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The impact of multimorbidity on sexual function in middle-aged and older women: beyond the single disease perspective.

ABSTRACT: Little is known about sexual activity and function in women with multiple chronic health conditions.To examine the impact of multimorbidity on sexual activity and function in middle-aged and older women.Multiethnic cross-sectional cohort of 1,997 community-dwelling women (mean age of 60.2 [±9.5] years) in California. Structured questionnaires assessed prior diagnoses of common cardiometabolic, colorectal, neuropsychiatric, respiratory, musculoskeletal, and genitourinary conditions.Sexual desire, frequency of sexual activity, overall sexual satisfaction, and specific sexual problems (i.e., difficulty with arousal, lubrication, orgasm, and pain) were assessed by structured questionnaires.Seventy-one percent of women had two or more diagnosed chronic conditions. Fifty-nine percent reported low sexual desire, 53% reported less than monthly sexual activity, and 47% reported low overall sexual satisfaction. Multimorbidity was associated with increased odds of reporting low sexual desire (OR?=?1.11, 95% CI?=?1.06-1.17, per each additional chronic condition), less than monthly sexual activity (OR?=?1.11, 95% CI?=?1.05-1.17 per each additional condition), and low sexual satisfaction (OR?=?1.10, 95% CI?=?1.04-1.16 per each additional condition), adjusting for age, race/ethnicity, and partner status. Depression and urinary incontinence were each independently associated with low desire (OR?=?1.53, 95% CI?=?1.19-1.97, and OR?=?1.23, 95% CI?=?1.00-1.52, respectively), less than monthly sexual activity (OR?=?1.39, 95% CI?=?1.06-1.83, and OR?=?1.29, 95% CI?=?1.02-1.62, respectively), and low sexual satisfaction (OR?=?1.49, 95% CI?=?1.14-1.93, and OR?=?1.38, 95% CI?=?1.11-1.73, respectively), adjusting for other types of conditions. After adjustment for total number of chronic conditions, age remained a significant predictor of low desire and less than monthly sexual activity, but not sexual satisfaction.Women with multiple chronic health conditions are at increased risk for decreased sexual function. Depression and incontinence may have particularly strong effects on sexual desire, frequency of activity, and satisfaction in women, independent of other comorbid conditions. Women's overall sexual satisfaction may be more strongly influenced by multimorbidity than age.

SUBMITTER: Appa AA

PROVIDER: S-EPMC4309673 | biostudies-literature | 2014 Nov

REPOSITORIES: biostudies-literature

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The impact of multimorbidity on sexual function in middle-aged and older women: beyond the single disease perspective.

Appa Ayesha A AA Creasman Jennifer J Brown Jeanette S JS Van Den Eeden Stephen K SK Thom David H DH Subak Leslee L LL Huang Alison J AJ

The journal of sexual medicine 20140822 11

<h4>Introduction</h4>Little is known about sexual activity and function in women with multiple chronic health conditions.<h4>Aim</h4>To examine the impact of multimorbidity on sexual activity and function in middle-aged and older women.<h4>Methods</h4>Multiethnic cross-sectional cohort of 1,997 community-dwelling women (mean age of 60.2 [±9.5] years) in California. Structured questionnaires assessed prior diagnoses of common cardiometabolic, colorectal, neuropsychiatric, respiratory, musculoskel ...[more]

PMID: 25146458

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Project description:Background and objectivesSexual satisfaction is an important part of sexual health and overall well-being. A large number of older people continue to be sexually active, and many are satisfied with their sex life. However, little is known about whether sexual satisfaction differs according to sexual orientation. Therefore, the aim of the study was to investigate whether sexual satisfaction differs according to sexual orientation in later life.Research design and methodsThe German Ageing Survey is a nationally representative study of the German population aged 40+. In the third wave (2008), data on both sexual orientation (heterosexual, homosexual, bisexual, other) and sexual satisfaction (1-very dissatisfied to 5-very satisfied) were collected. Multiple regression analyses with sampling weights were performed (stratified by age: 40-64; 65+).ResultsWe included 4,856 individuals in our analysis (mean age 57.6 ± 11.6; 40-85 years, 50.4% were women, 92.3% (n = 4,483) were heterosexual, and 7.7% (n = 373) were sexual minority adults). In sum, 55.9% of heterosexual individuals and 52.3% of sexual minority adults were satisfied or very satisfied with their sex life. Multiple regression analysis showed that sexual orientation was not significantly associated with sexual satisfaction among both middle-aged (β = 0.07; p = .45) and older adults (β = 0.01; p = .87). Higher sexual satisfaction was associated with lower loneliness scores, partnership satisfaction, importance of sexuality and intimacy, and better health status.Discussion and implicationsOur analysis showed that sexual orientation was not significantly associated with sexual satisfaction among both middle-aged and older adults. Lower loneliness, better health status, and partnership satisfaction significantly contributed to higher sexual satisfaction. Approximately 45% of older individuals (aged 65 years and older), regardless of their sexual orientation, were still satisfied with their sex life.

