@article {13468, title = {Multimorbidity and Functional Disability among Older Adults: The Role of Inflammation and Glycemic Status - An Observational Longitudinal Study.}, journal = {Gerontology}, volume = {69}, year = {2023}, pages = {826-838}, abstract = {

INTRODUCTION: Specific multimorbidity combinations, in particular those including arthritis, stroke, and cognitive impairment, have been associated with high burden of activities of daily living (ADL)-instrumental activities of daily living (IADL) disability in older adults. The biologic underpinnings of these associations are still unclear.

METHODS: Observational longitudinal study using data from the Health and Retirement Study (N = 8,618, mean age = 74 years, 58\% female, 25\% non-white) and negative binomial regression models stratified by sex to evaluate the role of inflammatory and glycemic biomarkers (high-sensitivity C-reactive protein (hs-CRP) and HbA1c) in the association between specific multimorbidity combinations (grouped around one of eight index diseases: arthritis, cancer, cognitive impairment, diabetes, heart disease, hypertension, lung disease, and stroke; assessed between 2006 and 2014) and prospective ADL-IADL disability (2 years later, 2008-2016). Results were adjusted for sociodemographic characteristics, body mass index, number of coexisting diseases, and baseline ADL-IADL score.

RESULTS: Multimorbidity combinations indexed by arthritis (IRR = 1.1, 95\% CI = 1.01-1.20), diabetes (IRR = 1.19, 95\% CI = 1.09-1.30), and cognitive impairment (IRR = 1.11, 95\% CI = 1.01-1.23) among men and diabetes-indexed multimorbidity combinations (IRR = 1.07, 95\% CI = 1.01-1.14) among women were associated with higher ADL-IADL scores at increasing levels of HbA1c. Across higher levels of hs-CRP, multimorbidity combinations indexed by arthritis (IRR = 1.06, 95\% CI = 1.02-1.11), hypertension (IRR = 1.06, 95\% CI = 1.02-1.11), heart disease (IRR = 1.06, 95\% CI = 1.01-1.12), and lung disease (IRR = 1.14, 95\% CI = 1.07-1.23) were associated with higher ADL-IADL scores among women, while there were no significant associations among men.

CONCLUSION: The findings suggest potential for anti-inflammatory management among older women and optimal glycemic control among older men with these particular multimorbidity combinations as focus for therapeutic/preventive options for maintaining functional health.

}, keywords = {Activities of Daily Living, Aged, Arthritis, C-reactive protein, Diabetes Mellitus, Disabled Persons, Female, Glycated Hemoglobin, Heart Diseases, Humans, Hypertension, Inflammation, Longitudinal Studies, Male, multimorbidity, Prospective Studies, Stroke}, issn = {1423-0003}, doi = {10.1159/000528648}, author = {Botoseneanu, Anda and Markwardt, Sheila and Qui{\~n}ones, Ana R} } @article {12247, title = {Multimorbidity Accumulation Among Middle-Aged Americans: Differences by Race/Ethnicity and Body Mass Index.}, journal = {The Journals of Gerontology: Series A }, volume = {77}, year = {2022}, pages = {e89-e97}, abstract = {

BACKGROUND: Obesity and multimorbidity are more prevalent among U.S. racial/ethnic minority groups. Evaluating racial/ethnic disparities in disease accumulation according to body mass index (BMI) may guide interventions to reduce multimorbidity burden in vulnerable racial/ethnic groups.

METHOD: We used data from the 1998-2016 Health and Retirement Study on 8 106 participants aged 51-55 at baseline. Disease burden and multimorbidity (>=2 co-occurring diseases) were assessed using 7 chronic diseases: arthritis, cancer, heart disease, diabetes, hypertension, lung disease, and stroke. Four BMI categories were defined per convention: normal, overweight, obese class 1, and obese class 2/3. Generalized estimating equations models with inverse probability weights estimated the accumulation of chronic diseases.

RESULTS: Overweight and obesity were more prevalent in non-Hispanic Black (82.3\%) and Hispanic (78.9\%) than non-Hispanic White (70.9 \%) participants at baseline. The baseline burden of disease was similar across BMI categories, but disease accumulation was faster in the obese class 2/3 and marginally in the obese class 1 categories compared with normal BMI. Black participants across BMI categories had a higher initial burden and faster accumulation of disease over time, while Hispanics had a lower initial burden and similar rate of accumulation, compared with Whites. Black participants, including those with normal BMI, reach the multimorbidity threshold 5-6 years earlier compared with White participants.

