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Multiple Chronic Conditions and Limitations in Activities of Daily Living in a Community-Based Sample of Older Adults in New York City, 2009
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Nancy L. Ralph, MPH; Thelma J. Mielenz, PhD, MS; Hilary Parton, MPH; Anne-Marie Flatley; Lorna E. Thorpe, PhD, MPH
Suggested citation for this article: Ralph NL, Mielenz TJ, Parton H, Flatley A, Thorpe LE. Multiple Chronic Conditions and Limitations in Activities of Daily Living in a Community-Based Sample of Older Adults in New York City, 2009. Prev Chronic Dis 2013;10:130159. DOI: http://dx.doi.org/10.5888/pcd10.130159.
Nationally, 60% to 75% of older adults have multiple (2 or more) chronic conditions (MCCs), and the burden is even higher among low-income, racial/ethnic minority populations. MCCs limit activities of daily living (ADLs), yet this association is not well characterized outside of clinical populations. We examined the association of MCCs with ADLs in a racially/ethnically diverse population of low-income older adults living in New York City public housing.
A representative sample of 1,036 New York City Housing Authority residents aged 65 or older completed a telephone survey in June 2009. We examined the association of up to 5 chronic conditions with basic ADL (BADL) limitations, adjusting for potential confounders by using logistic regression.
Of respondents, 28.7% had at least 1 BADL limitation; 92.9% had at least 1 chronic condition, and 79.0% had MCCs. We observed a graded association between at least 1 BADL limitation and number of chronic conditions (using 0 or 1 condition as the reference group): adjusted odds ratio (AOR) for 3 conditions was 2.2 (95% confidence interval [CI], 1.3–3.9); AOR for 4 conditions, 4.3 (95% CI, 2.5–7.6); and AOR for 5 conditions, 9.2 (95% CI, 4.3–19.5).
Prevalence of BADL limitations is high among low-income older adults and increases with number of chronic conditions. Initiating prevention of additional conditions and treating disease constellations earlier to decrease BADL limitations may improve aging outcomes in this population.
Author InformationCorresponding Author: Nancy L. Ralph, MPH, New York City Department of Health and Mental Hygiene, Gotham Center, CN# 34A, 42–09 28th St, 10th Floor, Queens, New York 11101-4132. Telephone: 347-396-4494. E-mail: firstname.lastname@example.org.
Author Affiliations: Thelma J. Mielenz, Columbia University Mailman School of Public Health, New York, New York; Hilary Parton, New York City Department of Health and Mental Hygiene, Long Island City, New York; Anne-Marie Flatley, New York City Housing Authority, New York, New York; Lorna E. Thorpe, City University of New York School of Public Health at Hunter College, New York, New York.
- Anderson G. Chronic care: making the case for ongoing care. Princeton (NJ): Robert Wood Johnson Foundation; 2010.
- Schoenberg NE, Kim H, Edwards W, Fleming ST. Burden of common multiple-morbidity constellations on out-of-pocket medical expenditures among older adults. Gerontologist 2007;47(4):423–37. CrossRefPubMed
- Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA. Causes and consequences of comorbidity: a review. J Clin Epidemiol 2001;54(7):661–74. CrossRefPubMed
- Freid VM, Bernstein AB, Bush MA. Multiple chronic conditions among adults aged 45 and over: trends over the past 10 years. Hyattsville (MD): National Center for Health Statistics; 2012.
- Rigler SK, Studenski S, Wallace D, Reker DM, Duncan PW. Co-morbidity adjustment for functional outcomes in community-dwelling older adults. Clin Rehabil 2002;16(4):420–8. CrossRefPubMed
- Chowdhury P. Racial/ethnic and socioeconomic disparities in multiple risk factors for heart diseases and stroke — United States, 2003. Atlanta (GA): Centers for Disease Control and Prevention; 2005.
