Self-rated health (SRH) is one of the most frequently used indicators in health and social research. Its robust association with mortality in very different populations implies that it is a comprehensive measure of health status and may even reflect the condition of the human organism beyond clinical diagnoses. Yet the biological basis of SRH is poorly understood. We used data from three independent European population samples (N approx. 15,000) to investigate the associations of SRH with 150 biomolecules in blood or urine (biomarkers). Altogether 57 biomarkers representing different organ systems were associated with SRH. In almost half of the cases the association was independent of disease and physical functioning. Biomarkers weakened but did not remove the association between SRH and mortality. We propose three potential pathways through which biomarkers may be incorporated into an individual's subjective health assessment, including (1) their role in clinical diseases; (2) their association with health-related lifestyles; and (3) their potential to stimulate physical sensations through interoceptive mechanisms. Our findings indicate that SRH has a solid biological basis and it is a valid but non-specific indicator of the biological condition of the human organism.

https://biblio.ugent.be/publication/8706456/file/8706457.pdf

Self-rated health in individuals with and without disease is associated with multiple biomarkers representing multiple biological domains

https://link.springer.com/content/pdf/10.1007/s41999-020-00338-7.pdf

Factors associated with institutionalization among home-dwelling patients of Urgent Geriatric Outpatient Clinic: a 3-year follow-up study

BACKGROUND Previous studies have evaluated the association of multimorbidity with higher mortality, but epidemiologic data on the association between the disease clusters and all-cause mortality risk are rare. We aimed to examine the relationship between multimorbidity (number/ cluster) and all-cause mortality in Chinese older adults. METHODS We conducted a population-based study of 50,100 Chinese participants. Multiple logistic regression analysis was used to estimate the impact of long-term conditions (LTCs) on all-cause mortality. RESULTS The prevalence of multimorbidity was 31.35% and all-cause mortality was 8.01% (50,100 participants). In adjusted models, the odds ratios (ORs) and 95% confidence intervals (CIs) of all-cause mortality risk for those with 1, 2, and ≥ 3 LTCs compared with those with no LTCs was 1.45 (1.32-1.59), 1.72 (1.55-1.90), and 2.15 (1.85-2.50), respectively (Ptrend < 0.001). In the LTCs ≥2 category, the cluster of chronic diseases that included hypertension, diabetes, CHD, COPD, and stroke had the greatest impact on mortality. In the stratified model by age and sex, absolute all-cause mortality was higher among the ≥75 age group with an increasing number of LTCs. However, the relative effect size of the increasing number of LTCs on higher mortality risk was larger among those < 75 years. CONCLUSIONS The risk of all-cause mortality is increased with the number of multimorbidity among Chinese older adults, particularly disease clusters.

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Relationship between multimorbidity, disease cluster and all-cause mortality among older adults: a retrospective cohort analysis.

In order to understand the phenomenon of stigma in different populations (e.g., different ethnicities, different diseases, and different conditions), this Special Issue collects papers from around the world to illustrate the stigma phenomenon. After a rigorous process of peer review, a total of 24 papers were published and included in the Special Issue. These papers were contributed from different continents and countries, including the Americas (e.g., United States), Europe (e.g., Finland), and Asia (e.g., Saudi Arabia). Therefore, the diversity of ethnicity was ensured in the Special Issue. Moreover, these papers address different stigmatized populations/conditions (e.g., mental illness, obesity, public housing, homosexuality, and transgender). The most discussed populations were those with mental illness and those with obesity/overweight. However, additional evidence on the stigma topic is still needed. Specifically, future studies could consider the following directions to explore in depth the issues of stigma in different populations: (1) using longitudinal designs to understand the temporal or causal relationship between stigma and other related psychosocial factors; (2) designing treatment programs to fight stigma-this could be carried out in healthcare providers, healthcare trainees, the public, caregivers, and the stigmatized populations.

https://www.mdpi.com/1660-4601/17/20/7615/pdf

Stigma, Health and Well-Being

http://www.thelancet.com/article/S2666756822001866/pdf

Comparing clinical trial population representativeness to real-world populations: an external validity analysis encompassing 43 895 trials and 5 685 738 individuals across 989 unique drugs and 286 conditions in England.

