Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care.

Abstract

OBJECTIVES:

The aim was to evaluate patterns of multimorbidity that increase the risk of institutionalization in older persons, also exploring the potential buffering effect of formal and informal care.

DESIGN:

Prospective cohort study.

SETTING AND PARTICIPANTS:

The population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, Sweden.

MEASURES:

In total, 2571 community-dwelling older adults were grouped at baseline according to their underlying multimorbidity patterns, using a fuzzy c-means cluster algorithm, and followed up for 6 years to test the association between multimorbidity patterns and institutionalization.

RESULTS:

Six patterns of multimorbidity were identified: psychiatric diseases; cardiovascular diseases, anemia, and dementia; metabolic and sleep disorders; sensory impairments and cancer; musculoskeletal, respiratory, and gastrointestinal diseases; and an unspecific pattern including diseases of which none were overrepresented. In total, 110 (4.3%) participants were institutionalized during the follow-up, ranging from 1.7% in the metabolic and sleep disorders pattern to 8.4% in the cardiovascular diseases, anemia, and dementia pattern. Compared with the unspecific pattern, only the cardiovascular diseases, anemia, dementia pattern was significantly associated with institutionalization [relative risk ratio (RRR) = 2.23; 95% confidence interval (CI) 1.07‒4.65)], after adjusting for demographic characteristics and disability status at baseline. In stratified analyses, those not receiving formal care in the psychiatric diseases pattern (RRR 3.34; 95% CI 1.20‒9.32) and those not receiving formal or informal care in the 'cardiovascular diseases, anemia, dementia' pattern (RRR 2.99; 95% CI 1.20‒7.46; RRR 2.79; 95% CI 1.16‒6.71, respectively) had increased risks of institutionalization.

CONCLUSIONS AND IMPLICATIONS:

Older persons suffering from specific multimorbidity patterns have a higher risk of institutionalization, especially if they lack formal or informal care. Interventions aimed at preventing the clustering of diseases could reduce the associated burden on residential long-term care. Formal and informal care provision may be effective strategies in reducing the risk of institutionalization.

• Authors: Alessandra Marengoni, Clare Tazzeo, Amaia Calderón-Larrañaga, Albert Roso-Llorach, Graziano Onder, Alberto Zucchelli, Debora Rizzuto, Davide Liborio Vetrano
• Journal: Journal of the American Medical Directors Association (J Am Med Dir Assoc) Vol. 22 Issue 10 Pg. 2184-2189.e1 (10 2021) ISSN: 1538-9375 [Electronic] United States
• PMID: 33556330 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Aged, 80 and over
• Aging
• Humans
• Independent Living
• Institutionalization
• Multimorbidity
• Prospective Studies