Search

To examine the association between the baseline number of chronic diseases and multimorbidity with regard to the incidence of all and injurious falls over 3 years among European community-dwelling older adults. Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial. Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status. The main outcomes were the number of all falls and injurious falls experienced over 3 years. The number of chronic diseases and multimorbidity, defined as the presence of 3 or more chronic diseases at baseline, were assessed with the Self-Administered Comorbidity Questionnaire by Sangha et al. Among the 2155 participants included in the analyses (mean age: 74.9 years, 62% were women, 52% were physically active more than 3 times a week), 569 (26.4%) had multimorbidity at baseline. Overall, each 1-unit increase in the baseline number of chronic diseases was linearly associated with a 7% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) 1.07, 95% CI 1.03-1.12, P <.001] and a 6% increased incidence rate of injurious falls (aIRR 1.06, 95% CI 1.02-1.11, P =.003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (aIRR 1.21, 95% CI 1.07-1.37, P =.002) and a 17% increased incidence rate of injurious falls (aIRR 1.17, 95% CI 1.03-1.32, P =.02). Baseline number of prevalent chronic diseases and multimorbidity in generally healthy and active community-dwelling older adults were associated with increased incidence rates of all and injurious falls over 3 years. These findings support that multimorbidity may need consideration as a risk factor for falls, even in generally healthy and active older adults. [ABSTRACT FROM AUTHOR]

We examine changes in the level of physical health using longitudinal data on people aged 50+ from nine European countries covering the years from 2004 to 2017. For this purpose we develop a novel approach to identify age, period and cohort effects, which, in contrast to methods relying on mechanical restrictions, uses a step-wise estimation combining information on physical health with data on cognitive abilities. The approach relies on two important assumptions. First, we estimate relative differences between cohorts in cognitive abilities assuming that only age and cohort effects are responsible for their evolution. We then use the estimated proportional cohort differences to restrict the differences between cohorts in health development. The method is applied to the dynamics of four measures of poor health: weak grip strength, limitations in mobility, in activities of daily living (ADL) and in instrumental activities of daily living (IADL). Our results suggest insignificant or adverse period effects for the evolution of physical health. For example, the difference in likelihood of poor health as measured through weak grip strength between 2004 and 2017 is 2.1 percentage points, p.p., (95% CI -4.3, 8.4), and the corresponding numbers for the other three measures are respectively: 2.0 p.p. (CI -1.6, 5.6); 2.2 p.p. (CI -0.2, 4.7) and 3.0 p.p. (CI 0.3, 5.8). These estimates, which reflect the implications of time over the period of 14 years, are relatively low, but they highlight the surprising fact that any improvements in health in the examined period have been driven essentially by cohort effects. Our evidence is consistent with some earlier studies and sheds new light on recent (pre-pandemic) trends in life expectancy. It also raises questions concerning efficacy of healthcare and equal access to high quality care – the factors one would consider as important determinants of period effects in health. • We propose a step-wise approach to identify age-period-cohort effects in health. • Data on dynamics of cognitive abilities is used in the identification process. • We find insignificant or negative effects of time for health development in Europe. • Results may be a signal reflecting required policy changes in European healthcare. [ABSTRACT FROM AUTHOR]