Multimorbidity and functional status in institutionalized older adults

Background: Multimorbidity research has increased progressively, especially in older adults, due to its major consequences such as mortality and reduced functional capacity. The objective of the study was to identify multimorbidity groups and how single, paired, and groups of multiple chronic conditions influence functional status in institutionalized older adults. Methods: The study is based on two cross-sectional samples of institutionalized people of 65-years-olds or over in Spain, with a total of 887 subjects. Sociodemographic data and functional status (Barthel index) were obtained by a structured interview. The diagnoses of 11 chronic health problems were collected from the medical record. Results: Ninety-two percent of the sample suffered two or more chronic diseases. Dementia was strongly associated with a reduction in functional independence (OR 3.22, 95% CI 2.33-4.44). In the analysis by pair of conditions, cardiovascular disease and cancer (OR 1.89, 95% CI 1.00-3.58) had the highest association with low functional status. Four multimorbidity groups emerged from the factor analysis: sensory, bone and gastrointestinal; cardiopulmonary and metabolic; dementia, cancer and gastrointestinal; and Parkinson's disease. The dementia, cancer and gastrointestinal disorders group was the only one significantly associated with physical impairment (OR 2.23, 95% CI 1.53-3.25). Conclusions: The large majority of institutionalized older adults presents multimorbidity and the results confirm the non-random associations between chronic diseases. The identification of multimorbidity patterns most associated with physical function offers the potential to the implementation of preventive strategies and better treatment of multimorbid patients in long-term care facilities. (C) 2015 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.