Marengoni A(1), Tazzeo C(2), Calderón-Larrañaga A(2), Roso-Llorach A(3), Onder G(4), Zucchelli A(5), Rizzuto D(6), Vetrano DL(2). Author information:
(1)Department of Clinical and Experimental Sciences, University of Brescia,
Brescia, Italy; Aging Research Center, Department of Neurobiology, Care Sciences
and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden.
Electronic address: [Email]
(2)Aging Research Center, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet and Stockholm University, Stockholm, Sweden.
(3)Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut
Jordi Gol i Gurina, (IDIAPJGol), Barcelona, Spain; Universitat Autònoma de
Barcelona, Campus de la UAB, Bellaterra (Cerdanyola del Vallès), Spain.
(4)Department of Cardiovascular, Endocrine-metabolic Diseases and Aging,
Istituto Superiore di Sanità, Rome, Italy.
(5)Department of Information Engineering, University of Brescia, Brescia, Italy.
(6)Aging Research Center, Department of Neurobiology, Care Sciences and Society,
Karolinska Institutet and Stockholm University, Stockholm, Sweden; Stockholm
Gerontology Research Centrum, Stockholm, Sweden.
OBJECTIVES: The aim was to evaluate patterns of multimorbidity that increase the risk of institutionalization in older persons, also exploring the potential buffering effect of formal and informal care. DESIGN: Prospective cohort study. SETTING AND PARTICIPANTS: The population-based Swedish National study on Aging and Care in Kungsholmen, Stockholm, Sweden. MEASURES: In total, 2571 community-dwelling older adults were grouped at baseline according to their underlying multimorbidity patterns, using a fuzzy c-means cluster algorithm, and followed up for 6 years to test the association between multimorbidity patterns and institutionalization. RESULTS: Six patterns of multimorbidity were identified: psychiatric diseases; cardiovascular diseases, anemia, and dementia; metabolic and sleep disorders; sensory impairments and cancer; musculoskeletal, respiratory, and gastrointestinal diseases; and an unspecific pattern including diseases of which none were overrepresented. In total, 110 (4.3%) participants were institutionalized during the follow-up, ranging from 1.7% in the metabolic and sleep disorders pattern to 8.4% in the cardiovascular diseases, anemia, and dementia pattern. Compared with the unspecific pattern, only the cardiovascular diseases, anemia, dementia pattern was significantly associated with institutionalization [relative risk ratio (RRR) = 2.23; 95% confidence interval (CI) 1.07‒4.65)], after adjusting for demographic characteristics and disability status at baseline. In stratified analyses, those not receiving formal care in the psychiatric diseases pattern (RRR 3.34; 95% CI 1.20‒9.32) and those not receiving formal or informal care in the 'cardiovascular diseases, anemia, dementia' pattern (RRR 2.99; 95% CI 1.20‒7.46; RRR 2.79; 95% CI 1.16‒6.71, respectively) had increased risks of institutionalization. CONCLUSIONS AND IMPLICATIONS: Older persons suffering from specific multimorbidity patterns have a higher risk of institutionalization, especially if they lack formal or informal care. Interventions aimed at preventing the clustering of diseases could reduce the associated burden on residential long-term care. Formal and informal care provision may be effective strategies in reducing the risk of institutionalization.
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