Skip to main content
×
Home

Comorbidity, health status, and quality of life in institutionalized older people with and without dementia

  • Salomé Martín-García (a1), Carmen Rodríguez-Blázquez (a2) (a3), Iluminada Martínez-López (a1), Pablo Martínez-Martín (a4) (a3) and Maria João Forjaz (a5) (a6)...
Abstract
ABSTRACT

Background: Comorbidity in older adults may lead to lower perceived health status and a decrease in quality of life (QoL). The objective of this study is to analyze the relationship between comorbidity, health status, QoL, and dementia in institutionalized older adults.

Methods: Cross-sectional, multicenter study in residential care settings in Spain. Two groups of institutionalized older adults of 60 years of age and older were compared: 234 persons with normal cognitive function and 525 with dementia according to DSM-IV-TR criteria. Assessments included: sociodemographic questionnaire, EQ-5D index for health-related QoL, Visual Analogue Scale (EQ-VAS) for health status, number of chronic medical conditions (comorbidity), Barthel Index for functional independence, and Short Portable Mental Status Questionnaire.

Results: The group with dementia presented significantly worse QoL, health, and functional status than people without dementia. The most prevalent chronic medical conditions were musculoskeletal (72.3%), followed by genito-urinary disorders (60.2%). Controlling for age and sex, people with dementia and higher comorbidity exhibited lower EQ-VAS scores; however, no significant difference was found for the EQ-5D index. The health conditions that contributed the most to the EQ-VAS differences between the dementia and non-dementia groups were sight, oral, and genito-urinary problems.

Conclusions: When compared to older adults with no dementia, people with dementia and high comorbidity reported the most compromised health status, especially in those with sight, oral, and genito-urinary problems. These differences should be taken into consideration when selecting strategies to maintain and improve the health status of older adults in residential care settings.

