Analysis of multiple chronic disease characteristics in middle-aged and elderly South Koreans by exercise habits based on association rules mining algorithm.

BACKGROUND: The term, "multiple chronic diseases" (MCD), describes a patient with two or more chronic conditions simultaneously at the same time. Compared with general chronic diseases, it is linked to poorer health outcomes, more difficult clinical management, and higher medical expenses. Several existing MCD guidelines support a healthy lifestyle including regular physical activities but do not include specific exercise therapy recommendations. This study aimed to understand the prevalence and model of MCD in middle-aged and elderly South Koreans by comparing MCD characteristics with exercise habits, to provide a theoretical basis for the implementation of exercise therapy in these patients. METHODS: The data of 8477 participants aged > 45 years from the "2020 Korean Health Panel Survey" were used to analyze the current status of MCD in the middle-aged and elderly. The Chi-square test for categorical variables and the t-test for continuous variables. the used software was IBM SPSS Statistics 26.0 and IBM SPSS Modeler 18.0. RESULTS: In this study, the morbidity rate of MCD was 39.1%. Those with MCD were more likely to be female (p < 0.001), seniors over 65 years of age (p < 0.001), with low education level, no regular exercise behavior (p < 0.01). Chronic renal failure (93.9%), depression (90.4%), and cerebrovascular disease (89.6%) were the top three diseases identified in patients with MCD. A total of 37 association rules were identified for the group of individuals who did not engage in regular exercise. This equated to 61% more than that of the regular exercise group, who showed only 23 association rules. In the extra association rules, cardiovascular diseases (150%), spondylosis (143%), and diabetes (125%) are the three chronic diseases with the highest frequency increase. CONCLUSIONS: Association rule analysis is effective in studying the relationship between various chronic diseases in patients with MCD. It also effectively helps with the identification of chronic diseases that are more sensitive to regular exercise behaviors. The findings from this study may be used to formulate more appropriate and scientific exercise therapy for patients with MCD.

Associations of multiple chronic disease and depressive symptoms with incident stroke among Chinese middle-aged and elderly adults: a nationwide population-based cohort study.

BACKGROUND: With the population aging, multiple chronic diseases, depressive symptoms, and stroke are increasingly common among middle-aged and elderly adults worldwide. This study aimed to explore the independent associations of multiple chronic diseases and depressive symptoms as well as their combination with incident stroke in a prospective cohort of Chinese middle-aged and elderly adults, and to sensitively estimate the association between each type of chronic disease and incident stroke. METHODS: This study used data from the China Health and Retirement Longitudinal Study (CHARLS). A total of 8389 participants meeting the inclusion criteria at baseline (between 2011 and 2012) survey were included, and 7108 eligible participants completed the follow-up survey over 8 years (Wave 4, in 2018). Questionnaire information, physical examination, and clinical and biochemical measurements were collected. RESULTS: The mean (SD) age at baseline was 58.5 (± 9.1) years. Multiple chronic disease and depressive symptoms were independently associated with incident stroke. After adjusting for control variables, patients having 1 type of chronic disease and depressive symptoms were at 1.943 (95% CI = 1.166-3.238) times higher risk of incident stroke than those without chronic disease and depressive symptoms, and patients having at least 2 types of chronic diseases and depressive symptoms were at 3.000 (95% CI = 1.846-4.877) times higher risk of incident stroke; the magnitudes of the associations increased by the numbers of having chronic diseases and depressive symptoms. Sensitivity analyses incorporating all five types of chronic disease (i.e., hypertension, dyslipidemia, heart disease, diabetes, and chronic kidney disease) showed that the magnitude of the associations between hypertension and incident stroke was most significant. CONCLUSIONS: We identified significant independent and combined longitudinal associations of multiple chronic diseases and depressive symptoms with incident stroke, and the combined associations reflected a dose-response relationship. The association between hypertension and incident stroke was strongest among the five chronic diseases.

Health literacy profiles of adults with multiple chronic diseases: A cross-sectional study using the Health Literacy Questionnaire.