CONCLUSIONS: Controlling weight and reducing obesity early in the lifecourse may slow the progression of multimorbidity in later life. Further investigations are needed to identify the factors responsible for the early and progressing nature of multimorbidity in Blacks of nonobese weight.

}, keywords = {Body Mass Index, Disease accumulation, multimorbidity, Race/ethnicity}, issn = {1758-535X}, doi = {10.1093/gerona/glab116}, author = {Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Allore, Heather G and Jason T Newsom and David A Dorr and Ana R Qui{\~n}ones} } @article {12985, title = {Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)}, journal = {Innovation in Aging}, volume = {5}, year = {2022}, pages = {614}, abstract = {Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2\%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2\%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6\%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1\% in youngest age category [67-69] vs. 50.3\% for incident and 66.7\% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6\% CIND/dementia vs. 15.4\% for incident and 16.8\% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4\%) than in the incident (11.8\%) and no multimorbidity groups (13.4\%). Non-Hispanic White beneficiaries were more represented in the incident (83.5\%) than the prevalent (77.2\%) and the no multimorbidity (77.7\%). Hispanic beneficiaries were more represented in the no (8.9\%) than the prevalent (7.4\%) and incident multimorbidity groups (4.7\%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.}, keywords = {Medicare Beneficiaries, multimorbidity progression}, doi = {10.1093/geroni/igab046.2347}, author = {Qui{\~n}ones, Ana R and Markwardt, Sheila and Allore, Heather and Newsom, Jason and Nagel, Corey and Dorr, David and Botoseneanu, Anda} } @article {11616, title = {Are there sex differences in potentially inappropriate prescribing in adults with multimorbidity?}, journal = {Journal of the American Geriatrics Society}, volume = {69}, year = {2021}, pages = {2163-2175}, abstract = {

BACKGROUND/OBJECTIVES: Limited knowledge exists regarding sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns. This study sought to determine sex differences in PIM prescribing in older adults with cardiovascular-metabolic patterns.

DESIGN: Retrospective cohort study.

SETTING: Health and Retirement Study (HRS) 2004-2014 interview data, linked to HRS-Medicare claims data annualized for 2005-2014.

STUDY SAMPLE: Six thousand three-hundred and forty-one HRS participants aged 65 and older with two and more chronic conditions.

MEASUREMENTS: PIM events were calculated using 2015 American Geriatrics Society Beers Criteria. Multimorbidity patterns included: "cardiovascular-metabolic only," "cardiovascular-metabolic plus other physical conditions," "cardiovascular-metabolic plus mental conditions," and "no cardiovascular-metabolic disease" patterns. Logistic regression models were used to determine the association between PIM and sex, including interaction between sex and multimorbidity categories in the model, for PIM overall and for each PIM drug class.

RESULTS: Women were prescribed PIMs more often than men (39.4\% vs 32.8\%). Overall, women had increased odds of PIM (Adj. odds ratio [OR]~=~1.30, 95\% confidence interval [CI]: 1.16-1.46). Women had higher odds of PIM than men with cardiovascular-metabolic plus physical patterns (Adj. OR~=~1.25, 95\% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj. OR~=~1.25, 95\% CI: 1.06-1.48), and there were no sex differences in adults with a cardiovascular-metabolic only patterns (Adj. OR~=~1.13, 95\% CI: 0.79-1.62). Women had greater odds of being prescribed the following PIMs: anticholinergics, antidepressants, antispasmodics, benzodiazepines, skeletal muscle relaxants, and had lower odds of being prescribed pain drugs and sulfonylureas compared with men.

CONCLUSION: This study evaluated sex differences in PIM prescribing among adults with complex cardiovascular-metabolic multimorbidity patterns. The effect of sex varied across multimorbidity patterns and by different PIM drug classes. This study identified important opportunities for future interventions to improve medication prescribing among older adults at risk for PIM.