Project description:BackgroundMultimorbidity (≥ 2 chronic diseases) is associated with greater disability and higher treatment burden, as well as difficulty coordinating self-management tasks for adults with complex multimorbidity patterns. Comparatively little work has focused on assessing multimorbidity patterns among patients seeking care in community health centers (CHCs).ObjectiveTo identify and characterize prevalent multimorbidity patterns in a multi-state network of CHCs over a 5-year period.DesignA cohort study of the 2014-2019 ADVANCE multi-state CHC clinical data network. We identified the most prevalent multimorbidity combination patterns and assessed the frequency of patterns throughout a 5-year period as well as the demographic characteristics of patient panels by prevalent patterns.ParticipantsThe study included data from 838,642 patients aged ≥ 45 years who were seen in 337 CHCs across 22 states between 2014 and 2019.Main measuresPrevalent multimorbidity patterns of somatic, mental health, and mental-somatic combinations of 22 chronic diseases based on the U.S. Department of Health and Human Services Multiple Chronic Conditions framework: anxiety, arthritis, asthma, autism, cancer, cardiac arrhythmia, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), congestive heart failure, coronary artery disease, dementia, depression, diabetes, hepatitis, human immunodeficiency virus (HIV), hyperlipidemia, hypertension, osteoporosis, post-traumatic stress disorder (PTSD), schizophrenia, substance use disorder, and stroke.Key resultsMultimorbidity is common among middle-aged and older patients seen in CHCs: 40% have somatic, 6% have mental health, and 24% have mental-somatic multimorbidity patterns. The most frequently occurring pattern across all years is hyperlipidemia-hypertension. The three most frequent patterns are various iterations of hyperlipidemia, hypertension, and diabetes and are consistent in rank of occurrence across all years. CKD-hyperlipidemia-hypertension and anxiety-depression are both more frequent in later study years.ConclusionsCHCs are increasingly seeing more complex multimorbidity patterns over time; these most often involve mental health morbidity and advanced cardiometabolic-renal morbidity.

Project description:Background: Determining the incidence, progression, and patterns of multimorbidity are important for the prevention, management, and treatment of concurrence of multiple conditions. This study aimed to analyze major multimorbidity patterns and the association of the onset of a primary condition or combinations of a primary and a secondary condition with the progression to subsequent conditions. Methods: We included 53,867 participants aged 45-64 years from the 45 and Up Study who were free of 10 predefined chronic conditions at baseline (2006-2009). The incidence of multimorbidity (coexistence of ≥2, ≥3, and ≥4 conditions) was identified using the claims database until December 31, 2016. The primary, secondary, tertiary, and quaternary condition for each participant was defined according to its temporal order of onset. Results: During a mean 9-years follow-up, the cumulative incidence of primary, secondary, tertiary, and quaternary conditions was 49.6, 23.7, 9.0, and 2.9%, respectively. The time to develop a subsequent condition decreased with the accumulation of conditions (P < 0.0001). Two concurrent cardiometabolic disorders (CMDs, 30.4%) and CMDs clustered with musculoskeletal disorders (15.2%), mental disorders (13.5%), asthma (12.0%), or cancer (8.7%) were the five most common multimorbidity patterns. CMDs tended to occur prior to mental or musculoskeletal disorders but after the onset of cancers or asthma. Compared with all participants who developed cancer as a primary condition, individuals who experienced mental disorders/neurodegenerative disorders and a comorbidity as cardiovascular disease, hypertension, dyslipidemia, diabetes, asthma, or osteoarthritis were 3.36-10.87 times more likely to develop cancer as a tertiary condition. Individuals with neurodegenerative disorders and a comorbidity as hypertension, dyslipidemia, osteoarthritis, or asthma were 5.14-14.15 times more likely to develop mental disorders as a tertiary condition. Conclusions: A high incidence of multimorbidity in middle-aged adults was observed and CMDs were most commonly seen in multimorbidity patterns. There may be accelerated aging after a primary condition occurs. Our findings also reveal a potential preventative window to obviate the development of secondary or tertiary conditions.

