Multimorbidity in Older Adults
Multimorbidity in Older Adults
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DOI：
10.1093/epirev/mxs009
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发表时间：
2013-02-04
影响因子：
5.5
通讯作者：
Salive, Marcel E.
中科院分区：
文献类型：
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作者：
Salive, Marcel E.
随着死亡率下降和人口老龄化，多发病，即两种或两种以上慢性病共存，在老年人中变得普遍。我们检查了基于人口的行政索赔数据，这些数据表明，针对15种常见慢性病，向近3100万医疗保险按服务收费受益人提供了特定的医疗服务。共有67%的人患有多发性硬化症，随着年龄的增长，从65岁以下的50%增加到65-74岁的62%和85岁以上的81.5%。一项系统性综述确定了在社区样本中进行的16项其他患病率研究，其中包括老年人，中位患病率为63%，众数为67%。研究之间的患病率差异可能是由于方法学偏倚;没有研究具有可比性。关键的方法学问题来自病例定义的要素，包括所包括的慢性疾病的类型和数量、确定方法和来源人群。需要标准化的方法来测量多发病率，以实现公共卫生监测和预防。多药耐药与死亡、残疾、功能状态差、生活质量差和药物不良事件的风险升高相关。需要进行更多的研究，以了解因果途径，并进一步开发和测试针对多药耐药的潜在临床和人群干预措施。
Multimorbidity, the coexistence of 2 or more chronic conditions, has become prevalent among older adults as mortality rates have declined and the population has aged. We examined population-based administrative claims data indicating specific health service delivery to nearly 31 million Medicare fee-for-service beneficiaries for 15 prevalent chronic conditions. A total of 67% had multimorbidity, which increased with age, from 50% for persons under age 65 years to 62% for those aged 65-74 years and 81.5% for those aged >= 85 years. A systematic review identified 16 other prevalence studies conducted in community samples that included older adults, with median prevalence of 63% and a mode of 67%. Prevalence differences between studies are probably due to methodological biases; no studies were comparable. Key methodological issues arise from elements of the case definition, including type and number of chronic conditions included, ascertainment methods, and source population. Standardized methods for measuring multimorbidity are needed to enable public health surveillance and prevention. Multimorbidity is associated with elevated risk of death, disability, poor functional status, poor quality of life, and adverse drug events. Additional research is needed to develop an understanding of causal pathways and to further develop and test potential clinical and population interventions targeting multimorbidity.