% (415,686) of people with heart disease and 48.4% (174,754) of stroke survivors. 71.2% of the sample reported eating fewer than five servings of fruits and vegetables per day. The odds of individuals with CM reporting zero minutes of physical activity was 2.35 [95% CI = 1.87 to 2.95] and having high stress was 1.89 [95% CI = 1.49 to 2.41] times the odds of the no cardiometabolic condition reference group. The odds of individuals with all three cardiometabolic conditions reporting zero minutes of physical activity was 4.31 [95% CI = 2.21 to 8.38] and having high stress was 3.93 [95% CI = 2.03 to 7.61]. CONCLUSION: The number of Canadians with CM or at risk of CM is high and these individuals have lifestyle behaviours that are associated with adverse health outcomes. Lifestyle behaviours tend to diminish with increasing onset of cardiometabolic conditions. Lifestyle modification interventions focusing on physical activity and stress management for the prevention and management CM are warranted.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Metabólicas/epidemiologia , Multimorbidade , Idoso , Canadá/epidemiologia , Estudos Transversais , Dieta/estatística & dados numéricos , Exercício , Feminino , Inquéritos Epidemiológicos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Estresse Psicológico/epidemiologia
6.
BMC Public Health ; 19(1): 1383, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660910

RESUMO

BACKGROUND: The aim of this study was to examine the association between multimorbidity and (i) loneliness, (ii) social exclusion and (iii) network size, respectively. METHODS: Cross-sectional data from a German representative sample of community-dwelling adults aged 40 and over was used (N = 7604). Multimorbidity was indicated with the presence of two or more diseases. Self-rated loneliness was assessed with a short form of the validated De Jong Gierveld Loneliness Scale and social exclusion was measured with a validated scale developed by Bude and Lantermann. Counts of important people in regular contact represented the network size of respondents. RESULTS: Multimorbidity was present in 68% of the sample. While controlling for potential confounders, multiple linear regression analysis yielded that multimorbidity was associated with increased loneliness (b = 0.08; p < 0.001) and increased social exclusion (b = 0.10; p < 0.01). Multimorbidity was also associated with an increased network size (b = 0.27; p < 0.001). CONCLUSION: While there was an association between multimorbidity and increased social exclusion as well as increased loneliness, regressions also revealed an association between multimorbidity and an increased network size. Although the association between multimorbidity and our outcome measures is weak, its complex nature should be investigated further using a longitudinal approach.


Assuntos
Solidão , Multimorbidade , Distância Social , Rede Social , Adulto , Idoso , Estudos Transversais , Feminino , Alemanha/epidemiologia , Humanos , Vida Independente , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Inquéritos e Questionários
7.
Fortschr Neurol Psychiatr ; 87(10): 564-570, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31627238

RESUMO

Multimorbidity in older psychiatric patients. OBJECTIVE: Multimorbidity represents a great challenge in the medical care of older people. METHODS: This exploratory study was part of the Gerontopsychiatry study Berlin (Gepsy-B), an analysis of data on all 941 older inpatients (> 65 years) admitted to a psychiatric hospital within a period of 3 years. RESULTS: Nearly all patients (94,2 %) suffered from a chronic somatic disorder. The mean number of chronic somatic disorders was 2.70 + 1.39 and showed age dependency (r = 0.257, p < .001). The most prevalent disorders were cerebrovascular disorders (56.5 %), hypertension (54.8 %), chronic ischemic heart diseases or arrhythmias (52.2 %) and diabetes mellitus type II (37.5 %). Furthermore, many of the patients suffered from disabilities such as movement disorders (26.2 %), severe hearing loss (16.5 %), incontinence (15.1 %) or severely reduced vision (7.4 %). Organic brain disorders were more often associated with chronic somatic disorders or disabilities. CONCLUSIONS: Older patients treated for psychiatric disorders very often show somatic multimorbidity that probably limit treatment outcome.


Assuntos
Transtornos Mentais/epidemiologia , Multimorbidade , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/epidemiologia , Hospitais Psiquiátricos , Humanos , Transtornos Mentais/complicações
8.
Rev Med Suisse ; 15(669): 1968-1971, 2019 Oct 30.
Artigo em Francês | MEDLINE | ID: mdl-31663696

RESUMO

We have been studying multimorbidity in epidemiology and clinical practice since the 1970s. Growing experience shows that the concept of multimorbidity is helpful for epidemiologists to describe population-level changes, but of little use to patients and clinicians who 'diagnose' multimorbidity. Several large, rigorous clinical trials show that organizational changes in primary care can improve the care of these complex patients, but do not improve directly health-related quality of life. This article describes the history of multimorbidity and results of recent randomized trials to prompt a discussion of new approaches to improve the experience of people living with multiple chronic diseases.