}, keywords = {multimorbidity patterns, potentially inappropriate medications, Sex differences}, issn = {1532-5415}, doi = {10.1111/jgs.17194}, author = {Ukhanova, Maria and Markwardt, Sheila and Furuno, Jon P and Davis, Laura and Noble, Brie N and Ana R Qui{\~n}ones} } @article {10.1093/geroni/igab046.2347, title = {Multimorbidity Progression among Medicare Beneficiaries in the Health and Retirement Study (1992-2014)}, journal = {Innovation in Aging}, volume = {5}, year = {2021}, pages = {614}, abstract = {Older adults are at greater risk for developing and accumulating multimorbidity, defined as 2 or more chronic diseases. This study describes the characteristics of multimorbidity progression-based groups using Medicare claims chronic condition warehouse algorithms over a 24-year period. The HRS-Medicare linked data (1991-2015, N=17,895, age 67 years and older) were used in descriptive analyses presented as a Sankey flow diagram. We identified 1,293 (7.2\%) beneficiaries who had not yet developed multimorbidity by the end of the observation period (no multimorbidity), 7,552 (42.2\%) who started without but developed multimorbidity over the course of observation (incident multimorbidity), and 9,050 (50.6\%) who had multimorbidity upon study entry (prevalent multimorbidity). There were notable differences between multimorbidity progression-based groups. Beneficiaries with prevalent multimorbidity were younger at baseline (73.1\% in youngest age category [67-69] vs. 50.3\% for incident and 66.7\% for no multimorbidity), had proportionately higher levels of cognitive impairment (21.6\% CIND/dementia vs. 15.4\% for incident and 16.8\% for no multimorbidity), and greater mean levels of functional impairment and healthcare utilization. Non-Hispanic Black beneficiaries were more represented in prevalent multimorbidity (15.4\%) than in the incident (11.8\%) and no multimorbidity groups (13.4\%). Non-Hispanic White beneficiaries were more represented in the incident (83.5\%) than the prevalent (77.2\%) and the no multimorbidity (77.7\%). Hispanic beneficiaries were more represented in the no (8.9\%) than the prevalent (7.4\%) and incident multimorbidity groups (4.7\%). Results highlight beneficiaries who experience clinically-meaningful transitions to multimorbidity states in late life, allowing new insights and informing interventions to address burdensome changes to their chronic disease status.}, issn = {2399-5300}, doi = {10.1093/geroni/igab046.2347}, author = {Qui{\~n}ones, Ana and Markwardt, Sheila and Allore, Heather and Newsom, Jason and Nagel, Corey and Dorr, David and Botoseneanu, Anda} } @article {11580, title = {Racial and Ethnic Differences in Multimorbidity Changes Over Time.}, journal = {Medical Care}, volume = {59}, year = {2021}, pages = {402-409}, abstract = {

BACKGROUND: Our understanding of how multimorbidity progresses and changes is nascent.

OBJECTIVES: Assess multimorbidity changes among racially/ethnically diverse middle-aged and older adults.

DESIGN, SETTING, AND PARTICIPANTS: Prospective cohort study using latent class analysis to identify multimorbidity combinations over 16 years, and multinomial logistic models to assess change relative to baseline class membership. Health and Retirement Study respondents (age 51 y and above) in 1998 and followed through 2014 (N=17,297).

MEASURES: Multimorbidity latent classes of: hypertension, heart disease, lung disease, diabetes, cancer, arthritis, stroke, high depressive symptoms.

RESULTS: Three latent classes were identified in 1998: minimal disease (45.8\% of participants), cardiovascular-musculoskeletal (34.6\%), cardiovascular-musculoskeletal-mental (19.6\%); and 3 in 2014: cardiovascular-musculoskeletal (13\%), cardiovascular-musculoskeletal-metabolic (12\%), multisystem multimorbidity (15\%). Remaining participants were deceased (48\%) or lost to follow-up (12\%) by 2014. Compared with minimal disease, individuals in cardiovascular-musculoskeletal in 1998 were more likely to be in multisystem multimorbidity in 2014 [odds ratio (OR)=1.78, P<0.001], and individuals in cardiovascular-musculoskeletal-mental in 1998 were more likely to be deceased (OR=2.45, P<0.001) or lost to follow-up (OR=3.08, P<0.001). Hispanic and Black Americans were more likely than White Americans to be in multisystem multimorbidity in 2014 (OR=1.67, P=0.042; OR=2.60, P<0.001, respectively). Black compared with White Americans were more likely to be deceased (OR=1.62, P=0.01) or lost to follow-up (OR=2.11, P<0.001) by 2014.

CONCLUSIONS AND RELEVANCE: Racial/ethnic older adults are more likely to accumulate morbidity and die compared with White peers, and should be the focus of targeted and enhanced efforts to prevent and/or delay progression to more complex multimorbidity patterns.

