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Patterns of Multimorbidity in a Population-Based Cohort of Older People: Sociodemographic, Lifestyle, and Functional Differences.

BACKGROUND
The aim of this study is to identify clusters of older persons based on their multimorbidity patterns, and to analyze differences among clusters according to sociodemographic, lifestyle, clinical, and functional characteristics.


METHODS
We analyzed data from the Swedish National Study on Aging and Care in Kungsholmen on 2931 participants aged 60+ years who had at least two chronic diseases. Participants were clustered by the fuzzy c-means cluster algorithm. A disease was considered to be associated with a given cluster when the observed/expected ratio was ≥2 or the exclusivity ≥25%.


RESULTS
Around half of the participants could be classified into five clinically meaningful clusters: respiratory and musculoskeletal diseases (RESP-MSK) 15.7%, eye diseases and cancer (EYE-CANCER) 10.7%, cognitive and sensory impairment (CNS-IMP) 10.6%, heart diseases (HEART) 9.3%, and psychiatric and respiratory diseases (PSY-RESP) 5.4%. Individuals in the CNS-IMP cluster were the oldest, with the worst function and more likely to live in a nursing home; those in the HEART cluster had the highest number of co-occurring diseases and drugs, and they exhibited the highest mean values of serum creatinine and C - reactive protein. The PSY-RESP cluster was associated with higher levels of alcoholism and neuroticism. The other half of the cohort was grouped in an unspecific cluster, which was characterized by the youngest individuals, the lowest number of co-occurring diseases, and the best functional and cognitive status.


CONCLUSIONS
The identified multimorbidity patterns provide insight for setting targets for secondary and tertiary preventative interventions and for designing care interventions for multimorbid older people.