Prevalence of disability according to multimorbidity and disease clustering: a population-based study

Background: The prevalence of chronic diseases has increased with population ageing, and research has attempted to elucidate the correlation between chronic diseases and disability. However, most studies in older populations have focused on the effect of single disabling conditions, even though most older adults have more than one chronic disease (multimorbidity). Objective: The aims of this study were to evaluate the association of disability with disease, in terms of multimorbidity and specified pairs of diseases, in a population-based study of older adults. Materials and Methods: Using the Kungsholmen Project, we estimated the prevalence of disability by the number of chronic diseases, disease status by organ systems, and in specific pairs of chronic conditions, in a Swedish population (n=1,099; ≥77 years). Disability was defined as need of assistance in at least one activity of daily living (Katz index). Results: Functional disability was seen in 17.9% of participants. It increased as the number of chronic diseases increased. The prevalence of disability varied greatly amongst specific pairs of diseases: from 6.7% in persons affected by hypertension and atrial fibrillation to 82.4% in persons affected by dementia and hip fracture. In multivariate logistic regression models, the disease pairs that were significantly associated with the highest increased relative odds of disability contained dementia (dementia–hip fracture, dementia–CVD, and dementia–depression). Conclusions: Our findings suggest specific pairs of diseases are much more highly associated with disability than others, particularly diseases coupled with dementia. This knowledge may improve prevention of disablement and planning of resource distribution.Journal of Comorbidity 2011;1(1):11–1

Multimorbidity: disease of society?

n/

Health inequalities in ageing: towards a multidimensional lifecourse approach

n/

Effect of Chronic Diseases and Multimorbidity on Survival and Functioning in Elderly Adults

Objectives To determine the effect of chronic disorders and their co-occurrence on survival and functioning in community-dwelling older adults. Design Population-based cohort study. Setting Kungsholmen, Stockholm, Sweden. Participants Individuals aged 78 and older examined by physicians four times over 11 years (N = 1,099). Measurements Chronic diseases (grouped according to 10 organ systems according to the International Classification of Diseases, Tenth Revision, code) and multimorbidity (≥2 coexisting chronic diseases) were evaluated in terms of mortality, population attributable risk of death, median years of life lost, and median survival time with and without disability (need of assistance in ≥1 activities of daily living). Results Approximately one in four deaths were attributable to cardiovascular and one in six to neuropsychiatric diseases. Malignancy was the condition with the shortest survival time (2.5 years). Malignancies and cardiovascular disorders each accounted for approximately 5 years of life lost. In contrast, neurosensorial and neuropsychiatric conditions had the longest median survival time (>6 years), and affected people were disabled for more than half of this time. The most-prevalent and -burdensome condition was multimorbidity, affecting 70.4% of the population, accounting for 69.3% of total deaths, and causing 7.5 years of life lost. Finally, people with multimorbidity lived 81% of their remaining years of life with disability (median 5.2 years). Conclusion Survival in older adults differs in length and quality depending on specific conditions. The greatest negative effect at the individual (shorter life, greater dependence) and societal (number of attributable deaths, years spent with disability) level was from multimorbidity, which has made multimorbidity a clinical and public health priority

Multimorbidity Patterns and 6-Year Risk of Institutionalization in Older Persons: The Role of Social Formal and Informal Care

Abstract 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

Ricostruzione e valutazione dello stato anteriore

Il 22% della popolazione anziana in Italia ha pi\uf9 di 65 anni, con un costo complessivo per le assicurazioni nel 2017 per i sinistri per macroinvalidit\ue0 e morte pari a 4,6 miliardi di euro. Si pone pertanto per il sistema sanitario nazionale e per i medici legali il problema di come valutare il danno biologico nella persona anziana. Infatti, le tabelle per la valutazione del danno a persona prendono in considerazione l\u2019entit\ue0 della lesione, ma non l\u2019et\ue0 del paziente. Si \ue8 deciso quindi di applicare per la prima volta alla medicina legale la metodologia della Consensus Conference, utilizzata generalmente per dirimere questioni controverse in ambito clinico, al fine di affrontare un tema di fondamentale interesse scientifico e produrre un unico documento contenente indicazioni per valutare in maniera metodologicamente corretta e condivisa il danno biologico nella persona anziana. Ad oggi la mancanza di una condivisione di opinioni su questo tema produce una forte disomogeneit\ue0 di comportamenti sul piano clinico e valutativo e il documento comporter\ue0 grandi ripercussioni sull\u2019attivit\ue0 quotidiana stante il costante invecchiamento della popolazione generale e le grandi problematiche che la fragilit\ue0 dell\u2019anziano crea nella valutazione del danno alla persona

Tutorial: Introdução à Visão Computacional usando OpenCV

Este tutorial apresenta conceitos introdutórios de processamento de imagens (filtros) e de visão computacional (segmentação, classificação, reconhecimento de padrão e rastreamento). Estes conceitos serão introduzidos utilizando a biblioteca OpenCV, que é distribuída gratuitamente e possui documentação farta na internet, com exemplos e aplicações práticas. Será mostrado como obter e como instalar a ferramenta para diversos tipos de plataformas e linguagens de desenvolvimento. Os conceitos de processamento de imagens e visão computacional serão discutidos não apenas no aspecto teórico, mas também serão apresentados exemplos de implementação para que os leitores possam entender e utilizar os exemplos apresentados neste tutorial