Multimorbidity patterns and associations with functional limitations among an aging population in prison

Co-occurring chronic diseases are associated with functional limitations, particularly for the aging population ≥50 years old. Aging offenders (individual who are imprisoned) tend to have greater prevalence of chronic, mental health, and substance use disorders compared to non-imprisoned populations. Our primary aim was to determine patterns of co-occurring conditions associated with functional limitations among aging offenders.

We included all male offenders from one correctional system who were ≥50 years old (n = 2270) and extracted diagnoses for chronic diseases, mental health, substance use disorders, and functional limitations from an electronic health record. We performed a principal factor analysis (PFA) to identify patterns and chi-square to determine if the multimorbid population (≥3 diagnoses) differed from peer groups in regard to functional limitations.

Three patterns (chronic diseases, geriatric conditions, and mental health/substance use) emerged from PFA. Functional limitations were associated with the chronic disease pattern (p = .03) where the multimorbid group compared to non-multimorbid peers had 1.5 odds, 95% CI [1.0, 2.1], for having a physical impairment. The geriatric (p = .10) and mental health/substance use disorders (p = .07) patterns were not associated with having a functional limitation compared to the population without multiple diagnoses. Controlling for multimorbidity, functional limitations, and overlapping patterns, increasing age was the only significant factor (p = .02) associated with having a physical impairment.

The chronic disease pattern was consistent with investigations that included non-imprisoned populations. However, the geriatric pattern was not significant, which was unexpected.