towards a research agenda on living well with multiple chronic conditions: a resilience model and...

Towards a Research Agenda on Living Well with Multiple Chronic Conditions: A Resilience Model and Multi-level Profile

AUTHORS KATHERINE COATTA & ANDREW WISTER

DEPARTMENT OF GERONTOLOGY, SIMON FRASER UNIVERSITY VANCOUVER CAMPUS, CANADA

Age Pyramids of the Canadian Population, 2009 & 2036

Purpose

Cross-cultural and generational comparative analysis of multiple chronic illness patterns

Demographic, health and social profile

“The Canadian Case”

Identify areas for multivariate analyses

Background

Attention devoted to multiple chronic illnesses (multiple morbidity), given potential synergistic effects, population aging & health care discourse

Research is still in infancy

Multiple chronic conditions have been correlated with longer hospital stays, increased use of health care resources, and decreased productivity

The ‘well-being paradox’ (Windle, Woods & Markland, 2010) - life satisfaction maintained in the face of poor health

Has led to ‘living well’ with multiple chronic illnesses

Defining Multiple Morbidity

1) Simple dichotomies: 0 vs. 1+ Illnesses; OR 0,1 vs. 2+

2) Additive Scales (counts of illnesses)

3) Weighted based on HRQL or diagnostic criteria (onset, severity)

4) Comorbidity (index disease)

5) Combinations of selected illnesses

90% of older adults have 1+ chronic illness; 70% have 2+ (2008/09 Canadian Community Health Survey CCHS)

[asthma, arthritis, osteoporosis, back problems, blood pressure, migraine headaches, bronchitis, emphysema, COPD, diabetes, heart disease, cancer, ulcers, stroke, urinary incontinence, bowel disorder, cataracts, glaucoma and thyroid problems]

Theoretical Frame for Living Well with Multiple Chronic Illnesses

Adaptation (Homeostasis; Person-environment)

Connections among individuals, community & health policies (Socio-ecological theory, e.g. Stokols, 1991)

Behavioural change and action (TOPB, Social learning, Transtheoretical model, etc.)

Interconnectedness of hardiness and resources at individual, community & policy spheres (Resilience Theory)

Population health and health care interface (Chronic Care Models)

Adapted from: Barr, V., Robsinson, S., Marin-Link, B., Underhill, L., Dotts, A., Ravensdale, D. & Salivaras, S. (2003) The expanded chronic care model: An integration of concepts and strategies from population health promotion and the chronic care model. Hospital Quarterly, 7(1), 73-82

Methods

Analyses of the CCHS 4.2 Healthy Aging 2008/09

45+ (N = 30, 639)

Weighted to Canadian population and rescaled to limit overpowering analyses

Chronic illness additive measure (selected 8 illnesses common across CCHS and Australian HILDA survey)

Age Groups: 45-64; 65-74; 75+

Gender

Prevalence of Chronic Illnesses

Male Female Male Female Male Female Male FemaleArthritis/ Osteoporosis High Blood Pressure Heart Disease Diabetes

0

10

20

30

40

50

60

70

Fig. 1A – Prevalence of Chronic Illnesses by Age Group & Gender

Perc

ent

(%)

Male 45-64 yrs 65-74 yrs 75+ yrs

Female

45-64 yrs 65-74 yrs 75+ yrs

Prevalence of Chronic Illnesses


Female

45-64 yrs 65-74 yrs 75+ yrs

Male Female Male Female Male Female Male FemaleAsthma Bronchitis/ Emphysema Cancer Stroke

0

2

4

6

8

10

12

14

Fig. 1B – Prevalence of Chronic Illnesses by Age Group and Gender

Perc

ent

(%)

Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender

Male Female Male Female Male Female Male FemaleMarried Divorced Widowed Single

0

0.5

1

1.5

2

2.5

Fig. 2A - Marital Status


Female

45-64 yrs 65-74 yrs 75+ yrs

Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes

* Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses

Married Divorced Widowed Single0.9

0.95

1

1.05

1.1

1.15

1.2

1.25

1.3

1.35

1.141.16

1.3

1.15

1.06

1.12

1.07

1.18

1.09

1.131.15

1

Fig. 2B - Marital Status

45-6465-7475+

Odds Ratios for Age Differences in Mean # of Chronic Illnesses for Selected Outcomes

* Numbers shown in columns are age group A (older)/ age group B (younger) odds ratios for number of chronic illnesses

Male 75+/45-64 yrs

65-74/45-64 yrs 75+/65-74 yrs Female

75+/45-64 yrs 65-74/45-64 yrs 75+/65-74 yrs

Male Female Male Female Male Female Male FemaleMarried Divorced Widowed Single

0

0.5

1

1.5

2

2.5

3

2.522.4

2.09 2.03 2.02

1.791.96

1.7

2.041.9 1.93 1.86 1.92

1.61.69 1.73

1.23 1.27 1.08 1.09 1.05 1.12 1.16

0.98

Fig. 2C – Marital Status


Male Female Male FemaleSecondary or Less More than Secondary

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

2

Fig. 2D - Education


Female

45-64 yrs 65-74 yrs 75+ yrs


Male Female Male FemaleSecondary or Less More than Secondary

0.00

0.50

1.00

1.50

2.00

2.50

3.00

2.172.01

2.51 2.51

1.871.70

2.06 2.03

1.16 1.181.22 1.24

Fig. 2F - Education

Male 75+/45-64 yrs

65-74/45-64 yrs 75+/65-74 yrs Female

75+/45-64 yrs 65-74/45-64 yrs 75+/65-74 yrs



Female

45-64 yrs 65-74 yrs 75+ yrs

Male

Fem

ale

Male

Fem

ale

Male

Fem

ale

Male

Fem

ale

Poor or Fair Good, Very Good, Excellent Admittance in 12 months No Admittance in 12 months

0

1

2

3

Fig. 2G - Self Perceived Health and Hospital Admittance

SELF PERCEIVED HEALTH HOSPITAL ADMITTANCE


SELF RATED HEALTH


Poor/Fair Good/Very Good/Excellent Within last 12 months No admittance in 12 months0.9

0.95

1

1.05

1.1

1.15

1.2

1.25

1.13

1.23

1.12

1.18

1.04

1.141.11 1.11

1.03

1.16

1.11.12

Fig. 2H – Self Rated Health & Hospital Admittance

45-6465-7475+

HOSPITAL ADMITTANCE


Male Female Male Female Male Female Male FemaleCanada Not Canada Caucasian Non-Caucasian

0

0.5

1

1.5

2

2.5

Fig. 2J - Country of Birth and Visible Minority Status Male

45-64 yrs 65-74 yrs 75+ yrs

Female

45-64 yrs 65-74 yrs 75+ yrs

VISIBLE MINORITY STATUSCOUNTRY OF BIRTH



Canada Not Canada Caucasian Non-Caucasian0.9

1

1.1

1.2

1.3

1.4

1.151.18

1.14

1.33

1.09

1.141.11

1.091.11.12

1.1

1.16

Fig. 2K – Country of Birth & Visible Minority Status

45-6465-7475+

COUNTRY OF BIRTH VISIBLE MINORITY STATUS


Male

Fem

ale

Male

Fem

ale

Male

Fem

ale

Male

Fem

ale

Requires Help/ Needs Mechanical Support

No Aid Required/ No Prob-lems

Did not assist Assisted

00.5

11.5

22.5

3

Fig. 2M - Mobility and Personal Care Assistance

MOBILITY PERSONAL CARE ASSISTANCE


Female

45-64 yrs 65-74 yrs 75+ yrs


Requires Help No Help Required Assisted Did not assist0.9

0.95

1

1.05

1.1

1.15

1.2

1.25

1.3

1.21.18

1.1

1.17

1.04

1.09

0.98

1.12

1.05

1.09

1.26

1.1

Fig 2N – Mobility & Personal Assistance

MOBILITY PERSONAL CARE



MOBILITY PERSONAL CARE

Male 75+/45-64 yrs

65-74/45-64 yrs 75+/65-74 yrs Female

75+/45-64 yrs 65-74/45-64 yrs 75+/65-74 yrs

Male Female Male Female Male Female Male FemaleRequires Help No Help Required Assisted Did not Assist

