Multimorbidity Patterns and 5-Year Mortality in Institutionalized Older Adults

Area of Science:

• Gerontology and Geriatric Medicine
• Epidemiology
• Health Services Research

Background:

• Multimorbidity, the coexistence of multiple chronic diseases, is prevalent in older adults residing in nursing homes (NHs).
• Understanding specific multimorbidity patterns is crucial for predicting health outcomes, particularly mortality.
• Functional status significantly influences the health trajectory of institutionalized older adults.

Purpose of the Study:

• To identify distinct multimorbidity patterns among a large cohort of nursing home residents.
• To investigate the association between these identified patterns and mortality risk.
• To examine the modifying effect of functional status on the relationship between multimorbidity patterns and mortality.

Main Methods:

• Retrospective analysis of data from 4131 NH residents in Italy (aged 60+).
• Principal Component Analysis (PCA) was used to identify multimorbidity patterns.
• Cox regression models, stratified by disability status, assessed the association between patterns and mortality.

Main Results:

• Four distinct multimorbidity patterns were identified: heart diseases; dementia and sensory impairments; heart, respiratory, and psychiatric diseases; and diabetes, musculoskeletal, and vascular diseases.
• Increased expression of the heart diseases pattern (HR Q5 vs Q1 = 1.83) and the dementia/sensory impairments pattern (HR Q5 vs Q1 = 1.23) was associated with increased mortality risk.
• The association between multimorbidity patterns and mortality varied when stratified by disability status.

Conclusions:

• Multimorbidity patterns exhibit differential associations with mortality in NH residents.
• The prognostic impact of multimorbidity is contingent upon the specific combination of diseases present.
• Findings support the development of tailored preventive and therapeutic strategies for institutionalized older adults based on their unique health profiles.