title: Combinations of Chronic Conditions, Functional Limitations, and Geriatric Syndromes that Predict Health Outcomes.
abstract: The strategic framework on multiple chronic conditions released by the US Department of Health and Human Services calls for identifying homogeneous subgroups of older adults to effectively target interventions aimed at improving their health.
  
  
  
  We aimed to identify combinations of chronic conditions, functional limitations, and geriatric syndromes that predict poor health outcomes. DESIGN, SETTING AND PARTICIPANTS Data from the 2010-2012 Health and Retirement Study provided a representative sample of U.S. adults 50 years of age or older (n = 16,640).
  
  
  
  Outcomes were: Self-reported fair/poor health, self-rated worse health at 2 years, and 2-year mortality. The main independent variables included self-reported chronic conditions, functional limitations, and geriatric syndromes. We conducted tree-based classification and regression analysis to identify the most salient combinations of variables to predict outcomes.
  
  
  
  Twenty-nine percent and 23 % of respondents reported fair/poor health and self-rated worse health at 2 years, respectively, and 5 % died in 2 years. The top combinations of conditions identified through our tree analysis for the three different outcome measures (and percent respondents with the outcome) were: a) for fair/poor health status: difficulty walking several blocks, depressive symptoms, and severe pain (> 80 %); b) for self-rated worse health at 2 years: 68.5 years of age or older, difficulty walking several blocks and being in fair/poor health (60 %); and c) for 2-year mortality: 80.5 years of age or older, and presenting with limitations in both ADLs and IADLs (> 40 %).
  
  
  
  Rather than chronic conditions, functional limitations and/or geriatric syndromes were the most prominent conditions in predicting health outcomes. These findings imply that accounting for chronic conditions alone may be less informative than also accounting for the co-occurrence of functional limitations and geriatric syndromes, as the latter conditions appear to drive health outcomes in older individuals.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA. skoroukian@case.edu.
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Schiltz
authors.affiliation: Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE, USA.
authors.forename: David F
authors.initials: DF
authors.lastname: Warner
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA.
authors.forename: Jiayang
authors.initials: J
authors.lastname: Sun
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Bakaki
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH, 44106-4945, USA.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Smyth
authors.affiliation: Department of Family Medicine and Community Health, School of Medicine, Epidemiology and Biostatistics, Sociology, Case Comprehensive Cancer Center, Cleveland Clinical & Translational Science Collaborative, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.affiliation: Department of Family Medicine, Michigan State University, East Lansing, MI, USA.
authors.forename: Charles W
authors.initials: CW
authors.lastname: Given
mesh_terms: D000203:Activities of Daily Living; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods*; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D011379:Prognosis; D012307:Risk Factors; D057566:Self Report; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013577:Syndrome; D014481:United States / Q000453:epidemiology
keywords: comorbidity; functional limitations; geriatric syndromes; health status; mortality; multimorbidity; worse health