Differences in function and recovery profiles between patterns of multimorbidity among older medical patients the first year after an acute admission-An exploratory latent class analysis

Helle Gybel Juul-Larsen; Ove Andersen; Thomas Bandholm; Ann Christine Bodilsen; Thomas Kallemose; Lillian Mørch Jørgensen; Henrik Hedegaard Klausen; Hanne Gilkes; Janne Petersen

doi:10.1016/j.archger.2019.103956

Differences in function and recovery profiles between patterns of multimorbidity among older medical patients the first year after an acute admission-An exploratory latent class analysis

Arch Gerontol Geriatr. 2020 Jan-Feb:86:103956. doi: 10.1016/j.archger.2019.103956. Epub 2019 Sep 25.

Authors

Helle Gybel Juul-Larsen¹, Ove Andersen², Thomas Bandholm³, Ann Christine Bodilsen⁴, Thomas Kallemose⁵, Lillian Mørch Jørgensen⁶, Henrik Hedegaard Klausen⁵, Hanne Gilkes⁵, Janne Petersen⁷

Affiliations

¹ Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark. Electronic address: helle.juul-larsen@regionh.dk.
² Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Emergency Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
³ Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark; Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research - Copenhagen (PMR-C), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Orthopedic Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
⁴ Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Department of Exercise and Health, Roskilde Municipality, Roskilde, Denmark.
⁵ Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
⁶ Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Emergency Department, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark.
⁷ Clinical Research Centre, Optimized Senior Patient Program (Optimed), Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark; Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark.

PMID: 31586786
DOI: 10.1016/j.archger.2019.103956

Abstract

Introduction: Multimorbidity is common among older people and may contribute to adverse health effects, such as functional limitations. It may help stratify rehabilitation of older medical patients, if we can identify differences in function under and after an acute medical admission, among patient with different patterns of multimorbidity.

Aim: To investigate differences in function and recovery profiles among older medical patients with different patterns of multimorbidity the first year after an acute admission.

Methods: Longitudinal prospective cohort study of 369 medical patients (77.9 years, 62% women) acutely admitted to the Emergency Department. During the first 24 h after admission, one month and one year after discharge we assessed mobility level using the de Morton Mobility Index. At baseline and one-year we assessed handgrip strength, gait speed, Barthel20, and the New Mobility Score. Information about chronic conditions was collected by national registers. We used Latent Class Analysis to determine differences among patterns of multimorbidity based on 22 chronic conditions.

Results: Four distinct patterns of multimorbidity were identified (Minimal chronic disease; Degenerative, lifestyle, and mental disorders; Neurological, functional and sensory disorders; and Metabolic, pulmonary and cardiovascular disorders). The "Neurological, functional and sensory disorders"-pattern showed significant lower function than the "Minimal chronic disease"-pattern in all outcome measures. There were no differences in recovery profile between patients in the four patterns.

Conclusion: The results support that patients with different patterns of multimorbidity among acutely hospitalized older medical patients differ in function, which suggests a differentiated approach towards treatment and rehabilitation warrants further studies.

Keywords: Acute hospitalization; Function; Mobility; Multimorbidity; Older medical patients.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Chronic Disease
Cohort Studies
Emergency Service, Hospital
Female
Geriatric Assessment / methods*
Hand Strength*
Hospitalization
Humans
Latent Class Analysis
Male
Middle Aged
Multimorbidity
Patient Discharge*
Prospective Studies
Treatment Outcome
Walking Speed*