Background prevalence of many chronic conditions is rising in the aging population worldwide. However, the long-term impact of these conditions and multimorbidity on other health outcomes in very old age is rarely studied. Methods the data were based on four waves of the Vitality 90+ Study conducted in 2001, 2003, 2007 and 2010. Associations of chronic conditions and multimorbidity with mortality were analysed in a total sample of 2,862 people aged over 90, and associations with long-term care (LTC) admission in a subsample of 1,954 participants living at home in baseline. Risk of death and LTC admission were assessed with Cox and competing risks regression with time-dependent covariates. Population attributable fractions (PAF) for mortality and LTC admission were calculated for chronic conditions based on the regression models. Results heart disease, diabetes and dementia predicted mortality in men and women. In addition, depression was associated with increased mortality in women. Parkinson's disease, dementia and hip fracture predicted LTC admission in women. Multimorbidity increased the risk of death and LTC admission in women but not in men. For both genders, dementia had the highest PAF for mortality and LTC admission. Conclusion heart disease and diabetes are still important predictors of mortality in very old age. However, the role of dementia is pronounced in this age group. Of the studied conditions, dementia is the main contributor both to mortality and LTC admission. Multimorbidity has predictive value concerning both mortality and LTC admission, at least in oldest old women.

/pdf/chronic-conditions-and-multimorbidity-in-population-aged-90-3pjkb8750h.pdf

Chronic conditions and multimorbidity in population aged 90 years and over: associations with mortality and long-term care admission.

BACKGROUND It remains unclear whether increasing longevity is accompanied by a compression or expansion of poor health and disability. We examined trends of physical functioning and morbidity in a population aged 90 and older, and disease- and disability-free life expectancy (LE) at age 90 between 2001 and 2018 in Finland's third most populated city. METHODS We used survey data from the Vitality 90+ Study, which comprises a series of six repeated mailed surveys (7,590 observations). Information on mortality came from Statistics Finland. We examined trends of functioning (activities of daily living [ADL] and mobility) and cardiovascular and dementia morbidity using age-adjusted generalized estimating equation models stratified by sex. In addition, age-, sex-, and period-specific health expectancies were calculated using Sullivan's method. RESULTS Over time, functioning improved, especially, in women, and morbidity increased in men. From 2001 to 2018, LE at age 90 increased by 5.3 months for men and 6.4 months for women. LE without ADL disability increased by 5.0 months for men and 8.4 months for women, and LE without mobility disability by 6.0 months for men and 4.4 months for women. LE without cardiovascular and dementia morbidity decreased for men (2.6 months) and increased for women (1.9 months). CONCLUSIONS In relative terms, we found a compression of disability for both sexes and an expansion of morbidity for men. Although the trends overall are rather positive, the increase in absolute morbidity and, to some extent, in disability will inevitably mean increasing care needs with population aging.

/pdf/trends-of-physical-functioning-morbidity-and-disability-free-qq1uhkfwsp.pdf

Trends of Physical Functioning, Morbidity, and Disability-Free Life Expectancy Among the Oldest Old: Six Repeated Cross-Sectional Surveys Between 2001 and 2018 in the Vitality 90+ Study

Tutkimuksessa selvitettiin pitkaaikaissairauksien ja monisairastavuuden esiintyvyytta 90-vuotiailla ja sita vanhemmilla tamperelaisilla. Erityisena mielenkiinnon kohteena oli sairastavuuden yhteys huonoon itse arvioituun terveyteen ja toimintakykyyn seka avun tarpeeseen paivittaisissa toiminnoissa ja liikkumisessa. Tutkimuksessa kaytettiin Tervaskannot 90+ -tutkimuksen vuoden 2014 postikyselyaineistoa, johon vastasi 1637 henkiloa ja vastausprosentti oli 80. Tutkimuksen mukaan miehista 77 prosenttia ja naisista 82 prosenttia sairasti vahintaan kahta pitkaaikaissairautta. Etenkin muistisairautta ja masennusta sairastavat henkilot arvioivat terveytensa ja toimintakykynsa huonoksi, ja heilla avun tarve liikkumisessa ja paivittaisissa toiminnoissa oli lisaantynyt. Naisilla useampi yksittainen sairaus oli yhteydessa huonoon itse arvioituun terveyteen ja toimintakykyyn kuin miehilla. Monisairaat henkilot arvioivat terveytensa ja toimintakykynsa heikommaksi ja tarvitsivat enemman apua liikkumisessa ja paivittaisissa toiminnoissa kuin ne henkilot, joilla oli vain yksi sairaus. Hyvin vanhojen sairastavuutta ja monisairastavuutta tulisi selvittaa lisaa, jotta terveydenhuollossa ja yha enemman kotona tapahtuvassa hoidossa voitaisiin nykyista paremmin huomioida monisairaiden henkiloiden tarpeet.
Chronic conditions and multimorbidity - associations with functioning and self-rated health among nonagenarians: The Vitality 90+ Study
The aim of this study was to examine the prevalence of chronic conditions and multimorbidity and their association with self-rated health, self-rated functioning, activities of daily living (ADL) and mobility in individuals aged 90 years and older. The study population consisted of 1637 nonagenarians who answered the mailed survey in the Vitality 90+ Study in 2014. Results showed that almost all of the nonagenarians had a chronic condition and the majority suffered from multimorbidity. Those who had memory disorder or depression had poor self-rated health and functioning and were more often disabled in ADL and mobility. In addition, multimorbidity was associated with poor health indicated by all four health outcomes. More research on morbidity is needed in this age group to meet the needs of nonagenarians with multimorbidity.

