Multimorbidity, dementia and health care in older people

a population-based cohort study

Marcello Tonelli (Lead / Corresponding author), Natasha Wiebe, Sharon Straus, Martin Fortin, Bruce Guthrie, Matthew T. James, Scott W. Klarenbach, Helen Tam-Tham, Richard Lewanczuk, Braden J. Manns, Hude Quan, Paul E. Ronksley, Peter Sargious, Brenda R. Hemmelgarn, for the Alberta Kidney Disease Network

    Research output: Contribution to journalArticle

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    Abstract

    BACKGROUND: Little is known about how multimorbidity, dementia and increasing age combine to influence health outcomes or utilization. Our objective was to examine the joint associations between age, dementia and burden of morbidity with mortality and other clinical outcomes.

    METHODS: We did a retrospective population-based cohort study of all adults aged 65 years and older residing in Alberta, Canada, between 2002 and 2013. We used validated algorithms applied to administrative and laboratory data from the provincial health ministry to assess the presence/absence of dementia and 29 other morbidities, and their associations with mortality (our primary outcome), other clinical outcomes (emergency department visits, all-cause hospital admissions) and a proxy for loss of independent living (discharge to long-term care). Cox and Poisson models were adjusted for year-varying covariates. A 3-way interaction was modelled for dementia, the number of comorbidities, and age.

    RESULTS: There were 610 457 adults aged 65 years and older living in Alberta over the study period. Over median follow-up of 6.8 years, 153 125 (25.1%) participants died and 5569 (0.9%) were discharged to long-term care. The prevalence of people with at least 3 morbidities was 33.7% in 2003 and 50.2% in 2012. The prevalence of dementia rose from 6.2% in fiscal year 2003 to 8.3% in fiscal year 2012, representing a net increase of approximately 13 700 people. The likelihood of all 4 outcomes increased with age and with greater burden of morbidity; the presence of dementia further increased these risks. For example, the risk of mortality increased by 1.54 to 6.38 in the presence of dementia, depending on age and morbidity burden. The risk associated with dementia was attenuated by increasing comorbidity.

    INTERPRETATION: Older age, multimorbidity and dementia are all strongly correlated with adverse health outcomes as well as a proxy for loss of independent living. The increasing prevalences of dementia and multimorbidity over time suggest the need for coordinated national strategies aimed at mitigating the health challenges associated with the aging of the population.

    Original languageEnglish
    Pages (from-to)E623-E631
    Number of pages9
    JournalCMAJ Open
    Volume5
    Issue number3
    DOIs
    Publication statusPublished - 30 Jun 2017

    Fingerprint

    Dementia
    Comorbidity
    Cohort Studies
    Delivery of Health Care
    Population
    Morbidity
    Independent Living
    Alberta
    Health
    Long-Term Care
    Proxy
    Mortality
    Proportional Hazards Models
    Canada
    Hospital Emergency Service

