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Comorbidity, health status, and quality of life in institutionalized older people with and without dementia

Published online by Cambridge University Press:  11 April 2013

Salomé Martín-García ,
Carmen Rodríguez-Blázquez ,
Iluminada Martínez-López ,
Pablo Martínez-Martín  and
Maria João Forjaz
Salomé Martín-García
Affiliation:
EULEN Socio-sanitary services, Madrid, Spain
Carmen Rodríguez-Blázquez*
Affiliation:
National Center of Epidemiology, Institute of Health Carlos III, Madrid, Spain CIBERNED, Madrid, Spain
Iluminada Martínez-López
Affiliation:
EULEN Socio-sanitary services, Madrid, Spain
Pablo Martínez-Martín
Affiliation:
Research Unit, CIEN Foundation, Institute of Health Carlos III, Alzheimer Center Reina Sofia Foundation, Madrid, Spain CIBERNED, Madrid, Spain
Maria João Forjaz
Affiliation:
National School of Public Health, Institute of Health Carlos III, Madrid, Spain REDISSEC, Bilbao, Spain
*
Correspondence should be addressed to: Carmen Rodriguez-Blazquez, National Center of Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain. Phone: +34-91-822-2657; Fax: +34-91-387-7815. Email: crodb@isciii.es.
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Abstract

Background: Comorbidity in older adults may lead to lower perceived health status and a decrease in quality of life (QoL). The objective of this study is to analyze the relationship between comorbidity, health status, QoL, and dementia in institutionalized older adults.

Methods: Cross-sectional, multicenter study in residential care settings in Spain. Two groups of institutionalized older adults of 60 years of age and older were compared: 234 persons with normal cognitive function and 525 with dementia according to DSM-IV-TR criteria. Assessments included: sociodemographic questionnaire, EQ-5D index for health-related QoL, Visual Analogue Scale (EQ-VAS) for health status, number of chronic medical conditions (comorbidity), Barthel Index for functional independence, and Short Portable Mental Status Questionnaire.

Results: The group with dementia presented significantly worse QoL, health, and functional status than people without dementia. The most prevalent chronic medical conditions were musculoskeletal (72.3%), followed by genito-urinary disorders (60.2%). Controlling for age and sex, people with dementia and higher comorbidity exhibited lower EQ-VAS scores; however, no significant difference was found for the EQ-5D index. The health conditions that contributed the most to the EQ-VAS differences between the dementia and non-dementia groups were sight, oral, and genito-urinary problems.

Conclusions: When compared to older adults with no dementia, people with dementia and high comorbidity reported the most compromised health status, especially in those with sight, oral, and genito-urinary problems. These differences should be taken into consideration when selecting strategies to maintain and improve the health status of older adults in residential care settings.

Keywords

comorbidityhealth statusquality of lifeolder adultsdementia
Type
Research Article
Information
International Psychogeriatrics , Volume 25 , Issue 7 , July 2013 , pp. 1077 - 1084
Copyright
Copyright © International Psychogeriatric Association 2013 