0.00

0.50

1.00

1.50

2.00

2.50

3.00

1.30 1.12

2.402.22

1.79

2.06

2.522.36

1.42 1.22

2.041.90

1.791.60

2.061.96

0.91 0.92

1.18 1.17

1.00

1.28 1.23 1.20

Fig. 2O – Mobility & Personal Care Assistance


Male Female Male Female Male Female Male FemaleReceived Did not receive Received Did not receive

0

0.5

1

1.5

2

2.5

Fig. 2P - Care Received: Formal & Informal

FORMAL INFORMAL


Female

45-64 yrs 65-74 yrs 75+ yrs


Received Did not receive Received Did not receive0.9

0.95

1

1.05

1.1

1.15

1.2

1.171.16 1.16

1.13

1.02

1.11

1

1.091.11

1.08

1.03

1.08

Fig. 2Q - Care Received: Formal & Informal

45-6465-7475+

FORMAL INFORMAL


Correlations between Chronic Illnesses Scale and Selected Outcomes by Age Group and Gender


Female

45-64 yrs 65-74 yrs 75+ yrs

Male Female Male FemaleMedication Use Daily Life Satisfaction

0

0.1

0.2

0.3

0.4

0.5

0.6

Fig. 3A - Medication Use Daily and Life Satis-faction

Pears

on R

Odds Ratios for Age Differences by Correlation Coefficients of Chronic Illness Scale and Selected Variables

Male Female Male FemaleMedication Use Life Satisfaction

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

0.820.92 0.88

0.80.93 0.92

1.43

0.90.881

0.6

0.88

Fig. 3C – Medication Use Daily & Life Satis-faction

Male 75+/45-64 yrs

65-74/45-64 yrs 75+/65-74 yrs Female

75+/45-64 yrs 65-74/45-64 yrs 75+/65-74 yrs

Correlations between Chronic Illnesses Scale and MOS Sub-scales Age Group and Gender

Male Female Male Female Male Female Male FemaleAffection Emotional/ Informational Positive Social Interaction Tangible

0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

0.09

Fig. 3D - Social Support

Pears

on R


Female

45-64 yrs 65-74 yrs 75+ yrs

Summary

Age effect on chronic illness prevalence

Gender differences depend on specific illness

Analysis of Multiple Chronic Illness Patterns:

Gender difference in multiple morbidity within marital status is largest for widowed boomers (female/male OR= 1.3)

The 75+/boomer age difference is large for males in all marital categories; but only for married females

Education effect on chronic illness is largest for boomers (45-64), declines with age

Gender difference in self-rated health & hospital admittance is largest for boomers

Summary – Con’t

Significantly higher gender difference in multiple morbidity for visible minority boomers

Large gender difference in multiple morbidity and personal care association for those aged 75+

Strong correlations between multiple morbidity and medication use (r=.45 to .55); slightly higher for boomers than seniors

Gender difference in chronic illness and formal and informal care is highest for boomers, smallest for seniors

Small (r=-.15 to -.25) correlations between multiple morbidity and life satisfaction, but boomers and young-old are most likely to be negatively affected

Correlations between multiple morbidity and social support dimensions are very low

towards a research agenda on living well with multiple chronic conditions: a resilience model and...

Documents

chronic illnesses scale

gender slide

illnesses common

canada slide

age differences

selected variables

expanded chronic care

femalemale odds ratios