    Keywords

    • Multimorbidity
    • Dementia
    • Older adults

    Cite this

    Tonelli, M., Wiebe, N., Straus, S., Fortin, M., Guthrie, B., James, M. T., ... for the Alberta Kidney Disease Network (2017). Multimorbidity, dementia and health care in older people: a population-based cohort study. CMAJ Open , 5(3), E623-E631. https://doi.org/10.9778/cmajo.20170052
    Tonelli, Marcello ; Wiebe, Natasha ; Straus, Sharon ; Fortin, Martin ; Guthrie, Bruce ; James, Matthew T. ; Klarenbach, Scott W. ; Tam-Tham, Helen ; Lewanczuk, Richard ; Manns, Braden J. ; Quan, Hude ; Ronksley, Paul E. ; Sargious, Peter ; Hemmelgarn, Brenda R. ; for the Alberta Kidney Disease Network. / Multimorbidity, dementia and health care in older people : a population-based cohort study. In: CMAJ Open . 2017 ; Vol. 5, No. 3. pp. E623-E631.
    @article{c29520e3cf4e445cbdec6a4172cd363c,
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    abstract = "BACKGROUND: Little is known about how multimorbidity, dementia and increasing age combine to influence health outcomes or utilization. Our objective was to examine the joint associations between age, dementia and burden of morbidity with mortality and other clinical outcomes.METHODS: We did a retrospective population-based cohort study of all adults aged 65 years and older residing in Alberta, Canada, between 2002 and 2013. We used validated algorithms applied to administrative and laboratory data from the provincial health ministry to assess the presence/absence of dementia and 29 other morbidities, and their associations with mortality (our primary outcome), other clinical outcomes (emergency department visits, all-cause hospital admissions) and a proxy for loss of independent living (discharge to long-term care). Cox and Poisson models were adjusted for year-varying covariates. A 3-way interaction was modelled for dementia, the number of comorbidities, and age.RESULTS: There were 610 457 adults aged 65 years and older living in Alberta over the study period. Over median follow-up of 6.8 years, 153 125 (25.1{\%}) participants died and 5569 (0.9{\%}) were discharged to long-term care. The prevalence of people with at least 3 morbidities was 33.7{\%} in 2003 and 50.2{\%} in 2012. The prevalence of dementia rose from 6.2{\%} in fiscal year 2003 to 8.3{\%} in fiscal year 2012, representing a net increase of approximately 13 700 people. The likelihood of all 4 outcomes increased with age and with greater burden of morbidity; the presence of dementia further increased these risks. For example, the risk of mortality increased by 1.54 to 6.38 in the presence of dementia, depending on age and morbidity burden. The risk associated with dementia was attenuated by increasing comorbidity.INTERPRETATION: Older age, multimorbidity and dementia are all strongly correlated with adverse health outcomes as well as a proxy for loss of independent living. The increasing prevalences of dementia and multimorbidity over time suggest the need for coordinated national strategies aimed at mitigating the health challenges associated with the aging of the population.",
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    author = "Marcello Tonelli and Natasha Wiebe and Sharon Straus and Martin Fortin and Bruce Guthrie and James, {Matthew T.} and Klarenbach, {Scott W.} and Helen Tam-Tham and Richard Lewanczuk and Manns, {Braden J.} and Hude Quan and Ronksley, {Paul E.} and Peter Sargious and Hemmelgarn, {Brenda R.} and {for the Alberta Kidney Disease Network}",
    note = "This work was supported by the Canadian Institutes for Health Research (MOP 133582), by a team grant to the Interdisciplinary Chronic Disease Collaboration from Alberta Innovates-Health Solutions and a Leaders Opportunity Fund grant from the Canada Foundation for Innovation. MT, HQ, and SK are supported by career salary awards from Alberta Innovates-Health Solutions.",
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    Tonelli, M, Wiebe, N, Straus, S, Fortin, M, Guthrie, B, James, MT, Klarenbach, SW, Tam-Tham, H, Lewanczuk, R, Manns, BJ, Quan, H, Ronksley, PE, Sargious, P, Hemmelgarn, BR & for the Alberta Kidney Disease Network 2017, 'Multimorbidity, dementia and health care in older people: a population-based cohort study', CMAJ Open , vol. 5, no. 3, pp. E623-E631. https://doi.org/10.9778/cmajo.20170052

    Multimorbidity, dementia and health care in older people : a population-based cohort study. / Tonelli, Marcello (Lead / Corresponding author); Wiebe, Natasha; Straus, Sharon; Fortin, Martin; Guthrie, Bruce; James, Matthew T.; Klarenbach, Scott W.; Tam-Tham, Helen ; Lewanczuk, Richard; Manns, Braden J.; Quan, Hude; Ronksley, Paul E.; Sargious, Peter; Hemmelgarn, Brenda R.; for the Alberta Kidney Disease Network.

    In: CMAJ Open , Vol. 5, No. 3, 30.06.2017, p. E623-E631.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Multimorbidity, dementia and health care in older people

    T2 - a population-based cohort study

    AU - Tonelli, Marcello

    AU - Wiebe, Natasha

    AU - Straus, Sharon

    AU - Fortin, Martin

    AU - Guthrie, Bruce

    AU - James, Matthew T.

    AU - Klarenbach, Scott W.

    AU - Tam-Tham, Helen

    AU - Lewanczuk, Richard

    AU - Manns, Braden J.

    AU - Quan, Hude

    AU - Ronksley, Paul E.

    AU - Sargious, Peter

    AU - Hemmelgarn, Brenda R.