- Ciol MA, Shumway-Cook A, Hoffman JM, Yorkston KM, Dudgeon BJ, Chan L. Minority disparities in disability between Medicare beneficiaries. J Am Geriatr Soc 2008;56(3):444–53. CrossRefPubMed
- August KJ, Sorkin DH. Racial and ethnic disparities in indicators of physical health status: do they still exist throughout late life? J Am Geriatr Soc 2010;58(10):2009–15. CrossRefPubMed
- Meador R, Chen E, Schultz L, Norton A, Henderson C Jr, Pillemer K. Going home: identifying and overcoming barriers to nursing home discharge. Care Manag J 2011;12(1):2–11. CrossRefPubMed
- Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A Biol Sci Med Sci 2004;59(3):255–63. CrossRefPubMed
- Johnson RJ, Wolinsky FD. The structure of health status among older adults: disease, disability, functional limitation, and perceived health. J Health Soc Behav 1993;34(2):105–21. CrossRefPubMed
- Tinetti ME, McAvay GJ, Chang SS, Newman AB, Fitzpatrick AL, Fried TR, et al. Contribution of multiple chronic conditions to universal health outcomes. J Am Geriatr Soc 2011;59(9):1686–91. CrossRefPubMed
- Vogeli C, Shields AE, Lee TA, Gibson TB, Marder WD, Weiss KB, et al. Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs. J Gen Intern Med 2007;22(Suppl 3):391–5. CrossRefPubMed
- Parton HB, Greene R, Flatley AM, Viswanathan N, Wilensky L, Berman J, et al. Health of older adults in public housing, NYCHA, executive summary: technical notes for Health of Older Adults in Public Housing Survey. New York (NY): NYC Department of Health and Mental Hygiene; 2011. http://www.nyc.gov/html/doh/downloads/pdf/episrv/nycha_senior_technotes.pdf Accessed April 7, 2012.
- Guralnik JM, LaCroix AZ. Assessing physical function in older populations. In: Wallace RB, Woolson RF, editors. Epidemiologic study of the elderly New York (NY): Oxford University Press; 1992. p. 159–81.
- Anderson RT, James MK, Miller ME, Worley AS, Longino CF Jr. The timing of change: patterns in transitions in functional status among elderly persons. J Gerontol B Psychol Sci Soc Sci 1998;53(1):S17–27. CrossRefPubMed
- Ferrucci L, Guralnik JM, Pahor M, Corti MC, Havlik RJ. Hospital diagnoses, Medicare charges, and nursing home admissions in the year when older persons become severely disabled. JAMA 1997;277(9):728–34. CrossRefPubMed
- Dunlop DD, Manheim LM, Sohn MW, Liu X, Chang RW. Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions. Arch Phys Med Rehabil 2002;83(7):964–71. CrossRefPubMed
- Limitations in activities of daily living and instrumental activities of daily living. 2003–2007. Hyattsville (MD): National Center for Health Statistics; 2009. http://www.cdc.gov/nchs/health_policy/ADL_tables.htm Accessed September 22, 2011
- Fortin M, Stewart M, Poitras ME, Almirall J, Maddocks H. A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 2012;10(2):142–51. CrossRefPubMed
- Ruo B, Baker DW, Thompson JA, Murray PK, Huber GM, Sudano JJ Jr. Patients with worse mental health report more physical limitations after adjustment for physical performance. Psychosom Med 2008;70(4):417–21. CrossRefPubMed
- Penninx BW, Guralnik JM, Ferrucci L, Simonsick EM, Deeg DJ, Wallace RB. Depressive symptoms and physical decline in community-dwelling older persons. JAMA 1998;279(21):1720–6. CrossRefPubMed
- Teixeira ME, Budd GM. Obesity stigma: a newly recognized barrier to comprehensive and effective type 2 diabetes management. J Am Acad Nurse Pract 2010;22(10):527–33. CrossRefPubMed
- Ormel J, Rijsdijk FV, Sullivan M, van Sonderen E, Kempen GI. Temporal and reciprocal relationship between IADL/ADL disability and depressive symptoms in late life. J Gerontol B Psychol Sci Soc Sci 2002;57(4):338–47. CrossRefPubMed
- Millán-Calenti JC, Maseda A, Rochette S, Vazquez GA, Sanchez A, Lorenzo T. Mental and psychological conditions, medical comorbidity and functional limitation: differential associations in older adults with cognitive impairment, depressive symptoms and co-existence of both. Int J Geriatr Psychiatry 2011;26(10):1071–9. CrossRefPubMed
- House JS, Lepkowski JM, Kinney AM, Mero RP, Kessler RC, Herzog AR. The social stratification of aging and health. J Health Soc Behav 1994;35(3):213–34. CrossRefPubMed
- Bayliss EA, Ellis JL, Steiner JF. Barriers to self-management and quality-of-life outcomes in seniors with multimorbidities. Ann Fam Med 2007;5(5):395–402. CrossRefPubMed
- Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2012;(4):CD006560. PubMed
- Stineman MG, Henry-Sanchez JT, Kurichi JE, Pan Q, Xie D, Saliba D, et al. Staging activity limitation and participation restriction in elderly community-dwelling persons according to difficulties in self-care and domestic life functioning. Am J Phys Med Rehabil 2012;91(2):126–40. CrossRefPubMed
- Fieo RA, Austin EJ, Starr JM, Deary IJ. Calibrating ADL-IADL scales to improve measurement accuracy and to extend the disability construct into the preclinical range: a systematic review. BMC Geriatr 2011;11:42. CrossRefPubMed
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