Health literacy is multidimensional, comprising functional, communicative, and critical thinking dimensions. Understanding health literacy is crucial for clinicians to develop effective health education strategies. In this study, we examined the multiple dimensions of health literacy in Vietnamese adults with chronic comorbidities. A cross-sectional sample of 600 patients, aged ≥18 years with a diagnosis of at least two chronic diseases (cardiovascular conditions, chronic kidney disease, or diabetes), completed the Health Literacy Questionnaire, an instrument assessing nine distinct domains. Descriptive and parametric tests were performed to analyze the health literacy levels for various demographic characteristics. Generalized linear models using backward modelling explored factors associated with higher health literacy. The lowest scoring domains were "Healthcare provider support" and "Appraisal of health information." In multivariate models greater health literacy was associated with those <65 years, having a postsecondary degree or higher level of education, greater income, urban residence, being cared for by spouses/children, and having fewer comorbidities. To improve health literacy, clinicians in primary and acute healthcare settings should build supportive relationships with patients and assist them with understanding and appraising health information.

"It's a fight to get anything you need" - Accessing care in the community from the perspectives of people with multimorbidity.

BACKGROUND: There is a growing interest in redesigning health-care systems to better manage the increasing numbers of people with multimorbidity. Knowing how patients experience health-care delivery and what they need from the health-care system are critical pieces of evidence that can be used to guide health system reforms. OBJECTIVE: The purpose of this study was to understand the challenges patients with multimorbidity face in accessing care in the community, and the implications for patients and their families. METHODS: A secondary analysis of qualitative data was conducted on semi-structured interviews with 116 patients who were receiving care in an urban rehabilitation facility in 2011. Exploratory interpretive analysis was used to identify themes about access to care. RESULTS: Challenges occurred at two levels: at the health system level and at the individual (patient) level. Issues at the health system level fell into two broad categories: availability of services (failing to qualify, coping with wait times, struggling with scarcity and negotiating the location of care) and service delivery (unreliable care, unmet needs, incongruent care and inflexible care). Challenges at the patient level fell into the themes of logistics of accessing care and financial strain. Patients interacted and responded to these challenges by: managing the system, making personal sacrifices, substituting with informal care, and resigning to system constraints. CONCLUSION: Identifying the barriers patients encounter and the lengths they go to in order to access care highlights areas where policy initiatives can focus to develop appropriate and supportive services that are more person and family-centred.

[Being cared for and caring: living with multiple chronic diseases (Leila)-a qualitative study about APN contributions to integrated care]. / Umsorgt werden und umsorgen: Leben mit mehreren Langzeiterkrankungen (Leila) - Eine qualitative Studie zum Beitrag von APN in integrierter Versorgung.

BACKGROUND: Living with multiple chronic diseases is complex and leads to enhanced care needs. To foster integrated care a project called "Living with chronic disease" (Leila) was initiated. AIM: The aim was to develop an Advanced Practice Nursing (APN) service in collaboration with medical centers for persons who are living with multiple chronic diseases. The following research questions were addressed: 1. What are patients' experiences, referring physicians and APNs with the Leila-Service? 2. How are referral processes performed? 3. How do the involved groups experience collaboration and APN role development? METHODS: A qualitative approach according grounded theory of Corbin and Strauss was used to explore the experiences with the Leila project and the interaction of the persons involved. 38 interviews were conducted with patients who are living with multiple chronic diseases, their APN's and the referring physicians. RESULTS: The findings revealed "Being cared for and caring" as main category. The data demonstrated how patients responded to their involvement into care and that they were taken as serious partners in the care process. The category "organizing everyday life" describes how patients learned to cope with the consequences of living with multiple chronic diseases. "Using all resources" as another category demonstrates how capabilities and strengths were adopted. CONCLUSIONS: The results of the cooperation- and allocation processes showed that the APN recognition and APN role performance have to be negotiated. Prospective APN-services for this patient population should be integrated along with physician networks and other service providers including community health nursing.

