title: Multimorbidity and functional status in community-dwelling older adults.
abstract: BACKGROUND
  Multimorbidity is common in older people and may contribute to many adverse health events, such as disability. The aim of the study was to investigate how chronic health conditions (single, paired, and grouped) affect functional independence.
  
  
  METHODS
  We used two samples (a one-time, convenience sample and a nationally representative cross-sectional survey) of community-dwelling people of 65 years old or over, with a total of 2818 subjects in Spain. To assess functional independence, we used the Barthel index, administered as an interview. Information about the presence of 11 chronic health problems was collected by interview or review of their medical chart. Explanatory factor analysis was performed to assess associations between chronic health conditions.
  
  
  RESULTS
  Diabetes mellitus and hypertension emerged as the pair of chronic health conditions that most affected functional status [OR 1.98; 95% CI (1.51-2.60)], followed by visual and hearing impairment. A synergistic effect was found (p<0.05) for the cardiovascular disease and hypertension pair. Four multimorbidity groups emerged from the factor analysis: sensory and bone; cancer, lung and gastrointestinal; cardiovascular and metabolic; neuropsychiatric disorders. The neuropsychiatric disorders group was the most strongly associated with physical impairment [OR 4.94; 95% CI (2.71-8.99)], followed by the sensory and bones group [OR 1.90; 95% CI (1.56-2.31)].
  
  
  CONCLUSIONS
  Despite its low prevalence, the neuropsychiatric disorders group was most strongly associated with lower functional status. Analysis of the relationship between chronic medical conditions and functional status could be useful to develop primary health care strategies to improve functional independence in older people with comorbidities.
authors.affiliation: Department "G.F. Ingrassia" Section of Hygiene and Public Health University of Catania, Italy. Electronic address: stefano.marventano@studium.unict.it.
authors.forename: Stefano
authors.initials: S
authors.lastname: Marventano
authors.affiliation: National School of Public Health, Carlos III Institute of Health, Madrid, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Ayala
authors.affiliation: Research Unit of Galdakao-Usansolo Hospital, Bilbao, Spain; Research Network on Health Services and Chronicity (REDISSEC), Spain.
authors.forename: Nerea
authors.initials: N
authors.lastname: Gonzalez
authors.affiliation: National Centre of Epidemiology and Consortium for Biomedical Research in Neurodegenerative Diseases (CIBERNED), Carlos III Institute of Health, Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Rodríguez-Blázquez
authors.affiliation: Research Unit of Galdakao-Usansolo Hospital, Bilbao, Spain; Research Network on Health Services and Chronicity (REDISSEC), Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Garcia-Gutierrez
authors.affiliation: National School of Public Health, Carlos III Institute of Health, Madrid, Spain; Research Network on Health Services and Chronicity (REDISSEC), Spain.
authors.forename: Maria João
authors.initials: MJ
authors.lastname: Forjaz
mesh_terms: D000367:Age Factors; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology*; D008297:Male; D009017:Morbidity / Q000639:trends; D011320:Primary Health Care; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology
keywords: Community-dwelling; Functional status; Multimorbidity; Older adults