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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)...

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.

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:
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K. Asakawa , D. Feeny , A. Senthilselvan , J. A. Johnson and D. Rolfson (2009). Do the determinants of health differ between people living in the community and in institutions? Social Science & Medicine, 69, 345353.

S. Bryan , W. Hardyman , P. Bentham , A. Buckley and A. Laight (2005). Proxy completion of EQ-5D in patients with dementia. Quality of Life Research, 14, 107118.

M. E. Charlson , P. Pompei , K. L. Ales and C. R. McKenzie (1987). A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases, 40, 373383.

W. Coucill , S. Bryan , P. Bentham , A. Buckley and A. Laight (2001). EQ-5D in patients with dementia: an investigation of inter-rater agreement. Medical Care, 39, 760771.

Y. M. Drewes , W. P. J. den Elzen , S. P. Mooijaart , W. J. J. Assendelft and J. Gussekloo (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.

A. Feinstein (1970). The pre-therapeutic classification of co-morbidity in chronic disease. Journal of Chronic Diseases, 23, 455468.

F. Formiga , I. Fort , M. J. Robles , E. Barranco , M. C. Espinosa and S. Riu (2007). Medical comorbidity in elderly patients with dementia: differences according to age and gender. Revista Clínica Española, 207, 495500. (In Spanish)

M. Fortin , L. Lapointe , C. Hudon , A. Vanasse , A. L. Ntetu and D. Maltais (2004). Multimorbidity and quality of life in primary care: a systematic review. Health and Quality of Life Outcomes, 2, 51.

L. P. Fried , L. Ferrucci , J. Darer , J. D. Williamson and G. Anderson (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.

L. Jönsson et al. (2006). Patient- and proxy-reported utility in Alzheimer disease using the EuroQoL. Alzheimer Disease and Associated Disorders, 20, 4955.

L. J. Keilman (2005). Urinary incontinence: basic evaluation and management in the primary care office. Primary Care, 32, 699722.

H. A. Kiyak , L. Teri and S. Borson (1994). Physical and functional health assessment in normal aging and in Alzheimer's disease: self-reports vs. family reports. Gerontologist, 34, 324330.

T. Lehnert et al. (2011). Review: health care utilization and costs of elderly persons with multiple chronic conditions. Medical Care Research and Review, 68, 387420.

M. Luppa , T. Luck , S. Weyerer , H. H. König , E. Brähler and S. G. Riedel-Heller (2010). Prediction of institutionalization in the elderly: a systematic review. Age and Ageing, 39, 3138.

S. K. Makhija , G. H. Gilbert , O. J. Clay , J. C. Matthews , P. Sawyer and R. M. Allman (2011). Oral health-related quality of life and life-space mobility in community-dwelling older adults. Journal of the American Geriatrics Society, 59, 512518.

A. Marengoni et al. (2011). Aging with multimorbidity: a systematic review of the literature. Ageing Research Reviews, 10, 430439.

M. D. Miller et al. (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research, 41, 237248.

R. Nutheti et al. (2006). Impact of impaired vision and eye disease on quality of life in Andhra Pradesh. Investigative Ophthalmology & Visual Science, 47, 47424748.

E. Pfeiffer (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.

C. C. Schubert et al. (2006). Comorbidity profile of dementia patients in primary care: are they sicker? Journal of the American Geriatrics Society, 54, 104109.

M. D. Sullivan , G. I. Kempen , E. Van Sonderen and J. Ormel (2000). Models of health-related quality of life in a population of community-dwelling Dutch elderly. Quality of Life Research, 9, 801810.

J. M. Valderas , B. Starfield , B. Sibbald , C. Salisbury and M. Roland (2009). Defining comorbidity: implications for understanding health and health services. Annals of Family Medicine, 7, 357363.

C. Vogeli et al. (2007). Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. Journal of General Internal Medicine, 22, 391395.

F. B. Waldorff , A. B. S. Nielsen and G. Waldemar (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.

R. Yancik , W. Ershler , W. Satariano , W. Hazzard , H. J. Cohen and L. Ferrucci (2007). Report of the National Institute on Aging Task Force on Comorbidity. Journals of Gerontology, Series A: Biological Sciences and Medical Sciences, 62, 275280.

J. X. Zhang et al. (2003). Comorbidity and the concentration of healthcare expenditures in older patients with heart failure. Journal of the American Geriatrics Society, 51, 476482.

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International Psychogeriatrics
  • ISSN: 1041-6102
  • EISSN: 1741-203X
  • URL: /core/journals/international-psychogeriatrics
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