Deconstructing Complex Multimorbidity in the Very Old: Findings from the Newcastle 85+ Study.
Deconstructing Complex Multimorbidity in the Very Old: Findings from the Newcastle 85+ Study.
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DOI：
10.1155/2016/8745670
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发表时间：
2016
影响因子：
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通讯作者：
Kirkwood TB
中科院分区：
文献类型：
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作者：
Collerton J;Jagger C;Yadegarfar ME;Davies K;Parker SG;Robinson L;Kirkwood TB
目标.研究85岁老年人发病负担的程度和复杂性;确定多发病模式;并探索与药物和医疗保健使用的相关性。参与者710例男性和女性;平均（SD）年龄85.5（0.4）岁。方法.根据一般医疗记录和参与者评估确定的20种慢性病（疾病和老年病）数据。多发病样本内的聚类分析确定了共享发病率概况的亚组。对药物和医疗保健使用进行了聚类比较。结果92.7%（658/710）的参与者患有多发性硬化症;中位疾病数量：4（IQR 3-6）。聚类分析（多发病样本）确定了5个亚组，具有相似的发病率概况; 60.0%（395/658）的参与者属于两个高发病率集群之一，只有4.9%（32/658）在最健康的集群。医疗保健使用率很高，69.8%（459/658）使用多种药物（≥5种药物）。在药物计数（p = 0.0001）、住院（p = 0.022）、全科医生（p = 0.034）和执业护士咨询（p = 0.011）方面发现了群集间差异。死亡负荷与药物负担和使用一些但不是全部的医疗服务有关。结论.大多数85岁的老年人有广泛和复杂的发病率。阐述共享相似发病率配置文件的参与者集群将有助于为未来的医疗保健提供信息，并确定共同的潜在生物学机制。
Objectives. To examine the extent and complexity of the morbidity burden in 85-year-olds; identify patterns within multimorbidity; and explore associations with medication and healthcare use. Participants. 710 men and women; mean (SD) age 85.5 (0.4) years. Methods. Data on 20 chronic conditions (diseases and geriatric conditions) ascertained from general practice records and participant assessment. Cluster analysis within the multimorbid sample identified subgroups sharing morbidity profiles. Clusters were compared on medication and healthcare use. Results. 92.7% (658/710) of participants had multimorbidity; median number of conditions: 4 (IQR 3–6). Cluster analysis (multimorbid sample) identified five subgroups sharing similar morbidity profiles; 60.0% (395/658) of participants belonged to one of two high morbidity clusters, with only 4.9% (32/658) in the healthiest cluster. Healthcare use was high, with polypharmacy (≥5 medications) in 69.8% (459/658). Between-cluster differences were found in medication count (p = 0.0001); hospital admissions (p = 0.022); and general practitioner (p = 0.034) and practice nurse consultations (p = 0.011). Morbidity load was related to medication burden and use of some, but not all, healthcare services. Conclusions. The majority of 85-year-olds had extensive and complex morbidity. Elaborating participant clusters sharing similar morbidity profiles will help inform future healthcare provision and the identification of common underlying biological mechanisms.