Dataset Information

Multimorbidity and Physical and Cognitive Function: Performance of a New Multimorbidity-Weighted Index.

ABSTRACT: Background:Multimorbidity is an important health outcome but is difficult to quantify. We recently developed a multimorbidity-weighted index (MWI) and herein assess its performance in an independent nationally-representative cohort. Methods:Health and Retirement Study (HRS) participants completed an interview on physician-diagnosed chronic conditions and physical functioning. We determined the relationship of chronic conditions on physical functioning and validated these weights with the original, independently-derived MWI. We then determined the association between MWI with physical functioning, grip strength, gait speed, basic and instrumental activities of daily living (ADL/IADL) limitations, and the modified Telephone Interview for Cognitive Status (TICS-m) in adjusted models. Results:Among 20,509 adults, associations between chronic conditions and physical functioning varied several-fold. MWI values based on weightings in the HRS and original cohorts correlated strongly (Pearson's r = .92) and had high classification agreement (? statistic = .80, p < .0001). Participants in the highest versus lowest MWI quartiles had weaker grip strength (-2.91 kg, 95% confidence interval [CI]: -3.51, -2.30), slower gait speed (-0.29 m/s, 95% CI: -0.35, -0.23), more ADL (0.79, 95% CI: 0.71, 0.87) and IADL (0.49, 95% CI: 0.44, 0.55) limitations, and lower TICS-m (-0.59, 95% CI: -0.77, -0.41) (all p < .001). We observed monotonic graded relationships for all outcomes with increasing MWI quartiles. Conclusion:A multimorbidity index weighted to physical functioning performed nearly identically in a nationally-representative cohort as it did in its development cohorts, confirming broad generalizability. MWI was strongly associated with subjective and objective physical and cognitive performance. Thus, MWI serves as a valid patient-centered measure of multimorbidity, an important construct in research and clinical practice.

SUBMITTER: Wei MY

PROVIDER: S-EPMC5861895 | biostudies-other | 2018 Jan

REPOSITORIES: biostudies-other

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Multimorbidity and Physical and Cognitive Function: Performance of a New Multimorbidity-Weighted Index.

Wei Melissa Y MY Kabeto Mohammed U MU Langa Kenneth M KM Mukamal Kenneth J KJ

The journals of gerontology. Series A, Biological sciences and medical sciences 20180101 2

<h4>Background</h4>Multimorbidity is an important health outcome but is difficult to quantify. We recently developed a multimorbidity-weighted index (MWI) and herein assess its performance in an independent nationally-representative cohort.<h4>Methods</h4>Health and Retirement Study (HRS) participants completed an interview on physician-diagnosed chronic conditions and physical functioning. We determined the relationship of chronic conditions on physical functioning and validated these weights w ...[more]

PMID: 28605457

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Project description:ObjectivesMost older adults have multimorbidity that impairs physical functioning, but it is difficult to quantify using claims data. We previously developed and validated a multimorbidity-weighted index (MWI) that embeds physical functioning through disease weightings. We mapped these conditions to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes and compared them with existing indices.DesignPopulation-based prospective cohort.SettingRespondents to the 2006-2016 waves of the Health and Retirement Study (HRS) with linked Medicare claims data and continuous enrollment in 2006.ParticipantsCommunity-dwelling Medicare-eligible HRS participants (N = 9923; mean age = 75.5 ± 8.5 y).MeasurementsIndividuals were followed for future physical functioning (2006-2014) and mortality (2007-2016). MWI conditions were mapped to ICD-9-CM codes to produce an ICD-coded MWI (MWI-ICD). We compared MWI-ICD, simple disease count, Charlson, Elixhauser, and the health-related quality of life comorbidity index (HRQOL-CI) through distributions, hazard ratios for mortality, and relationships with future physical functioning.ResultsMWI-ICD exhibited the broadest distribution and most unique values (5891). Left censoring was most pronounced for Charlson (34.3% score = 0) and Elixhauser (13.1% score = 0) vs MWI (5.0% score = 0). Hazard ratios and concordance (C)-statistics for mortality across extreme quartiles were similar for MWI-ICD, Elixhauser, and Charlson but lower for disease count and the HRQOL-CI. For physical functioning, MWI-ICD yielded the greatest contrast across extreme quartiles and overall coefficient of determination (R2 ).ConclusionMWI-ICD was significantly associated with mortality and future physical functioning and comparable with established metrics for mortality prediction although not weighted to mortality. MWI-ICD successfully captures diseases accumulation and functioning in claims data. J Am Geriatr Soc 68:999-1006, 2020.

Project description:Background and objectivesWhile several studies have examined the association between cognitive and physical function, the consistency of these associations across functional contexts is unclear. The consistency of the association between cognitive and physical function performance was examined at baseline across 17 clinical studies with diverse and heterogeneous conditions such as overweight/obese, sedentary, at risk for a mobility disability, osteoarthritis, low vitamin D, or had signs of cognitive impairment.Research design and methodsData are from 1,388 adults 50 years and older who completed a cognitive and physical function assessment as part of a research study at the Wake Forest Alzheimer's Disease Research Center or the Wake Forest Older Americans Independence Center. Linear regression models were used to relate cognitive measures (Mini-Mental Status Examination, Montreal Cognitive Assessment, and the Digit Symbol Substitution Task) and physical measures (the Short Physical Performance Battery and hand grip strength) for the whole sample and treat each study as a fixed effect. All models controlled for age, sex, race, and body mass index.ResultsOverall, there was a significant association between higher scores on the Mini-Mental Status Examination (per standard deviation) and better physical function performance (Short Physical Performance Battery score b = 0.24, p < .001) and its components (gait speed, chair rise, and standing balance; ps < .05). Higher scores on the Montreal Cognitive Assessment produced similar results (Short Physical Performance Battery score b = 0.31, p ≤ .001), and higher scores on the Digit Symbol Substitution Task were also significantly associated with a better Short Physical Performance Battery score (b = 0.75, p < .001). The relationship between Digit Symbol Substitution Task and physical function performance demonstrated a stronger magnitude of association compared to the Mini-Mental Status Examination or Montreal Cognitive Assessment.Discussion and implicationsOlder adults with heterogeneous health conditions showed a consistent pattern between better cognitive function and better physical function performance with the strongest association among Digit Symbol Substitution Task scores.

Dataset Information

Multimorbidity and Physical and Cognitive Function: Performance of a New Multimorbidity-Weighted Index.

Publications

Multimorbidity and Physical and Cognitive Function: Performance of a New Multimorbidity-Weighted Index.

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