What is the impact of levels of activity and function on the development multimorbidity over time?
Multimorbidity, affects up to one quarter of primary care populations. It is associated with reduced quality of life, an increased risk of mental health difficulties and increased healthcare utilisation. Multimorbidity has also been demonstrated to predict future functional decline. It is not known whether the effect is comparable in the opposite direction i.e. does poor physical functioning will lead to the development of multimorbidity? This is the relationship our study group are examining in an ongoing prospective cohort study in Ireland. The aim of this study is to identify whether and to what extent less active adults develop multimorbidity.
The Irish Longitudinal Study on Ageing (TILDA) is a population based study assessing health, economic and social aspects of ageing. We are conducting secondary analysis of 3,924 participants >50 years with one or no chronic conditions in the Wave 1 and Wave 2 datasets. Development of multimorbidity is being measured by accrual of additional conditions between Wave 1 and Wave 2. Multimorbidity being defined as two or more chronic conditions in the same individual. Levels of activity and function are being measured using four validated outcome measures: the International Physical Activity Questionnaire (IPAQ), Timed up and Go (TUG), gait speed and grip strength. Logistic regression analyses are being conducted to determine the relationship between levels of activity and incidence of multimorbidity. Confounders such as age, sex and socioeconomic status will be adjusted for when completing our analysis. Crude and adjusted risk ratios will be presented with 95% confidence intervals.
Of 8,175 participants included in the study 48% have presented with one or no conditions. The most common conditions being high cholesterol (37%), high blood pressure (27%) and arthritis (27%) while the prevalence of other conditions such as diabetes, asthma, cataracts and osteoporosis vary from 8% to 12%. Physical activity levels as measured by the IPAQ demonstrate that two thirds of the cohort reported moderate or high physical activity levels while one third had low activity levels. These are likely to be optimistic estimates considering that self-reported physical activity tends to overestimate the actual level of activity. The TUG, gait speed and grip strength results will give a stronger sense of the cohort’s level of activity and function. We will have our results detailing whether less active patients develop worsened multimorbidity by April 2016.
With an ageing population, the management of chronic medical conditions is at the forefront of healthcare planning and policy. Determining the impact of levels of activity and function on multimorbidity development will inform the design of appropriate interventions that can improve health outcomes and significantly reduce health care costs.