title: Comorbidity and 1-year mortality risks in nursing home residents.
abstract: OBJECTIVE
  To investigate the effect of chronic diseases and disease combinations on 1-year mortality in nursing home residents.
  
  
  METHODS
  Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data.
  
  
  METHODS
  Five hundred twenty-two nursing homes in Missouri.
  
  
  METHODS
  Forty-three thousand five hundred ten nursing home residents with a full MDS assessment in 1999.
  
  
  METHODS
  Information about chronic diseases, age, sex, and performance in activities of daily living (ADLs) available from the first full MDS 2.0 assessment in 1999; death within 1 year after the first full MDS-assessment in 1999.
  
  
  RESULTS
  After adjustment for age and sex, eight variables were predictive for 1-year mortality: seven chronic diseases (dementia, cancer, heart failure, renal failure, emphysema/chronic obstructive pulmonary disease, diabetes mellitus, and anemia) and an interaction variable containing age and cancer. Adding terms for disease combinations (e.g., diabetes mellitus and heart failure) did not enhance survival prediction. When there was also adjustment for ADL performance as measured using the MDS-ADL Short Form, dementia and anemia were not included, because they had no prognostic value above that of the other variables.
  
  
  CONCLUSIONS
  Several chronic diseases were associated with 1-year mortality in the institutionalized elderly after adjustment for ADL performance, age, and sex. Evidence of a synergistic effect of disease combinations on mortality is lacking.
authors.affiliation: Institute for Research in Extramural Medicine, VU University Medical Center, van der Boechorststraat 7, 1081 BT Amsterdam, the Netherlands. bulderdijk@freeler.nl
authors.forename: Pieter T M
authors.initials: PT
authors.lastname: van Dijk
authors.forename: David R
authors.initials: DR
authors.lastname: Mehr
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Ooms
authors.forename: Richard
authors.initials: R
authors.lastname: Madsen
authors.forename: Greg
authors.initials: G
authors.lastname: Petroski
authors.forename: Dinnus H
authors.initials: DH
authors.lastname: Frijters
authors.forename: Anne Margriet
authors.initials: AM
authors.lastname: Pot
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D006707:Homes for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008923:Missouri / Q000453:epidemiology; D009026:Mortality; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data*; D012189:Retrospective Studies