New study shows how multimorbidity restricts life in the elderly
Multiple neuropsychiatric diseases are major predisposing factors for functional decline in older people and may play a greater role in this age-related phenomenon than cardiovascular diseases, according to a new study by researchers at Karolinska Institutet published in PLOS Medicine.
A progressive decline in physical function, commonly referred to as functional decline, is a strong health determinant in older people. The accumulation of chronic diseases, multimorbidity, plays a major role in functional decline and has a negative impact on quality of life. Cardiovascular and neuropsychiatric diseases are common in older people and tend to cluster in the same individuals. Understanding the associations between cardiovascular and neuropsychiatric multimorbidity and functional decline may assist in managing the health and care of people with multimorbidity.
In a new study, researchers at Karolinska Institutet aimed to find out how the increasing number and the combination of cardiovascular and neuropsychiatric diseases are associated with two important measures of physical function in older people: walking speed and activities of daily living (ADL). Using data from the Swedish National study on Aging and Care in Kungsholmen (SNAC-K), they examined how these functions were affected in 2,385 older people with and without cardiovascular disease (such as ischemic heart disease, heart failure, and atrial fibrillation) and neuropsychiatric disease (such as mood disorders, dementia, and stroke).
Neuropsychiatric diseases may play a greater role
During the 9-year follow-up, individuals with multiple cardiovascular and neuropsychiatric diseases had the steepest declines in walking speed and ADL independence. The researchers observed significant declines over time for both walking speed and ADL in older people with one or more neuropsychiatric diseases, but only for walking speed in those with cardiovascular multimorbidity.
“Our findings suggest that the presence of multiple neuropsychiatric diseases may play a greater role in functional decline in older people than multiple cardiovascular diseases. Both patients and physicians should be aware that neuropsychiatric diseases are major predisposing factors for functional decline”, says Davide Vetrano, PhD student at Karolinska Institutet’s Department of Neurobiology, Care Sciences and Society.
The study was supported by the funders of the Swedish National study on Aging and Care, SNAC: the Ministry of Health and Social Affairs, Sweden, the participating County Councils and Municipalities, and the Swedish Research Council. Specific grants were received from the Swedish Research Council for Medicine and the Swedish Research Council for Health, Working life and Welfare, Catholic University of Rome, Lindhés Advokatbyrå AB, Stiftelsen för Gamla Tjänarinnor, and Stonhes Stiftelse.
Publication
”Trajectories of functional decline in older adults with neuropsychiatric and cardiovascular multimorbidity: A Swedish cohort study”
Davide L. Vetrano, Debora Rizzuto, Amaia Calderón-Larrañaga, Graziano Onder, Anna-Karin Welmer, Roberto Bernabei, Alessandra Marengoni, Laura Fratiglioni
PLOS Medicine, online 6 March 2018, doi: 10.1371/journal.pmed.1002503