- People with multiple chronic conditions also have poorer physical functioning
- “The unknown factors of a complex care plan can cause anxiety”
CHICAGO — As the global population ages, more and more research is focusing on the impact of multimorbidity: the presence of two or more long-term health conditions.
A new Northwestern Medicine study finds that people with multiple chronic conditions report persistently higher levels of anxiety and depression and poorer physical functioning. The study found that those who identified as non-white had poorer health-related quality of life as multiple chronic health conditions increased compared with white study participants.
“As people age, they don’t just develop high blood pressure and that’s it. These conditions are often very manageable, but unfortunately, there are some negative quality-of-life side effects that come with it.” Northwestern Determinants of the Health Department at the University Feinberg School of Medicine.
Symptoms that begin in early adulthood are less severe, but may increase in severity with age and may be compounded by the presence of other symptoms. For example, a person may be diagnosed with high blood pressure in middle age and later develop type 2 diabetes and arthritis.
“There are many unknowns in a complex care plan, such as the need to coordinate with multiple physicians, taking contraindicated medications, and managing possible complications, which can cause patient anxiety.” Graham said. “Coupled with the impairments in physical function associated with multiple illnesses, all of this may contribute to increased reports of depressive symptoms.”
“Alarming Racial Health Disparities”
The most sobering finding, Graham said, is that multiple medical conditions among minorities lead to reduced quality of life.
“I was disappointed, but not entirely surprised, to see that multi-morbidity has a more pronounced impact on quality of life for non-white people,” Graham said. “It points to a greater need for us to understand how health care systems can better support People from underrepresented communities.”
The study will be published Jan. 29 in Journal of Gerontology Series B: Psychological Sciences and Social Sciences.
Depression rates are higher in certain illnesses
People in the study experienced a wide range of chronic conditions, Graham said. These include angina, high blood pressure, high cholesterol, liver disease, thyroid disease, celiac disease, chronic kidney disease, gout, arthritis, peripheral artery disease, diabetes, fluid in the lungs, bronchitis, cataracts, deafness, hearing problems, hip fractures, Asthma, emphysema and cancer.
The study found that depression was higher in people with circulatory, musculoskeletal, metabolic and respiratory conditions, but lower in people with digestive disease, kidney or ear disease, cataracts or cancer. People with respiratory illnesses have higher rates of depression initially, but their depression improves over time.
Next step: How to help older adults mitigate these effects
Graham said more research is needed to explore what kind of support older adults need to mitigate these effects. Better coordination among caregivers can help reduce patients’ anxiety about care options, or help from the health care system can help patients develop stronger support networks, Graham said.
The study used data from the Longitudinal Study of Health Literacy and Cognitive Function in Older Adults, a prospective cohort study of late middle-aged and older adults. Participants were enrolled between August 2008 and October 2010 from one academic general internal medicine clinic and six federally qualified health centers in the Chicago area.
Throughout the study, participants reported anxiety, depression, and physical functioning, chronic conditions, and sociodemographic characteristics using the Patient-Reported Outcomes Information System (PROMIS).
The study is titled “Longitudinal associations between multiple medical conditions and patient-reported quality of life.” Additional authors from Northwestern University include Michael S. Wolf; David Serra; Daniel K. Mrozek; Lily Piramic; Laura Curtis; Lauren · Opsasnik; Rebecca Lovett; Rachel O’Connor; and Marquetta Lewis-Thames.
Research reported in this publication was supported in part by the National Institute on Aging (grants P30AG059988 and K01AG070107). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.