Project description:Understanding how attachment to pets can alleviate depression and anxiety offers valuable insights for developing preventive and therapeutic strategies, particularly for those with insecure attachment styles from childhood trauma. To determine if a close bond with a pet is associated with reduced depression and anxiety, especially among women who experienced childhood abuse. This cross-sectional study involved women who voluntarily enrolled in the Mind Body Study (MBS), a substudy of the Nurses' Health Study II (NHS2) focusing on psychosocial factors. Women reporting childhood abuse were oversampled to capture their psychosocial distress in adulthood. MBS participants were invited to complete comprehensive online questionnaires, which were administered twice (March 2013 and February 2014). Pet attachment measured by Lexington Attachment to Pets Scale (LAPS). Levels of depression and anxiety (10-item Centre for Epidemiologic Studies Depression Scale [CESD-10]; Kessler Psychological Distress Scale [K6]; 7-item Generalized Anxiety Disorder scale [GAD-7]; Crown Crisp Experiential Index phobic anxiety subscale [CCI]), considered individually and combined into an overall z-score measure of anxiety and depression symptoms. A total of 214 women (mean [SD] age, 60.8 [3.9] years) were included; 156 women (72.6%) reported a history of childhood abuse. Of 688 invited MBS participants in 2013, 293 (42.6%) expressed interest; there were 228 completed questionnaires (response rate, 77.8%) in 2013 and 208 questionnaires (response rate, 71.0%) in 2014. LAPS scores were provided by 140 participants (65.4%), 78 (55.7%) for dogs and 46 (32.9%) for cats. Overall higher pet attachment on the LAPS score was significantly associated with lower GAD-7 scores (β = -0.17; 95% CI, -0.29 to -0.06), but there was no association for phobic anxiety or depression. There were no statistically significant associations between cat attachment and depression or anxiety. Higher dog attachment was associated with significantly lower scores in depression (CESD-10: β, -0.47; 95% CI, -0.68 to -0.26; K6: β = -0.42; 95% CI, -0.54 to -0.31), generalized anxiety (GAD-7: β = -0.47; 95% CI, -0.65 to -0.3), and the overall measure of anxiety and depression (z score: β = -0.12; 95% CI, -0.17 to -0.08), but there was no association between dog attachment and phobic anxiety (CCI: β = -0.08; 95% CI, -0.24 to 0.09). All effect sizes for associations were higher when analyses were restricted to women with a history of childhood abuse. In this explorative cross-sectional study, strong attachment to pets, especially dogs, was associated with lower anxiety and depression symptoms. The favorable association was particularly apparent in women with a history of childhood abuse.

Project description:BACKGROUND:The prevalence of diabetes, heart disease, and stroke multimorbidity (co-occurrence of two or three of these conditions) has increased rapidly. Little is known about how the three conditions progress from one to another sequentially through the life course. We aimed to delineate this progression in middle-aged women and to determine the roles of common risk factors in the accumulation of diabetes, heart disease, and stroke multimorbidity. METHODS AND FINDINGS:We used data from 13,714 women aged 45-50 years without a history of any of the three conditions. They were participants in the Australian Longitudinal Study on Women's Health (ALSWH), enrolled in 1996, and surveyed approximately every 3 years to 2016. We characterized the longitudinal progression of the three conditions and multimorbidity. We estimated the accumulation of multimorbidity over 20 years of follow-up and investigated their association with both baseline and time-varying predictors (sociodemographic factors, lifestyle factors, and other chronic conditions). Over 20 years, 2,511 (18.3%) of the women progressed to at least one condition, of whom 1,420 (56.6%) had diabetes, 1,277 (50.9%) had heart disease, and 308 (12.3%) had stroke; 423 (16.8%) had two or three of these conditions. Over a 3-year period, the age-adjusted odds of two or more conditions was approximately twice that of developing one new condition compared to women who did not develop any new conditions. For example, the odds for developing one new condition between Surveys 7 and 8 were 2.29 (95% confidence interval [CI], 1.93-2.72), whereas the odds for developing two or more conditions was 6.51 (95% CI, 3.95-10.75). The onset of stroke was more strongly associated with the progression to the other conditions (i.e., 23.4% [95% CI, 16.3%-32.2%] of women after first onset of stroke progressed to other conditions, whereas the percentages for diabetes and heart disease were 9.9% [95% CI, 7.9%-12.4%] and 11.4% [95% CI, 9.1%-14.4%], respectively). Being separated, divorced, or widowed; being born outside Australia; having difficulty managing on their available income; being overweight or obese; having hypertension; being physically inactive; being a current smoker; and having prior chronic conditions (i.e., mental disorders, asthma, cancer, osteoporosis, and arthritis) were significantly associated with increased odds of accumulation of diabetes, heart disease, and stroke multimorbidity. The main limitations of this study were the use of self-reported data and the low number of events. CONCLUSIONS:Stroke was associated with increased risk of progression to diabetes or heart disease. Social inequality, obesity, hypertension, physical inactivity, smoking, or having other chronic conditions were also significantly associated with increased odds of accumulating multimorbidity. Our findings highlight the importance of awareness of the role of diabetes, heart disease, and stroke multimorbidity among middle-aged women for clinicians and health-promotion agencies.

Dataset Information

The impact of multimorbidity on sexual function in middle-aged and older women: beyond the single disease perspective.

Publications

The impact of multimorbidity on sexual function in middle-aged and older women: beyond the single disease perspective.

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