}, keywords = {multimorbidity, race and ethnicity}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000001527}, author = {Ana R Qui{\~n}ones and Jason T Newsom and Elman, Miriam R and Markwardt, Sheila and Corey L Nagel and David A Dorr and Heather G. Allore and Anda Botoseneanu} } @article {11160, title = {Annual Wellness Visits and Influenza Vaccinations among Older Adults in the US.}, journal = {Journal of Primary Care \& Community Health}, volume = {11}, year = {2020}, abstract = {

OBJECTIVES: Investigate whether combinations of sociodemographic factors, chronic conditions, and other health indicators pose barriers for older adults to access Annual Wellness Visits (AWVs) and influenza vaccinations.

METHODS: Data on 4999 individuals aged >=65 years from the 2012 wave of the Health and Retirement Study linked with Medicare claims were analyzed. Conditional Inference Tree (CIT) and Random Forest (CIRF) analyses identified the most important predictors of AWVs and influenza vaccinations. Multivariable logistic regression (MLR) was used to quantify the associations.

RESULTS: Two-year uptake was 22.8\% for AWVs and 65.9\% for influenza vaccinations. For AWVs, geographical region and wealth emerged as the most important predictors. For influenza vaccinations, number of somatic conditions, race/ethnicity, education, and wealth were the most important predictors.

CONCLUSIONS: The importance of geographic region for AWV utilization suggests that this service was unequally adopted. Non-Hispanic black participants and/or those with functional limitations were less likely to receive influenza vaccination.

}, keywords = {annual wellness visits, influenza vaccinations, machine learning methods, preventive healthcare utilization}, issn = {2150-1327}, doi = {10.1177/2150132720962870}, author = {J{\o}rgensen, Terese Sara H{\o}j and Heather G. Allore and Elman, Miriam R and Corey L Nagel and Zhang, Mengran and Markwardt, Sheila and Ana R Qui{\~n}ones} } @article {10070, title = {Diabetes-multimorbidity combinations and disability among middle-aged and older adults.}, journal = {Journal of General Internal Medicine}, year = {2019}, month = {2019 Feb 27}, abstract = {

BACKGROUND: Older adults with diabetes rarely have only one chronic disease. As a result, there is a need to re-conceptualize research and clinical practice to address the growing number of older Americans with diabetes and concurrent chronic diseases (diabetes-multimorbidity).

OBJECTIVE: To identify prevalent multimorbidity combinations and examine their association with poor functional status among a nationally representative sample of middle-aged and older adults with diabetes.

DESIGN: A prospective cohort study of the 2012-2014 Health and Retirement Study (HRS) data. We identified the most prevalent diabetes-multimorbidity combinations and estimated negative binomial models of diabetes-multimorbidity on prospective disability.

PARTICIPANTS: Analytic sample included 3841 HRS participants with diabetes, aged 51~years and older.

MAIN MEASURES: The main outcome measure was the combined activities of daily living (ADL)-instrumental activities of daily living (IADL) index (range 0-11; higher index denotes higher disability). The main independent variables were diabetes-multimorbidity combination groups, defined as the co-occurrence of diabetes and at least one of six somatic chronic diseases (hypertension, cardiovascular disease, lung disease, cancer, arthritis, and stroke) and/or two mental chronic conditions (cognitive impairment and high depressive symptoms (CESD score >= 4).

KEY RESULTS: The three most prevalent multimorbidity combinations were, in rank-order diabetes-arthritis-hypertension (n = 694, 18.1\%); diabetes-hypertension (n = 481, 12.5\%); and diabetes-arthritis-hypertension-heart disease (n = 383, 10\%). Diabetes-multimorbidity combinations that included high depressive symptoms or stroke had significantly higher counts of ADL-IADL limitations compared with diabetes-only. In head-to-head comparisons of diabetes-multimorbidity combinations, high depressive symptoms or stroke added to somatic multimorbidity combinations was associated with a higher count of ADL-IADL limitations (diabetes-arthritis-hypertension-high depressive symptoms vs. diabetes-arthritis-hypertension: IRR = 1.95 [1.13, 3.38]; diabetes-arthritis-hypertension-stroke vs. diabetes-arthritis-hypertension: IRR = 2.09 [1.15, 3.82]) even after adjusting for age, gender, education, race/ethnicity, BMI, baseline ADL-IADL, and diabetes duration. Coefficients were robust to further adjustment for diabetes treatment.

CONCLUSIONS: Depressive symptoms or stroke added onto other multimorbidity combinations may pose a substantial functional burden for middle-aged and older adults with diabetes.

