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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
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Age Pyramids of the Canadian Population, 2009 & 2036
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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
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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
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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]
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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)
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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
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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
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Prevalence of Chronic Illnesses
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Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender
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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
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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
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Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender
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Odds Ratios for Age Differences in Mean # of Chronic Illnesses for Selected Outcomes
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Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender SELF PERCEIVED HEALTHHOSPITAL ADMITTANCE
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Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes SELF RATED HEALTH * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses HOSPITAL ADMITTANCE
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Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender VISIBLE MINORITY STATUSCOUNTRY OF BIRTH
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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 COUNTRY OF BIRTHVISIBLE MINORITY STATUS
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Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender MOBILITYPERSONAL CARE ASSISTANCE
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Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes MOBILITY PERSONAL CARE * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses
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Odds Ratios for Age Differences in Mean # of Chronic Illnesses for Selected Outcomes MOBILITYPERSONAL CARE
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Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender
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Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes FORMAL INFORMAL * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses
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Correlations between Chronic Illnesses Scale and Selected Outcomes by Age Group and Gender
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Odds Ratios for Age Differences by Correlation Coefficients of Chronic Illness Scale and Selected Variables
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Correlations between Chronic Illnesses Scale and MOS Sub-scales Age Group and Gender
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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
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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
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