Assuntos
Doença Crônica , Multimorbidade/tendências , Atenção Primária à Saúde/métodos , Doença Crônica/epidemiologia , Doença Crônica/terapia , Humanos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
9.
BMC Health Serv Res ; 19(1): 708, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623664

RESUMO

BACKGROUND: Multimorbidity is associated with higher healthcare resource utilization, but we lack data on the association of specific combinations of comorbidities with healthcare resource utilization. We aimed to identify the combinations of comorbidities associated with high healthcare resource utilization among multimorbid medical inpatients. METHODS: We performed a multicentre retrospective cohort study including 33,871 multimorbid (≥2 chronic diseases) medical inpatients discharged from three Swiss hospitals in 2010-2011. Healthcare resource utilization was measured as 30-day potentially avoidable readmission (PAR), prolonged length of stay (LOS) and difference in median LOS. We identified the combinations of chronic comorbidities associated with the highest healthcare resource utilization and quantified this association using regression techniques. RESULTS: Three-fourths of the combinations with the strongest association with PAR included chronic kidney disease. Acute and unspecified renal failure combined with solid malignancy was most strongly associated with PAR (OR 2.64, 95%CI 1.79;3.90). Miscellaneous mental health disorders combined with mood disorders was the most strongly associated with LOS (difference in median LOS: 17 days) and prolonged LOS (OR 10.77, 95%CI 8.38;13.84). The number of chronic diseases was strongly associated with prolonged LOS (OR 9.07, 95%CI 8.04;10.24 for ≥10 chronic diseases), and to a lesser extent with PAR (OR 2.16, 95%CI 1.75;2.65 for ≥10 chronic diseases). CONCLUSIONS: Multimorbidity appears to have a higher impact on LOS than on PAR. Combinations of comorbidities most strongly associated with healthcare utilization included kidney disorders for PAR, and mental health disorders for LOS.


Assuntos
Doença Crônica/epidemiologia , Doença Crônica/terapia , Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suíça/epidemiologia
10.
Clin Interv Aging ; 14: 1681-1691, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631989

RESUMO

Grip strength has been proposed as a biomarker. Supporting this proposition, evidence is provided herein that shows grip strength is largely consistent as an explanator of concurrent overall strength, upper limb function, bone mineral density, fractures, falls, malnutrition, cognitive impairment, depression, sleep problems, diabetes, multimorbidity, and quality of life. Evidence is also provided for a predictive link between grip strength and all-cause and disease-specific mortality, future function, bone mineral density, fractures, cognition and depression, and problems associated with hospitalization. Consequently, the routine use of grip strength can be recommended as a stand-alone measurement or as a component of a small battery of measurements for identifying older adults at risk of poor health status.


Assuntos
Depressão/psicologia , Força da Mão/fisiologia , Nível de Saúde , Resistência Física/fisiologia , Qualidade de Vida/psicologia , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Depressão/epidemiologia , Feminino , Avaliação Geriátrica , Hospitalização , Humanos , Masculino , Multimorbidade
11.
J Stroke Cerebrovasc Dis ; 28(11): 104358, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31519456

RESUMO

BACKGROUND: The majority of studies on multimorbidity have been in aging populations and there is a paucity of data on individuals following stroke. OBJECTIVE: In order to better understand the overall complexity of the stroke population in rural Kentucky, we examined the prevalence of multimorbidity that impact the overall long-term health and health care for these individuals. METHODS: A secondary analysis examined whether there are gender or age differences in this stroke population related to the prevalence of multimorbidity. A total of 5325 individuals, 18 years of age and older, seen at an academic medical center for the primary diagnosis of acute ischemic stroke or transient ischemic attack between the years of 2010-2017 were identified using the Kentucky Appalachian Stroke Registry. Descriptive analysis was used to report the prevalence of each comorbidity in the rural population by age group, gender, and level of multimorbidity by looking at concurrent frequencies. RESULTS: Overall, hypertension, dyslipidemia, tobacco use, diabetes, and obesity were the comorbidities with the highest prevalence in our population irrespective of gender. Over 78% (n = 4153) of the individuals had 3 or more comorbidities while 61% (n = 3285) had at least 3 out of the top 5 comorbidities (hypertension, hyperlipidemia, tobacco, obesity, diabetes). With respect to age, 15% (n = 795) of the sample was under the age of 50, while 32% (n = 1704) were between the age of 50 and 64 and 53% (n = 2826) of the sample were 65 years or older. CONCLUSIONS: The results of this study indicate the majority of individuals affected by stroke in rural Appalachia Kentucky have multimorbidity. In addition, almost half of these individuals are having their strokes at a younger age, which will require a shift in the focus for therapeutic interventions (eg, reintegration into the workforce versus just community reintegration).