    AU - for the Alberta Kidney Disease Network

    N1 - This work was supported by the Canadian Institutes for Health Research (MOP 133582), by a team grant to the Interdisciplinary Chronic Disease Collaboration from Alberta Innovates-Health Solutions and a Leaders Opportunity Fund grant from the Canada Foundation for Innovation. MT, HQ, and SK are supported by career salary awards from Alberta Innovates-Health Solutions.

    PY - 2017/6/30

    Y1 - 2017/6/30

    N2 - BACKGROUND: Little is known about how multimorbidity, dementia and increasing age combine to influence health outcomes or utilization. Our objective was to examine the joint associations between age, dementia and burden of morbidity with mortality and other clinical outcomes.METHODS: We did a retrospective population-based cohort study of all adults aged 65 years and older residing in Alberta, Canada, between 2002 and 2013. We used validated algorithms applied to administrative and laboratory data from the provincial health ministry to assess the presence/absence of dementia and 29 other morbidities, and their associations with mortality (our primary outcome), other clinical outcomes (emergency department visits, all-cause hospital admissions) and a proxy for loss of independent living (discharge to long-term care). Cox and Poisson models were adjusted for year-varying covariates. A 3-way interaction was modelled for dementia, the number of comorbidities, and age.RESULTS: There were 610 457 adults aged 65 years and older living in Alberta over the study period. Over median follow-up of 6.8 years, 153 125 (25.1%) participants died and 5569 (0.9%) were discharged to long-term care. The prevalence of people with at least 3 morbidities was 33.7% in 2003 and 50.2% in 2012. The prevalence of dementia rose from 6.2% in fiscal year 2003 to 8.3% in fiscal year 2012, representing a net increase of approximately 13 700 people. The likelihood of all 4 outcomes increased with age and with greater burden of morbidity; the presence of dementia further increased these risks. For example, the risk of mortality increased by 1.54 to 6.38 in the presence of dementia, depending on age and morbidity burden. The risk associated with dementia was attenuated by increasing comorbidity.INTERPRETATION: Older age, multimorbidity and dementia are all strongly correlated with adverse health outcomes as well as a proxy for loss of independent living. The increasing prevalences of dementia and multimorbidity over time suggest the need for coordinated national strategies aimed at mitigating the health challenges associated with the aging of the population.

    AB - BACKGROUND: Little is known about how multimorbidity, dementia and increasing age combine to influence health outcomes or utilization. Our objective was to examine the joint associations between age, dementia and burden of morbidity with mortality and other clinical outcomes.METHODS: We did a retrospective population-based cohort study of all adults aged 65 years and older residing in Alberta, Canada, between 2002 and 2013. We used validated algorithms applied to administrative and laboratory data from the provincial health ministry to assess the presence/absence of dementia and 29 other morbidities, and their associations with mortality (our primary outcome), other clinical outcomes (emergency department visits, all-cause hospital admissions) and a proxy for loss of independent living (discharge to long-term care). Cox and Poisson models were adjusted for year-varying covariates. A 3-way interaction was modelled for dementia, the number of comorbidities, and age.RESULTS: There were 610 457 adults aged 65 years and older living in Alberta over the study period. Over median follow-up of 6.8 years, 153 125 (25.1%) participants died and 5569 (0.9%) were discharged to long-term care. The prevalence of people with at least 3 morbidities was 33.7% in 2003 and 50.2% in 2012. The prevalence of dementia rose from 6.2% in fiscal year 2003 to 8.3% in fiscal year 2012, representing a net increase of approximately 13 700 people. The likelihood of all 4 outcomes increased with age and with greater burden of morbidity; the presence of dementia further increased these risks. For example, the risk of mortality increased by 1.54 to 6.38 in the presence of dementia, depending on age and morbidity burden. The risk associated with dementia was attenuated by increasing comorbidity.INTERPRETATION: Older age, multimorbidity and dementia are all strongly correlated with adverse health outcomes as well as a proxy for loss of independent living. The increasing prevalences of dementia and multimorbidity over time suggest the need for coordinated national strategies aimed at mitigating the health challenges associated with the aging of the population.

    KW - Multimorbidity

    KW - Dementia

    KW - Older adults

    U2 - 10.9778/cmajo.20170052

    DO - 10.9778/cmajo.20170052

    M3 - Article

    VL - 5

    SP - E623-E631

    JO - CMAJ Open

    JF - CMAJ Open

    SN - 2291-0026

    IS - 3

    ER -