Tipping Points – Do the Prognostic Values of Multimorbidity and Functional Status Vary with Age?

• Main Authors: Thygesen LC, Christensen K, Rørth M, Sørensen HT, Vandenbroucke JP, Westendorp RGJ
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-09-01
• Series: Clinical Epidemiology
• Subjects: chronic disease; health services; public health; aged; multimorbidity
• Online Access: https://www.dovepress.com/tipping-points--do-the-prognostic-values-of-multimorbidity-and-functio-peer-reviewed-fulltext-article-CLEP

Lau Caspar Thygesen,1 Kaare Christensen,2 Mikael Rørth,3,4 Henrik Toft Sørensen,3,4 Jan P Vandenbroucke,3,5,6 Rudi GJ Westendorp7 1National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; 2The Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark; 3Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark; 4Aarhus University Hospital, Aarhus, Denmark; 5Department of Medical Statistics and Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK; 6Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands; 7Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, DenmarkCorrespondence: Lau Caspar ThygesenNational Institute of Public Health, University of Southern Denmark, Studiestræde 6, Copenhagen, DK-1455, DenmarkTel [phone]Email [e-mail]: Aging of the population is a pressing challenge for healthcare systems and knowledge of a patient’s prognosis is a key to shaping effective interventions. As the prevalence of multimorbidity strongly increases with age, the prognostic value of multiple disease diagnoses for survival among older people may diminish, whereas other measures of health, such as functional status (defined as a measure of an individual’s ability to perform activities of daily living), may become more important. In this commentary, the impact of age on the prognostic value of multimorbidity is discussed, with the aim of identifying relevant alternative risk indicators for different age groups. The key question is to determine at what age the prognostic value of multimorbidity for meaningful clinical outcomes decreases and is overridden by the prognostic value of functional status. This tipping point likely depends on age, calendar time, and birth cohort. The public health and clinical implications of these tipping points are important. Among younger and middle-aged persons, interventions could be directed towards prevention and treatment of specific diseases, while among older persons efforts should focus more on improving functional levels that include physical, emotional, and social dimensions.Keywords: chronic disease, health services, public health, aged, multimorbidity