Analysis of multiple chronic disease characteristics in South Koreans by age groups using association rules analysis.

The prevalence of MCD (multiple chronic disease) is increasing due to increased life expectancies and aging populations. Individual and socioeconomic burdens of MCD are also increasing. To reduce these burdens, it is necessary to establish policies to prevent MCD; therefore, it is important to understand the characteristics of MCD in the current population. In this study, the combinations of MCD that affect hypertension, which has the highest prevalence, were examined according to different age groups. The combinations of diseases were identified utilizing association rules analysis, using the Community Health Survey as the raw data. Two association rules were determined in young adult group, 18 in the middle-aged group, and 30 in the senior group, showing that the number of rules increases with age. Association rules of this study mean that combined chronic diseases are highly associated with hypertension. Then logistic regression analysis was performed on the MCD combinations with highest lift value in each age group to identify relationships between health behavior and MCD combinations. Especially, alcohol consumption was found to be a common factor affecting MCD prevalence in three combinations. On the contrary, sleep habit did not have a statistically significant influence on any combination.

Psychosocial phenotyping as a personalization strategy for chronic disease self-management interventions.

BACKGROUND: As the U.S. population grows older and more diverse, self-management needs are increasingly complicated. In order to deliver effective personalized interventions to those suffer from chronic conditions social determinants of health must be considered. Therefore, psychosocial phenotyping holds strong promise as a tool for tailoring interventions based on precision health principles. PURPOSE: To define psychosocial phenotyping and develop a research agenda that promotes its integration into chronic disease management as a tool for precision self-management interventions. METHODS: Since psychosocial phenotyping is not yet used in interventions for self-management support, we conducted a literature review to identify potential phenotypes for chronic disease self-management. We also reviewed policy intervention case reports from the Centers for Medicare and Medicaid Services to examine factors related to social determinants of health in people with chronic illnesses. Finally, we reviewed methodological approaches for identifying patient profiles or phenotypes. RESULTS: The literature review revealed areas within which to collect data for psychosocial phenotyping that can inform personalized interventions. The findings of our exemplar cases revealed that several environmental or key SDOH such as factors realted with economic stability and neighborhood environment have been closely linked with the success of chronic disease management interventions. We elucidated theory, definitions, and pragmatic conceptual boundaries related to psychosocial phenotyping for precision health. CONCLUSIONS: Our literature review with case example analysis demonstrates the potential usefulness of psychosocial phenotyping as a tool to enhance personalized self-management interventions for people with chronic diseases, with implications for future research.

Individualized Absolute Risk Calculations for Persons with Multiple Chronic Conditions: Embracing Heterogeneity, Causality, and Competing Events.

Approximately 75% of adults over the age of 65 years are affected by two or more chronic medical conditions. We provide a conceptual justification for individualized absolute risk calculators for competing patient-centered outcomes (PCO) (i.e. outcomes deemed important by patients) and patient reported outcomes (PRO) (i.e. outcomes patients report instead of physiologic test results). The absolute risk of an outcome is the probability that a person receiving a given treatment will experience that outcome within a pre-defined interval of time, during which they are simultaneously at risk for other competing outcomes. This allows for determination of the likelihood of a given outcome with and without a treatment. We posit that there are heterogeneity of treatment effects among patients with multiple chronic conditions (MCC) largely depends on those coexisting conditions. We outline the development of an individualized absolute risk calculator for competing outcomes using propensity score methods that strengthen causal inference for specific treatments. Innovations include the key concept that any given outcome may or may not concur with any other outcome and that these competing outcomes do not necessarily preclude other outcomes. Patient characteristics and MCC will be the primary explanatory factors used in estimating the heterogeneity of treatment effects on PCO and PRO. This innovative method may have wide-spread application for determining individualized absolute risk calculations for competing outcomes. Knowing the probabilities of outcomes in absolute terms may help the burgeoning population of patients with MCC who face complex treatment decisions.