Copyright
Corresponding author
Correspondence should be addressed to: Carmen Rodriguez-Blazquez, National Center of Epidemiology, Institute of Health Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain. Phone: +34-91-822-2657; Fax: +34-91-387-7815. Email: crodb@isciii.es.
References
Hide All
Antonovsky A. (1979). Health, Stress, and Coping. San Fransisco, CA: Jossey-Bass.
Asakawa K., Feeny D., Senthilselvan A., Johnson J. A. and Rolfson D. (2009). Do the determinants of health differ between people living in the community and in institutions? Social Science & Medicine, 69, 345353.
Bryan S., Hardyman W., Bentham P., Buckley A. and Laight A. (2005). Proxy completion of EQ-5D in patients with dementia. Quality of Life Research, 14, 107118.
Charlson M. E., Pompei P., Ales K. L. and McKenzie C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373383.
Coucill W., Bryan S., Bentham P., Buckley A. and Laight A. (2001). EQ-5D in patients with dementia: an investigation of inter-rater agreement. Medical Care, 39, 760771.
Cuijpers P., van Lammeren P. and Duzijn B. (1999). Relation between quality of life and chronic illnesses in elderly living in residential homes: a prospective study. International Psychogeriatrics, 11, 445454.
Delgado-Sanz M. C.et al. (2011). Influence of chronic health problems in dimensions of EQ-5D: study of institutionalized and non-institutionalized elderly. Revista Española De Salud Pública, 85, 555568. (In Spanish)
Drewes Y. M., den Elzen W. P. J., Mooijaart S. P., Assendelft W. J. J. and Gussekloo J. (2011). The effect of cognitive impairment on the predictive value of multimorbidity for the increase in disability in the oldest old: the Leiden 85-plus Study. Age and Ageing, 40, 352357.
EuroQol Group (1990). EuroQol – a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy, 16, 199208.
Feinstein A. (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23, 455468.
Fernandez-Mayoralas G., Giraldez-Garcia C., Forjaz M. J., Rojo-Perez F., Martinez-Martin P. and Prieto-Flores M.-E. (2012). Design, measures and sample characteristics of the CadeViMa-Spain survey on quality of life in community-dwelling older adults. International Psychogeriatrics, 24, 425438.
Formiga F., Fort I., Robles M. J., Barranco E., Espinosa M. C. and Riu S. (2007). Medical comorbidity in elderly patients with dementia: differences according to age and gender. Revista Clínica Española, 207, 495500. (In Spanish)
Fortin M., Lapointe L., Hudon C., Vanasse A., Ntetu A. L. and Maltais D. (2004). Multimorbidity and quality of life in primary care: a systematic review. Health and Quality of Life Outcomes, 2, 51.
Fried L. P., Ferrucci L., Darer J., Williamson J. D. and Anderson G. (2004). Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 59, 255263.
García García F. J.et al. (2001). The prevalence of dementia and its main subtypes in subjects older than 65 years: impact of occupation and education. The Toledo Study. Medicina Clínica, 116, 401407. (In Spanish)
Jönsson L.et al. (2006). Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Disease and Associated Disorders, 20, 4955.
Keilman L. J. (2005). Urinary incontinence: basic evaluation and management in the primary care office. Primary Care, 32, 699722.
Kiyak H. A., Teri L. and Borson S. (1994). Physical and functional health assessment in normal aging and in Alzheimer's disease: self-reports vs. family reports. Gerontologist, 34, 324330.
Lehnert T.et al. (2011). Review: health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review, 68, 387420.
Luppa M., Luck T., Weyerer S., König H. H., Brähler E. and Riedel-Heller S. G. (2010). Prediction of institutionalization in the elderly: a systematic review. Age and Ageing, 39, 3138.
Mahoney F. I. and Barthel D. W. (1965) Functional evaluation: the Barthel Index. Maryland State Medical Journal, 14, 6165.
Makhija S. K., Gilbert G. H., Clay O. J., Matthews J. C., Sawyer P. and Allman R. M. (2011). Oral health-related quality of life and life-space mobility in community-dwelling older adults. Journal of the American Geriatrics Society, 59, 512518.
Marengoni A.et al. (2011). Aging with multimorbidity: a systematic review of the literature. Ageing Research Reviews, 10, 430439.
Miller M. D.et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237248.
Nutheti R.et al. (2006). Impact of impaired vision and eye disease on quality of life in Andhra Pradesh. Investigative Ophthalmology & Visual Science, 47, 47424748.
Pfeiffer E. (1975). A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. Journal of the American Geriatrics Society, 23, 433441.
Schubert C. C.et al. (2006). Comorbidity profile of dementia patients in primary care: are they sicker? Journal of the American Geriatrics Society, 54, 104109.
Sullivan M. D., Kempen G. I., Van Sonderen E. and Ormel J. (2000). Models of health-related quality of life in a population of community-dwelling Dutch elderly. Quality of Life Research, 9, 801810.
Valderas J. M., Starfield B., Sibbald B., Salisbury C. and Roland M. (2009). Defining comorbidity: implications for understanding health and health services. Annals of Family Medicine, 7, 357363.
Vogeli C.et al. (2007). Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22, 391395.
Waldorff F. B., Nielsen A. B. S. and Waldemar G. (2010). Self-rated health in patients with mild Alzheimer's disease: baseline data from the Danish Alzheimer Intervention Study. Archives of Gerontology and Geriatrics, 50, 15.
Yancik R., Ershler W., Satariano W., Hazzard W., Cohen H. J. and Ferrucci L. (2007). Report of the National Institute on Aging Task Force on Comorbidity. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 62, 275280.
Zhang J. X.et al. (2003). Comorbidity and the concentration of healthcare expenditures in older patients with heart failure. Journal of the American Geriatrics Society, 51, 476482.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 7
Total number of PDF views: 53 *
Loading metrics...

Abstract views

Total abstract views: 292 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 18th November 2017. This data will be updated every 24 hours.