title: Consequences of interaction of functional, somatic, mental and social problems in community-dwelling older people.
abstract: This study explores the combination of four common health problems in older people and whether problems on four domains result in an additional effect on indicators of poor health. For this purpose, a total of 2681 participants (32% male, mean age 82 years) of the Integrated Systematic Care for Older People (ISCOPE) study were screened on the presence of health problems on four domains (functional, somatic, mental, social) with the postal ISCOPE questionnaire. Extensive interview data on health indicators were obtained at baseline and at 12-months follow-up, including disability (Groningen Activities Restriction Scale, GARS), cognitive function (Mini-Mental State Examination, MMSE), depressive symptoms (Geriatric Depression Scale-15, GDS), loneliness (loneliness scale of De Jong Gierveld), and health-related quality of life (EQ-5D). General practitioner (GP) contact time (min/year) was estimated via GP electronic medical records. Of the study population, 9% had no health problems according to the screening, 8% had problems on one domain, 27% on two, 38% on three and 18% on four domains. At baseline, the number of health domains with problems was associated with poorer scores on the GARS, the MMSE, the GDS-15, the loneliness scale, the EQ-5D and with more GP contact time (p <0.001). Problems on all four domains had an additional negative effect on these health indicators (all pinteraction <0.001). At follow-up, an increased number of domains with problems was associated with an increased decline in health indicators (all p<0.001) and with an additional negative effect on GP contact time of the presence of problems on all four domains (pinteraction <0.001). We conclude that combinations of functional, somatic, mental and social problems are associated with poor health indicators in community-dwelling older people. Since problems on four domains have an additional effect on health, individuals with combined functional, somatic, mental and social problems could benefit from integrated care.
  
  
  BACKGROUND
  Netherlands Trial Register: NTR1946.
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Anne H
authors.initials: AH
authors.lastname: van Houwelingen
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Wendy P J
authors.initials: WP
authors.lastname: den Elzen
authors.affiliation: Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Saskia
authors.initials: S
authors.lastname: le Cessie
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jeanet W
authors.initials: JW
authors.lastname: Blom
authors.affiliation: Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition; D003072:Cognition Disorders / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology*; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D057187:Independent Living; D008132:Loneliness; D008297:Male; D009426:Netherlands; D011788:Quality of Life; D012940:Social Problems; D011795:Surveys and Questionnaires