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- Damiano, Cecilia, et al.
(författare)
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Frailty, multimorbidity patterns and mortality in institutionalized older adults in Italy
- 2022
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Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 34:12, s. 3123-3130
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Tidskriftsartikel (refereegranskat)abstract
- Background Little is known on how frailty influences clinical outcomes in persons with specific multimorbidity patterns.Aims To investigate the interplay between multimorbidity and frailty in the association with mortality in older individuals living in nursing homes (NH).Methods We considered 4,131 NH residents aged 60 years and over, assessed through the interRAI LTCF instrument between 2014 and 2018. Follow-up was until 2019. Considering four multimorbidity patterns identified via principal component analysis, subjects were stratified in tertiles (T) with respect to their loading values. Frailty Index (FI) considered 23 variables and a cut-off of 0.24 distinguished between high and low frailty levels. For each pattern, all possible combinations of tertiles and FI were evaluated. Their association (Hazard Ratio [HR] and 95% confidence interval) with mortality was tested in Cox regression models.Results In the heart diseases and dementia and sensory impairments patterns, the hazard of death increases progressively with patterns expression and frailty severity (being HR T3 vs. T1 = 2.36 [2.01–2.78]; HR T3 vs. T1 = 2.12 [1.83–2.47], respectively). In heart, respiratory and psychiatric diseases and diabetes, musculoskeletal and vascular diseases patterns, frailty seems to have a stronger impact on mortality than patterns’ expression.Discussion Frailty increases mortality risk in all the patterns and provides additional prognostic information in NH residents with different multimorbidity patterns.Conclusions These findings support the need to routinely assess frailty. Older people affected by specific groups of chronic diseases need a specific care approach and have high risk of negative health outcomes.
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| 2. |
- Vetrano, Davide L., et al.
(författare)
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Multimorbidity Patterns and 5-Year Mortality in Institutionalized Older Adults
- 2022
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Ingår i: Journal of the American Medical Directors Association. - : Elsevier BV. - 1525-8610 .- 1538-9375. ; 23:8, s. 1389-1395, 1395.e1-1395.e4
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: The aim was to characterize multimorbidity patterns in a large sample of older individuals living in nursing homes (NHs) and to investigate their association with mortality, also considering the effect of functional status.Design: Observational and retrospective study.Setting and Participants: We analyzed data on 4131 NH residents in Italy, aged 60 years and older, assessed through the interRAI long-term care facility instrument. Entry date was between 2014 and 2018, and participants were followed until 2019.Methods: Multimorbidity patterns were identified through principal component analysis; for the identified components, subjects were stratified in quintiles (Q) with respect to their loading values, with the higher quantiles indicating greater expression of the component's pattern. Their association [hazard ratio (HR) and 95% CI] with mortality was tested in Cox regression models. Analyses were stratified by disability status.Results: Four patterns of multimorbidity were identified: (1) heart diseases; (2) dementia and sensory impairments; (3) heart, respiratory, and psychiatric diseases; and (4) diabetes, musculoskeletal, and vascular diseases. For the heart diseases pattern [HR Q5 vs Q1 = 1.83 (1.53–2.20)] and the dementia and sensory impairments pattern [HR Q5 vs Q1 = 1.23 (1.06–1.42)], as the specific multimorbidity expression increases, the risk of mortality increases. On stratifying by disability status, the association between the multimorbidity patterns and mortality was not always present.Conclusions and Implications: Different multimorbidity patterns are differentially associated with mortality in older residents of NHs, confirming that multimorbidity's prognosis is strictly dependent on the underlying disease combinations. This knowledge may be useful to implement personalized preventive and therapeutic care pathways for institutionalized older adults, which respond to individuals’ health needs.
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| 3. |
- Zazzara, Maria Beatrice, et al.
(författare)
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Adverse drug reactions in older adults : a narrative review of the literature
- 2021
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Ingår i: European Geriatric Medicine. - : Springer Science and Business Media LLC. - 1878-7649 .- 1878-7657. ; 12, s. 463-473
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Forskningsöversikt (refereegranskat)abstract
- Purpose Adverse drug reactions (ADRs) represent a common and potentially preventable cause of unplanned hospitalization, increasing morbidity, mortality, and healthcare costs. We aimed to review the classification and occurrence of ADRs in the older population, discuss the role of age as a risk factor, and identify interventions to prevent ADRs.Methods We performed a narrative scoping review of the literature to assess classification, occurrence, factors affecting ADRs, and possible strategies to identify and prevent ADRs.Results Adverse drug reactions (ADRs) are often classified as Type A and Type B reactions, based on dose and effect of the drugs and fatality of the reaction. More recently, other approaches have been proposed (i.e. Dose, Time and Susceptibility (DoTS) and EIDOS classifications). The frequency of ADRs varies depending on definitions, characteristics of the studied population, and settings. Their occurrence is often ascribed to commonly used drugs, including anticoagulants, antiplatelet agents, digoxin, insulin, and non-steroidal anti-inflammatory drugs. Age-related factors-changes in pharmacokinetics, multimorbidity, polypharmacy, and frailty-have been related to ADRs. Different approaches (i.e. medication review, software identifying potentially inappropriate prescription and drug interactions) have been suggested to prevent ADRs and proven to improve the quality of prescribing. However, consistent evidence on their effectiveness is still lacking. Few studies suggest that a comprehensive geriatric assessment, aimed at identifying individual risk factors, patients' needs, treatment priorities, and strategies for therapy optimization, is key for reducing ADRs.Conclusions Adverse drug reactions (ADRs) are a relevant health burden. The medical complexity that characterizes older patients requires a holistic approach to reduce the burden of ADRs in this population.
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| 4. |
- Zazzara, Maria Beatrice, et al.
(författare)
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Comorbidity patterns in institutionalized older adults affected by dementia
- 2022
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Ingår i: Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring (DADM). - : Wiley. - 2352-8729. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Dementia is common in nursing homes (NH) residents. Defining dementia comorbidities is instrumental to identify groups of persons with dementia that differ in terms of health trajectories and resources consumption. We performed a cross-sectional study to identify comorbidity patterns and their associated clinical, behavioral, and functional phenotypes in institutionalized older adults with dementia.Methods: We analyzed data on 2563 Italian NH residents with dementia, collected between January 2014 and December 2018 using the multidimensional assessment instrument interRAI Long-Term Care Facility (LTCF). A standard principal component procedure was used to identify comorbidity patterns. Linear regression analyses were used to ascertain correlates of expression of the different patterns.Results: Among NH residents with dementia, we identified three different comorbidity patterns: (1) heart diseases, (2) cardiovascular and respiratory diseases and sensory impairments, and (3) psychiatric diseases. Older age significantly related to increased expression of the first two patterns, while younger patients displayed increased expression of the third one. Recent hospital admissions were associated with increased expression of the heart diseases pattern (β = 0.028; 95% confidence interval [CI] 0.003 to 0.05). Depressive symptoms and delirium episodes increased the expression of the psychiatric diseases pattern (β = 0.130, 95% CI 0.10 to 0.17, and β 0.130, CI 0.10 to 0.17, respectively), while showed a lower expression of the heart diseases pattern.Discussion: We identified different comorbidity patterns within NH residents with dementia that differ in term of clinical and functional profiles. The prompt recognition of health needs associated to a comorbidity pattern may help improve long-term prognosis and quality of life of these individuals.
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