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Pitkäaikaissairaudet ja monisairastavuus hyvin vanhoilla sekä niiden yhteys toimintakykyyn ja itse arvioituun terveyteen – Tervaskannot 90+ -tutkimus

Comorbidities have major implications for the care of people with dementia.
 To investigate the patterns of comorbidities in dementia in the last five years of life and how these patterns differed between three cohorts. The study included people who died at age 70 and above in 2001 (n = 13,717), 2007 (n = 34,750) and 2013 (n = 38,087) in Finland. ICD-10 morbidity data for a five-year period prior to death were extracted from national registers. Principal component analysis was employed to identify patterns for several morbidities. The associations of principal component scores with dementia were analysed using binary logistic regression. Linear regression was used to examine changes in the number of morbidities in patterns over time.
 The morbidity patterns identified in the last years of life were (1) cardiometabolic disorders, (2) neurological, (3) cerebrovascular diseases and (4) musculoskeletal, thyroid and psychiatric disorders. Among the patterns, neurological and musculoskeletal, thyroid and psychiatric disorders were associated with dementia. The number of diagnoses in the cerebrovascular pattern increased and those in the musculoskeletal, thyroid and psychiatric pattern decreased over time. Comorbidity patterns identified in this nationwide register study are largely in line with previous evidence. Time difference in these patterns provide crucial information for service planning.
 Comorbidities in dementia in the last years of life occur in patterns and change over time. More systematic monitoring and updated clinical guidelines are needed for the care of comorbidities with dementia.

/pdf/comorbidities-in-dementia-during-the-last-years-of-life-a-4mlz57j2u3.pdf

Comorbidities in dementia during the last years of life: a register study of patterns and time differences in Finland

Objectives To examine trends in the prevalence of dementia and related comorbidities among the oldest old. Methods Six repeated cross-sectional surveys were conducted between 2001 and 2018, each including all inhabitants aged over 90 in Tampere, Finland (n = 5386). Co-occurring conditions and their time trends among participants with dementia were examined using logistic regression and generalized estimating equations. Results The prevalence of dementia decreased from 47% in 2007 to 41% in 2018. Throughout the study period, depression was more common among people with dementia compared to those without. The prevalence of hypertension, diabetes, and osteoarthritis increased and the prevalence of depression decreased among people with dementia. The mean number of comorbidities increased from 2.0 in 2001 to 2.3 in 2018. Discussion Dementia remains highly prevalent among the oldest old and it is accompanied by an increasing burden of comorbidities, posing a challenge to people with dementia, their caregivers, and care systems.

https://doi.org/10.1177/08982643221123451

Pauliina Halonen

Papers

Chronic conditions and multimorbidity in population aged 90 years and over: associations with mortality and long-term care admission.

Trends of Physical Functioning, Morbidity, and Disability-Free Life Expectancy Among the Oldest Old: Six Repeated Cross-Sectional Surveys Between 2001 and 2018 in the Vitality 90+ Study

Pitkäaikaissairaudet ja monisairastavuus hyvin vanhoilla sekä niiden yhteys toimintakykyyn ja itse arvioituun terveyteen – Tervaskannot 90+ -tutkimus

Comorbidities in dementia during the last years of life: a register study of patterns and time differences in Finland

Dementia and Related Comorbidities in the Population Aged 90 and Over in the Vitality 90+ Study, Finland: Patterns and Trends From 2001 to 2018