}, keywords = {Chronic disease, Comorbidity, Diabetes, Disabilities}, issn = {1525-1497}, doi = {10.1007/s11606-019-04896-w}, author = {Ana R Qui{\~n}ones and Markwardt, Sheila and Anda Botoseneanu} } @article {10147, title = {Racial/ethnic differences in multimorbidity development and chronic disease accumulation for middle-aged adults.}, journal = {PLoS One}, volume = {14}, year = {2019}, pages = {e0218462}, abstract = {

BACKGROUND: Multimorbidity-having two or more coexisting chronic conditions-is highly prevalent, costly, and disabling to older adults. Questions remain regarding chronic diseases accumulation over time and whether this differs by racial and ethnic background. Answering this knowledge gap, this study identifies differences in rates of chronic disease accumulation and multimorbidity development among non-Hispanic white, non-Hispanic black, and Hispanic study participants starting in middle-age and followed up to 16 years.

METHODS AND FINDINGS: We analyzed data from the Health and Retirement Study (HRS), a biennial, ongoing, publicly-available, longitudinal nationally-representative study of middle-aged and older adults in the United States. We assessed the change in chronic disease burden among 8,872 non-Hispanic black, non-Hispanic white, and Hispanic participants who were 51-55 years of age at their first interview any time during the study period (1998-2014) and all subsequent follow-up observations until 2014. Multimorbidity was defined as having two or more of seven somatic chronic diseases: arthritis, cancer, heart disease (myocardial infarction, coronary heart disease, angina, congestive heart failure, or other heart problems), diabetes, hypertension, lung disease, and stroke. We used negative binomial generalized estimating equation models to assess the trajectories of multimorbidity burden over time for non-Hispanic black, non-Hispanic white, and Hispanic participants. In covariate-adjusted models non-Hispanic black respondents had initial chronic disease counts that were 28\% higher than non-Hispanic white respondents (IRR 1.279, 95\% CI 1.201, 1.361), while Hispanic respondents had initial chronic disease counts that were 15\% lower than non-Hispanic white respondents (IRR 0.852, 95\% CI 0.775, 0.938). Non-Hispanic black respondents had rates of chronic disease accumulation that were 1.1\% slower than non-Hispanic whites (IRR 0.989, 95\% CI 0.981, 0.998) and Hispanic respondents had rates of chronic disease accumulation that were 1.5\% faster than non-Hispanic white respondents (IRR 1.015, 95\% CI 1.002, 1.028). Using marginal effects commands, this translates to predicted values of chronic disease for white respondents who begin the study period with 0.98 chronic diseases and end with 2.8 chronic diseases; black respondents who begin the study period with 1.3 chronic diseases and end with 3.3 chronic diseases; and Hispanic respondents who begin the study period with 0.84 chronic diseases and end with 2.7 chronic diseases.

CONCLUSIONS: Middle-aged non-Hispanic black adults start at a higher level of chronic disease burden and develop multimorbidity at an earlier age, on average, than their non-Hispanic white counterparts. Hispanics, on the other hand, accumulate chronic disease at a faster rate relative to non-Hispanic white adults. Our findings have important implications for improving primary and secondary chronic disease prevention efforts among non-Hispanic black and Hispanic Americans to stave off greater multimorbidity-related health impacts.

}, keywords = {Chronic conditions, Comorbidity, Racial/ethnic differences}, issn = {1932-6203}, doi = {10.1371/journal.pone.0218462}, author = {Ana R Qui{\~n}ones and Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Jason T Newsom and David A Dorr and Heather G. Allore} } @article {10450, title = {TRACKING CHANGES IN MULTIMORBIDITY AMONG RACIALLY AND ETHNICALLY DIVERSE POPULATIONS}, journal = {Innovation in Aging}, volume = {3}, year = {2019}, pages = {S354-S354}, abstract = {Multimorbidity is widely recognized as having adverse effects on health and wellbeing above and beyond the risk attributable to individual chronic disease. Much of what is known about multimorbidity rests on research that has largely focused on one point-in-time, or from a static perspective, with little consideration to issues involved in assessing longitudinal changes in multimorbidity. In addition, less focus has been placed on assessing racial and ethnic variations in longitudinal changes of multimorbidity. Addressing this knowledge gap, we highlight important issues and considerations in addressing multimorbidity research from a longitudinal perspective and present findings from longitudinal models that examine differences in the rate of chronic disease accumulation and multimorbidity onset between non-Hispanic white (white), non-Hispanic black (black), and Hispanic study participants in the Health and Retirement Study starting in middle-age and followed for up to 16 years.}, keywords = {multimorbidity, race-ethnicity, Racial and ethnic differences}, isbn = {2399-5300}, doi = {10.1093/geroni/igz038.1285}, author = {Ana R Qui{\~n}ones and Anda Botoseneanu and Markwardt, Sheila and Corey L Nagel and Jason T Newsom and David A Dorr and Heather G. Allore} } @article {9932, title = {Using Skype to Beat the Blues: Longitudinal Data from a National Representative Sample.}, journal = {American Journal of Geriatric Psychiatry}, volume = {27}, year = {2019}, pages = {254-262}, abstract = {

