title: Patterns of chronic co-morbid medical conditions in older residents of U.S. nursing homes: differences between the sexes and across the agespan.
abstract: OBJECTIVE
  There are limited data on combinations of co-morbid conditions to guide efforts to improve therapeutic strategies in patients with multiple co-morbid conditions. To some extent, this may be due to limited data on combinations of co-morbid conditions in patient groups. Our goal was to determine the most common co-morbid medical conditions in older residents of U.S. nursing homes and identify sex differences in prevalences and changes across the agespan of nursing residents.
  
  
  METHODS
  Cross sectional analysis of National Nursing Home Survey (NNHS)--a nationally representative sample with comprehensive medical data on nursing home residents.
  
  
  METHODS
  1174 Nursing homes.
  
  
  METHODS
  Long term stay residents of U.S. Nursing Homes aged 65 years and older (11,734 :8745 women, 2989 men).
  
  
  METHODS
  Determination of the prevalences of the most frequent two and three disease combinations identified using Clinical Classifications Software (CCS) for ICD-9-CM and a composite vascular disease diagnosis (atherosclerosis and/or coronary artery disease, and/or peripheral arterial disease, and/or cerebrovascular disease or stroke) from the most recent and only NNHS survey with comprehensive medical diagnosis information.
  
  
  RESULTS
  Frequent 2-disease combinations were: hypertension (HTN) + dementia (DEM) in 27%, HTN + any Vascular (Vasc) disease (26%), HTN + depression(DEP) 21%, HTN + arthritis(ARTH) 20%, DEM + Vasc (21%), DEM+Depression 19%, Arthritis + DEM 17%, DEP + Vasc (16%), ARTH + Vasc (15%), followed by HTN + GERD (14%) and ARTH + DEP (14%). Frequent 3-disease combinations: HTN +VASC+ DEP in 13%, HTN +DEM +DEP (11%), and HTN+Arthritis+DEM (10%). HTN was in 80% of the top 3-disease combinations, Vasc in 50%, HTN+VASC in 35%, DEM or DEP in 40%, ARTH in 25% and GERD in 20%. Combinations with anemia, arthritis, dementia, heart failure, osteroporosis, thyroid disease were higher in women, COPD combinations higher in men. As age increased, dementia, depression, arthritis, and anemia with hypertension were common co-morbid combinations, diabetes and heart failure were not.
  
  
  CONCLUSIONS
  Hypertension, vascular disease, dementia, arthritis, depression, and gastro-esophageal reflux disease were part of the most prevalent co-morbid conditions. Multimorbidity patterns can be identified in nursing home residents and vary with age and by sex.
authors.affiliation: J.B. Schwartz, MD, Research Department, 302 Silver Avenue, San Francisco, CA 94112; (415) 406-1573, fax (415) 406-1577; Janice.schwartz@ucsf.edu.
authors.forename: K L
authors.initials: KL
authors.lastname: Moore
authors.forename: W J
authors.initials: WJ
authors.lastname: Boscardin
authors.forename: M A
authors.initials: MA
authors.lastname: Steinman
authors.forename: J B
authors.initials: JB
authors.lastname: Schwartz
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D001168:Arthritis / Q000453:epidemiology; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003704:Dementia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D015577:Geriatric Assessment; D006306:Health Surveys; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D009735:Nursing Homes; D015995:Prevalence; D017678:Sex Distribution; D014481:United States / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology