title: Chronic diseases and geriatric syndromes: The different weight of comorbidity.
abstract: BACKGROUND
  Comorbidity is a relevant health determinant in older adults. Co-occurrence of several diseases and other age-associated conditions generates new clinical phenotypes (geriatric syndromes [GS] as falls, delirium etc.). We investigated the association of chronic diseases, alone or in combination, and GS in older adults receiving home care services in 11 European countries and one Canadian province.
  
  
  METHODS
  Participants were cross-sectionally evaluated with the multidimensional assessment instrument RAI HC. We assessed 14 different diagnoses and 8 GS (pain, urinary incontinence, falls, disability, dizziness, weight loss, pressure ulcers and delirium). Adjusted mean number of GS per participant was calculated for groups of participants with each disease when occurring alone or with comorbidity.
  
  
  RESULTS
  The mean age of the 6903 participants was 82.2±7.4 years and 4750 (69%) were women. Participants presented with an average of 2.6 diseases and 2.0 GS: pain (48%), urinary incontinence (47%) and falls (33%) were the most prevalent. Parkinson's disease, cerebrovascular disease and peripheral artery disease were associated with the highest number of GS (2.5, 2.3 and 2.2, respectively). Conversely, hypertension, diabetes, dementia, cancer and thyroid dysfunction were associated with the lowest number of GS (2.0 on average). For 9/14 examined diseases (hypertension, diabetes, dementia, COPD, heart failure, ischemic heart disease, atrial fibrillation, cancer and thyroid dysfunction) the number of GS increased with the degree of comorbidity.
  
  
  CONCLUSIONS
  Comorbidity and GS are prevalent in older adults receiving home care. Different diseases have a variable impact on occurrence of GS. Comorbidity is not always associated with an increased number of GS.
authors.affiliation: Department of Geriatrics, Orthopedics and Neurosciences, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: davidevetrano@gmail.com.
authors.forename: Davide L
authors.initials: DL
authors.lastname: Vetrano
authors.affiliation: Schlegel-UW Research Institute for Aging, School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada; Department of Medical Epidemiology and Biostatistics, Karolinksa Institute, Stockholm, Sweden.
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Foebel
authors.affiliation: Geriatric Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
authors.affiliation: Department of Geriatrics, Orthopedics and Neurosciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Brandi
authors.affiliation: Department of Geriatrics, Orthopedics and Neurosciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Collamati
authors.affiliation: Schlegel-UW Research Institute for Aging, School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
authors.forename: George A
authors.initials: GA
authors.lastname: Heckman
authors.affiliation: School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Hirdes
authors.affiliation: Department of Geriatrics, Orthopedics and Neurosciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernabei
authors.affiliation: Department of Geriatrics, Orthopedics and Neurosciences, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Graziano
authors.initials: G
authors.lastname: Onder
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005060:Europe / Q000453:epidemiology; D005260:Female; D015577:Geriatric Assessment; D006801:Humans; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010146:Pain / Q000453:epidemiology; D012189:Retrospective Studies; D014549:Urinary Incontinence / Q000453:epidemiology
keywords: Chronic diseases; Comorbidity; Elderly; Frailty; Geriatric syndromes; Multimorbidity