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References

Antonovsky, A. (1979). Health, Stress, and Coping. San Fransisco, CA: Jossey-Bass.Google Scholar
Asakawa, K., Feeny, D., Senthilselvan, A., Johnson, J. A. and Rolfson, D. (2009). Do the determinants of health differ between people living in the community and in institutions? Social Science & Medicine, 69, 345–353.CrossRefGoogle ScholarPubMed
Bryan, S., Hardyman, W., Bentham, P., Buckley, A. and Laight, A. (2005). Proxy completion of EQ-5D in patients with dementia. Quality of Life Research, 14, 107–118.CrossRefGoogle ScholarPubMed
Charlson, M. E., Pompei, P., Ales, K. L. and McKenzie, C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373–383.CrossRefGoogle ScholarPubMed
Coucill, W., Bryan, S., Bentham, P., Buckley, A. and Laight, A. (2001). EQ-5D in patients with dementia: an investigation of inter-rater agreement. Medical Care, 39, 760–771.CrossRefGoogle ScholarPubMed
Cuijpers, P., van Lammeren, P. and Duzijn, B. (1999). Relation between quality of life and chronic illnesses in elderly living in residential homes: a prospective study. International Psychogeriatrics, 11, 445–454.CrossRefGoogle ScholarPubMed
Delgado-Sanz, M. C.et al. (2011). Influence of chronic health problems in dimensions of EQ-5D: study of institutionalized and non-institutionalized elderly. Revista Española De Salud Pública, 85, 555–568. (In Spanish)Google ScholarPubMed
Drewes, Y. M., den Elzen, W. P. J., Mooijaart, S. P., Assendelft, W. J. J. and Gussekloo, J. (2011). The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study. Age and Ageing, 40, 352–357.CrossRefGoogle ScholarPubMed
EuroQol Group (1990). EuroQol – a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy, 16, 199–208.CrossRefGoogle Scholar
Feinstein, A. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23, 455–468.CrossRefGoogle ScholarPubMed
Fernandez-Mayoralas, G., Giraldez-Garcia, C., Forjaz, M. J., Rojo-Perez, F., Martinez-Martin, P. and Prieto-Flores, M.-E. (2012). Design, measures and sample characteristics of the CadeViMa-Spain survey on quality of life in community-dwelling older adults. International Psychogeriatrics, 24, 425–438.CrossRefGoogle ScholarPubMed
Formiga, F., Fort, I., Robles, M. J., Barranco, E., Espinosa, M. C. and Riu, S. (2007). Medical comorbidity in elderly patients with dementia: differences according to age and gender. Revista Clínica Española, 207, 495–500. (In Spanish)CrossRefGoogle ScholarPubMed
Fortin, M., Lapointe, L., Hudon, C., Vanasse, A., Ntetu, A. L. and Maltais, D. (2004). Multimorbidity and quality of life in primary care: a systematic review. Health and Quality of Life Outcomes, 2, 51.CrossRefGoogle ScholarPubMed
Fried, L. P., Ferrucci, L., Darer, J., Williamson, J. D. and Anderson, G. (2004). Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 59, 255–263.CrossRefGoogle ScholarPubMed
García García, F. J.et al. (2001). The prevalence of dementia and its main subtypes in subjects older than 65 years: impact of occupation and education. The Toledo Study. Medicina Clínica, 116, 401–407. (In Spanish)Google ScholarPubMed
Jönsson, L.et al. (2006). Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Disease and Associated Disorders, 20, 49–55.CrossRefGoogle ScholarPubMed
Keilman, L. J. (2005). Urinary incontinence: basic evaluation and management in the primary care office. Primary Care, 32, 699–722.CrossRefGoogle ScholarPubMed
Kiyak, H. A., Teri, L. and Borson, S. (1994). Physical and functional health assessment in normal aging and in Alzheimer's disease: self-reports vs. family reports. Gerontologist, 34, 324–330.CrossRefGoogle ScholarPubMed
Lehnert, T.et al. (2011). Review: health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review, 68, 387–420.CrossRefGoogle ScholarPubMed
Luppa, M., Luck, T., Weyerer, S., König, H. H., Brähler, E. and Riedel-Heller, S. G. (2010). Prediction of institutionalization in the elderly: a systematic review. Age and Ageing, 39, 31–38.CrossRefGoogle ScholarPubMed
Mahoney, F. I. and Barthel, D. W. (1965) Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 61–65.Google ScholarPubMed
Makhija, S. K., Gilbert, G. H., Clay, O. J., Matthews, J. C., Sawyer, P. and Allman, R. M. (2011). Oral health-related quality of life and life-space mobility in community-dwelling older adults. Journal of the American Geriatrics Society, 59, 512–518.CrossRefGoogle ScholarPubMed
Marengoni, A.et al. (2011). Aging with multimorbidity: a systematic review of the literature. Ageing Research Reviews, 10, 430–439.CrossRefGoogle ScholarPubMed
Miller, M. D.et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237–248.CrossRefGoogle ScholarPubMed
Nutheti, R.et al. (2006). Impact of impaired vision and eye disease on quality of life in Andhra Pradesh. Investigative Ophthalmology & Visual Science, 47, 4742–4748.CrossRefGoogle ScholarPubMed
Pfeiffer, E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23, 433–441.CrossRefGoogle Scholar
Schubert, C. C.et al. (2006). Comorbidity profile of dementia patients in primary care: are they sicker? Journal of the American Geriatrics Society, 54, 104–109.CrossRefGoogle ScholarPubMed
Sullivan, M. D., Kempen, G. I., Van Sonderen, E. and Ormel, J. (2000). Models of health-related quality of life in a population of community-dwelling Dutch elderly. Quality of Life Research, 9, 801–810.CrossRefGoogle Scholar
Valderas, J. M., Starfield, B., Sibbald, B., Salisbury, C. and Roland, M. (2009). Defining comorbidity: implications for understanding health and health services. Annals of Family Medicine, 7, 357–363.CrossRefGoogle ScholarPubMed
Vogeli, C.et al. (2007). Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22, 391–395.CrossRefGoogle ScholarPubMed
Waldorff, F. B., Nielsen, A. B. S. and Waldemar, G. (2010). Self-rated health in patients with mild Alzheimer's disease: baseline data from the Danish Alzheimer Intervention Study. Archives of Gerontology and Geriatrics, 50, 1–5.CrossRefGoogle ScholarPubMed
Yancik, R., Ershler, W., Satariano, W., Hazzard, W., Cohen, H. J. and Ferrucci, L. (2007). Report of the National Institute on Aging Task Force on Comorbidity. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 62, 275–280.CrossRefGoogle ScholarPubMed
Zhang, J. X.et al. (2003). Comorbidity and the concentration of healthcare expenditures in older patients with heart failure. Journal of the American Geriatrics Society, 51, 476–482.CrossRefGoogle ScholarPubMed