Assuntos
Ataque Isquêmico Transitório/epidemiologia , Multimorbidade , Saúde da População Rural , Acidente Vascular Cerebral/epidemiologia , Idade de Início , Idoso , Região dos Apalaches/epidemiologia , Feminino , Nível de Saúde , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Medição de Risco , Fatores de Risco , Serviços de Saúde Rural , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral
12.
Soins Gerontol ; 24(139): 22-24, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31540717

RESUMO

Polymorbidity is frequent in very old people, particularly in nursing homes, where patients are often extremely frail. They are particularly at risk of polypharmacy and iatrogenic effects, which can result in worsen the quality of the end of life of these patients. A new approach must be found, centred on the patient rather than the disease.


Assuntos
Idoso Fragilizado , Multimorbidade , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Humanos , Casas de Saúde , Polimedicação
15.
Sr Care Pharm ; 34(7): 456-463, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31383057

RESUMO

OBJECTIVE: To determine whether the pharmacistled Geriatric Education and Medication Management (GEMM) clinic utilizing the Pharmacists' Patient Care Process (PPCP) improves therapeutic and safety outcomes in ambulatory older adults. DESIGN/PATIENTS: This is a retrospective, case series of veterans newly enrolled into the GEMM clinic from September 2013 to September 2015. SETTING: This study was conducted in an ambulatory pharmacist-led clinic at the Baltimore Veteran Affairs Medical Center in Maryland. INTERVENTION: Demographic, clinical, laboratory, and pharmacy fill data were collected from the computerized patient record system. Medication use patterns were collected using the clinic's supplemental medication reconciliation flowsheet. Descriptive statistics were used to analyze data. MAIN OUTCOME MEASURE(S): Change in adherence rate, number of potentially inappropriate medications, and number of care transitions within the 12-month study period. RESULTS: The primary outcome of medication adherence was high throughout the 12-month study period; beginning at 91.1% at baseline and increasing to 99.0% by the fourth quarter. There was a 36.4% decrease in number of potentially inappropriate medications (PIMs) from 22 at baseline to 14 at 12 months. Medication-related, short-term care transitions decreased from 10 to 4 in the pre- to post-clinic enrollment time frame. Only one subject experienced a long-term care transition during the study period. CONCLUSIONS: Implementing the PPCP in the pharmacist-led GEMM clinic improved medication adherence and persistence, decreased number of PIMs, and assisted in preventing care transitions in ambulatory older adults with multimorbidity and polypharmacy.


Assuntos
Assistência ao Paciente , Farmacêuticos , Idoso , Baltimore , Humanos , Adesão à Medicação , Multimorbidade , Estudos Retrospectivos
16.
Geriatr Gerontol Int ; 19(8): 699-704, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31397060

RESUMO

The number of older adults is increasing worldwide, including in Asian countries. Various problems associated with medical care for older adults are being highlighted in aging societies. As the number of chronic diseases increases with age, older adults are more likely to have multiple chronic diseases simultaneously (multimorbidity). Multimorbidity results in poor health-related outcomes, leading to increased use and cost of healthcare. Above all, it leads to deterioration in older adults' quality of life. However, it is unclear whether any medical interventions are effective for multimorbidity, which means medical practitioners currently offer medical care "in the dark." It is therefore necessary for researchers and medical professionals involved in geriatric medicine to establish ways to manage multimorbidity among older adults. This means that the development of research in this field is essential. Geriatr Gerontol Int 2019; 19: 699-704.


Assuntos
Geriatria , Multimorbidade/tendências , Múltiplas Afecções Crônicas , Qualidade de Vida , Idoso , Geriatria/métodos , Geriatria/tendências , Saúde Global , Serviços de Saúde para Idosos , Transição Epidemiológica , Humanos , Múltiplas Afecções Crônicas/economia , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Pesquisa
17.
Clin Interv Aging ; 14: 1285-1296, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31409978

