title: Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults.
abstract: OBJECTIVE
  To determine the effect of chronic disorders and their co-occurrence on survival and functioning in community-dwelling older adults.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Kungsholmen, Stockholm, Sweden.
  
  
  METHODS
  Individuals aged 78 and older examined by physicians four times over 11 years (N = 1,099).
  
  
  METHODS
  Chronic diseases (grouped according to 10 organ systems according to the International Classification of Diseases, Tenth Revision, code) and multimorbidity (≥2 coexisting chronic diseases) were evaluated in terms of mortality, population attributable risk of death, median years of life lost, and median survival time with and without disability (need of assistance in ≥1 activities of daily living).
  
  
  RESULTS
  Approximately one in four deaths were attributable to cardiovascular and one in six to neuropsychiatric diseases. Malignancy was the condition with the shortest survival time (2.5 years). Malignancies and cardiovascular disorders each accounted for approximately 5 years of life lost. In contrast, neurosensorial and neuropsychiatric conditions had the longest median survival time (>6 years), and affected people were disabled for more than half of this time. The most-prevalent and -burdensome condition was multimorbidity, affecting 70.4% of the population, accounting for 69.3% of total deaths, and causing 7.5 years of life lost. Finally, people with multimorbidity lived 81% of their remaining years of life with disability (median 5.2 years).
  
  
  CONCLUSIONS
  Survival in older adults differs in length and quality depending on specific conditions. The greatest negative effect at the individual (shorter life, greater dependence) and societal (number of attributable deaths, years spent with disability) level was from multimorbidity, which has made multimorbidity a clinical and public health priority.
authors.affiliation: Department of Neurobiology, Health Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Debora
authors.initials: D
authors.lastname: Rizzuto
authors.affiliation: Department of Geriatric Medicine, Nijmegen Alzheimer Centre, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: René J F
authors.initials: RJF
authors.lastname: Melis
authors.affiliation: Department of Neurobiology, Health Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Angleman
authors.affiliation: Department of Neurobiology, Health Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
authors.forename: Chengxuan
authors.initials: C
authors.lastname: Qiu
authors.affiliation: Department of Neurobiology, Health Care Sciences and Society, Aging Research Center, Karolinska Institutet and Stockholm University, Stockholm, Sweden.|Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Marengoni
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D057187:Independent Living; D008137:Longitudinal Studies; D008297:Male; D009026:Mortality; D015995:Prevalence; D013548:Sweden / Q000453:epidemiology
keywords: chronic conditions; disability; median survival time; multimorbidity; population attributable risk