OBJECTIVES: This study aimed to determine whether use of certain types of online communication technology is associated with subsequent depressive symptoms.

DESIGN: Nationally representative, population-based prospective cohort.

SETTING: Data were obtained from the 2012 and 2014 waves of the Health and Retirement Study (HRS).

PARTICIPANTS: 1,424 community-residing older adults (mean age, 64.8) in the United States.

MEASUREMENTS: We examined associations between use of four communication technologies (email, social networks, video chat, and instant messaging) in 2012 and depressive symptoms (eight-item Center for Epidemiologic Studies Depression scale) at two-year follow-up.

RESULTS: 564 participants (39.6\%) did not use any communication technologies, 314 (22.1\%) used email only, and 255 (17.9\%) used video chat (e.g., Skype). Compared to non-users (13.1\%, 95\% CI: 9.5-16.7\%) or those who used only email (14.3\%, 95\% CI: 10.1-18.5\%), users of video chat had approximately half the probability of depressive symptoms (6.9\%, 95\% CI: 3.5-10.3\%, Wald Chi test, Chi=13.82, p < 0.001; 7.6\%, 95\% CI: 3.6-11.6, Wald Chi test, Chi=13.56, p < 0.001). Use of email, social media, and instant messaging were not associated with a lower risk of depression.

CONCLUSIONS: Older adults who use video chat such as Skype, but not other common communication technologies, have a lower risk of developing depression.

}, keywords = {Depressive symptoms, Social Support, Technology}, issn = {1545-7214}, doi = {10.1016/j.jagp.2018.10.014}, author = {Alan R Teo and Markwardt, Sheila and Hinton, Ladson} } @article {8409, title = {Multimorbidity Combinations and Disability in Older Adults}, journal = {The Journals of Gerontology Series A: Biological Sciences and Medical Sciences}, volume = {71}, year = {2016}, pages = {823-830}, publisher = {71}, abstract = {Background: Multimorbidity (multiple co-occurring chronic diseases) is associated with greater likelihood of disability and mortality, above and beyond the risk attributable to individual diseases. This study identifies prevalent multimorbidity patterns and evaluates their association with disability among U.S. older adults.Methods: Prospective cohort study using longitudinal Health and Retirement Study data (2010 2012). We included 8,782 participants aged 65 years and older and used negative binomial models to examine prospective disability, measured by the combined activities of daily living instrumental activities of daily living index. Multimorbidity was defined as the co-occurring combination of at least two of the following chronic diseases: hypertension, cardiovascular disease, lung disease, diabetes, cancer, arthritis, stroke, cognitive impairment, or high depressive symptoms (CES-D score 4).Results: We found 291 unique disease combinations with 1 to 1,167 older adults per disease combination. The three most prevalent combinations were: (a) hypertension and arthritis (n = 1,167); (b) hypertension, arthritis, and cardiovascular disease (n = 510); and (c) hypertension, arthritis, and diabetes (n = 430). Only one of the prevalent combinations included depressive symptoms (in combination with arthritis, hypertension; n = 129). This group showed the highest level of activities of daily living instrumental activities of daily living disability compared to healthy participants or participants with a single disease (either included in the combination or different from diseases in the combination) even after adjusting for age, gender, education, race/ethnicity, and body mass index.Conclusions: Clinicians stand to gain from a better understanding of which disease combinations are more and less disabling among older adults. Understanding how multimorbidity combinations relate to functional status is an important step towards reducing disability and sustaining independent living among older adults.}, keywords = {Disabilities, Health Conditions and Status}, doi = {10.1093/gerona/glw035}, url = {http://biomedgerontology.oxfordjournals.org/content/71/6/823.abstract}, author = {A. R. Quinones and Markwardt, Sheila and Anda Botoseneanu} }