RESUMO

Background: South Africa has been experiencing a growing proportion of elderly population with rapid increases in the burden of non-communicable diseases (NCDs) characteristic of population aging. Rural areas in South Africa represent a far smaller fraction of the population, however, share a relatively higher burden of NCDs. In the current literature, there is limited evidence on rural studies in the context of chronic diseases and activities of daily living (ADLs) among the elderly population (60 years and above) in South Africa. Purpose: In this regard, we undertook the present study with the objective of examining the demographic, behavioral, and socioeconomic predictors of subjective health, depression, and quality of life among elderly men and women living in the rural areas (n=2,627). Methods: Data for this study were collected from the Health and Aging in Africa: A Longitudinal Study of an INDEPTH Community in South Africa (HAALSI). Main explanatory variables were self-reported NCDs and difficulties in ADLs. The predictors of subjective health, depression, and quality of life were assessed using multivariable regression methods. Results: We found that the proportion of participants who reported good health, not having depression, and good quality of life was respectively 44.7%, 81.3%, and 63%. Women in the oldest age group (80+ years) were significantly less likely to report good health (OR=0.577, 95% CI=0.420, 0.793) and quality of life (OR=0.709, 95% CI=0.539, 0.933) compared with those in the youngest group. Having more than one chronic condition and ADL difficulties significantly lowered the odds of good health, having no depression, and quality of life among men and women. Conclusion: The present findings suggest the involvement of sociodemographic factors in health and quality of life outcomes among elderly South Africans, and call for enhanced efforts to address these health limiting conditions such as ADLs and chronic multimorbidity.


Assuntos
Depressão/epidemiologia , Comportamentos Relacionados com a Saúde , Multimorbidade , Qualidade de Vida , População Rural , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Nível de Saúde , Humanos , Estudos Longitudinais , Masculino , Análise de Regressão , Autorrelato , Fatores Sexuais , Fatores Socioeconômicos , África do Sul/epidemiologia
18.
J Glob Health ; 9(2): 020413, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31448114

RESUMO

Background: Past studies have demonstrated how single non-communicable diseases (NCDs) affect health care utilisation and quality of life (QoL), but not how different NCD combinations interact to affect these. Our study aims to investigate the prevalence of NCD dyad and triad combinations, and the implications of different NCD dyad combinations on health care utilisation and QoL. Methods: Our study utilised cross-sectional data from the WHO SAGE study to examine the most prevalent NCD combinations in six large middle-income countries (MICs). Subjects were mostly aged 50 years and above, with a smaller proportion aged 18 to 49 years. Multivariable linear regression was applied to investigate which NCD dyads increased or decreased health care utilisation and QoL, compared with subjects with only one NCD. Results: The study included 41 557 subjects. Most prevalent NCD combinations differed by subgroups, including age, gender, income, and residence (urban vs rural). Diabetes, stroke, and depression had the largest effect on increasing mean number of outpatient visits, increasing mean number of hospitalisation days, and decreasing mean QoL scores, respectively. Out of the 36 NCD dyads in our study, thirteen, four, and five dyad combinations were associated with higher or lower mean number of outpatient visits, mean number of hospitalisations, or mean QoL scores, respectively, compared with treating separate patients with one NCD each. Dyads of depression were associated with fewer mean outpatient visits, more hospitalisations, and lower mean QoL scores, compared to patients with one NCD. Dyads of hypertension and diabetes were also associated with a reduced mean number of outpatient visits. Conclusions: Certain NCD combinations increase or decrease health care utilisation and QoL substantially more than treating separate patients with one NCD each. Health systems should consider the needs of patients with different multimorbidity patterns to effectively respond to the demands on health care utilisation and to mitigate adverse effects on QoL.


Assuntos
Países em Desenvolvimento , Multimorbidade/tendências , Doenças não Transmissíveis/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Qualidade de Vida , Adolescente , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Índia/epidemiologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prevalência , Federação Russa/epidemiologia , África do Sul/epidemiologia , Adulto Jovem
20.
Ned Tijdschr Geneeskd ; 1632019 08 19.
Artigo em Holandês | MEDLINE | ID: mdl-31433143

RESUMO

Complexity of patient care is rapidly increasing as a consequence of rising numbers of patients with complex multimorbidity. Not just the patient as a whole, but also the networks of organs, tissues and cells are forming a complex adaptive system (CAS). A CAS is defined as a network of several components ('agents') with lots of mutual feedback loops between which there are circular causalities; the predictability of a CAS is limited by definition. However, current guidelines and evidence-based medicine assume that diseases and the medical interventions to address them are predictable. Physicians' brains are complex neural networks that are much better at dealing with complex situations than guidelines. In the near future, physicians will also get help from advanced computer simulation models that make better diagnostic analyses on the basis of detailed phenotyping and are more accurate when predicting possible courses of disease and treatment outcomes.


Assuntos
Envelhecimento , Multimorbidade/tendências , Múltiplas Afecções Crônicas/terapia , Idoso , Pesquisa Biomédica/organização & administração , Simulação por Computador , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA