Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults
Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults
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DOI：
10.1111/jgs.14868
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发表时间：
2017-05-01
影响因子：
6.3
通讯作者：
Marengoni, Alessandra
中科院分区：
文献类型：
--
作者：
Rizzuto, Debora;Melis, Rene J. F.;Marengoni, Alessandra
[目的]探讨慢性疾病及其并存对社区老年人生存和功能的影响。设计基于人群的队列研究。研究对象瑞典斯德哥尔摩的昆舍尔门。研究对象78岁及以上的老年人在11年内接受医生四次检查(N=1,099)。测量慢性疾病(根据国际疾病分类第10版，代码按10个器官系统分组)和多发病(2种并存的慢性病)的死亡率，人口归因死亡风险，中位寿命损失年数，结果约四分之一的死亡可归因于心血管疾病，六分之一的死亡可归因于神经精神疾病。恶性肿瘤是生存时间最短的疾病(2.5年)。恶性肿瘤和心血管疾病各占寿命损失的大约5年。相比之下，神经感觉和神经精神疾病的中位存活时间最长(6年)，受影响的人有一半以上的时间是残疾的。最常见和负担最重的疾病是多发病，影响70.4%的人口，占总死亡人数的69.3%，造成7.5年的生命损失。最后，患有多发病的人81%的余生是残疾的(中位数为5.2年)。结论老年人的存活时间和质量因具体情况而异。在个人(较短的寿命、更大的依赖性)和社会(可归因性死亡人数、残疾年数)这两个层面上最大的负面影响来自多病，这使得多病成为临床和公共卫生的优先事项。
ObjectivesTo determine the effect of chronic disorders and their co-occurrence on survival and functioning in community-dwelling older adults.DesignPopulation-based cohort study.SettingKungsholmen, Stockholm, Sweden.ParticipantsIndividuals aged 78 and older examined by physicians four times over 11 years (N = 1,099).MeasurementsChronic diseases (grouped according to 10 organ systems according to the International Classification of Diseases, Tenth Revision, code) and multimorbidity (2 coexisting chronic diseases) were evaluated in terms of mortality, population attributable risk of death, median years of life lost, and median survival time with and without disability (need of assistance in 1 activities of daily living).ResultsApproximately one in four deaths were attributable to cardiovascular and one in six to neuropsychiatric diseases. Malignancy was the condition with the shortest survival time (2.5 years). Malignancies and cardiovascular disorders each accounted for approximately 5 years of life lost. In contrast, neurosensorial and neuropsychiatric conditions had the longest median survival time (>6 years), and affected people were disabled for more than half of this time. The most-prevalent and -burdensome condition was multimorbidity, affecting 70.4% of the population, accounting for 69.3% of total deaths, and causing 7.5 years of life lost. Finally, people with multimorbidity lived 81% of their remaining years of life with disability (median 5.2 years).ConclusionSurvival in older adults differs in length and quality depending on specific conditions. The greatest negative effect at the individual (shorter life, greater dependence) and societal (number of attributable deaths, years spent with disability) level was from multimorbidity, which has made multimorbidity a clinical and public health priority.