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Patterns of Multimorbidity in Elderly Veterans

Authors

  • Michael A. Steinman MD,

    Corresponding author
    1. Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
    • Division of Geriatrics, University of California at San Francisco, San Francisco, California
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  • Sei J. Lee MD, MAS,

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
    2. Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • W. John Boscardin PhD,

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
    2. Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • Yinghui Miao MPH,

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
    2. Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • Kathy Z. Fung MS,

    1. Division of Geriatrics, University of California at San Francisco, San Francisco, California
    2. Health Services Research Enhancement Award Program, San Francisco Veterans Affairs Medical Center, San Francisco, California
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  • Kelly L. Moore PhD,

    1. Jewish Home of San Francisco, San Francisco, California
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  • Janice B. Schwartz MD

    1. Department of Medicine, University of California at San Francisco, San Francisco, California
    2. Jewish Home of San Francisco, San Francisco, California
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Address correspondence to Michael A. Steinman, 4150 Clement St, SFVAMC Box 181G, San Francisco, CA 94121. E-mail: Mike.steinman@ucsf.edu

Abstract

Objectives

To determine patterns of co-occurring diseases in older adults and the extent to which these patterns vary between the young-old and the old-old.

Design

Observational study.

Setting

Department of Veterans Affairs.

Participants

Veterans aged 65 years and older (1.9 million male, mean age 76 ± 7; 39,000 female, mean age 77 ± 8) with two or more visits to Department of Veterans Affairs (VA) or Medicare settings in 2007 and 2008.

Measurements

The presence of 23 common conditions was assessed using hospital discharge diagnoses and outpatient encounter diagnoses from the VA and Medicare.

Results

The mean number of chronic conditions (out of 23 possible) was 5.5 ± 2.6 for men and 5.1 ± 2.6 for women. The prevalence of most conditions increased with advancing age, although diabetes mellitus and hyperlipidemia were 11% to 13% less prevalent in men and women aged 85 and older than in those aged 65 to 74 (P < .001 for each). In men, the most common three-way combination of conditions was hypertension, hyperlipidemia, and coronary heart disease, which together were present in 37% of men. For women, the most common combination was hypertension, hyperlipidemia, and arthritis, which co-occurred in 25% of women. Reflecting their high population prevalence, hypertension and hyperlipidemia were both present in 9 of the 15 most common three-way disease combinations in men and in 11 of the 15 most common combinations in women. The prevalence of many disease combinations varied substantially between young-old and old-old adults.

Conclusions

Specific combinations of diseases are highly prevalent in older adults and inform the development of guidelines that account for the simultaneous presence of multiple chronic conditions.

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