A new tool “scores” patients with multiple chronic conditions. Those with higher multimorbidity scores have faster memory loss, a higher suicide risk, and a higher overall risk of death, researchers report.
Assessing the effect of chronic disease on a person’s health is important because 45 percent of all adults have more than one condition—and that figure jumps to 80 percent after age 65, says researcher Melissa Wei, a primary care physician at Michigan Medicine, who led development of the new scoring system, called the multimorbidity-weighted index, or MWI.
“Multimorbidity scores” can help doctors understand a patient’s overall prognosis—and can help identify special risks that people with multiple chronic illnesses face, researchers say.
As reported in The Journals of Gerontology: Series A, people with higher scores had a much faster decline in thinking and memory abilities than those with lower scores, even though most of the chronic conditions included in the index had no direct relationship with brain health. The higher a person’s score, the faster their ability to recall words and do simple math declined over a 14-year period.
Researchers used data from more than 14,265 people studied multiple times over a decade or more through the University of Michigan Health and Retirement Study.
The index previously revealed that people with higher scores were more than twice as likely to commit suicide than those with lower scores, and that they suffered from poorer overall mental health, researchers say.
Researchers calculated the multimorbidity index for participants in three long-term studies of more than 250,000 health professionals including dentists, podiatrists, chiropractors, and nurses to come to those findings, which appear in the Journal of the American Geriatrics Society.
Wei compiled and tested a way to assess what life is like for people with multiple chronic conditions, such as glaucoma, heart arrhythmias, multiple sclerosis, or histories of knee, hip, and spinal disk problems. But it’s not as simple as counting the number of diseases and conditions a person has been diagnosed with, the researchers caution.
Rather, the risk of cognitive decline, suicide, or poor mental well being has to do with the total impact of a person’s unique combination of conditions on quality of life. Because different conditions affect people in different ways, the scoring system takes into account how that happens—and how those effects might interact with one another.
Early this year, Wei and colleagues published a study showing that the risk of dying rose 8 percent for every single-point rise in MWI score, and that the rise in score tracked closely with the decrease in physical abilities of people with multiple conditions.
That study, also in The Journals of Gerontology: Series A, also used Health and Retirement Study data, from 18,174 people ages 51 and older who took part in the study over 11 years.
Begin the conversation
Wei and colleagues say they hope that clinicians can use the index to help understand the needs and manage the care of patients with multiple conditions. They have made the tool free and available at the ePrognosis website that the University of California, San Francisco runs.
Any clinician can enter a few pieces of anonymous information about patients over age 54 into the calculator and come up with a score and a breakdown of how likely people with similar numbers are to die within the next 10 years or to experience a decline in their physical functioning in the next four to eight years.
Clinicians shouldn’t use the score as the sole indicator of a patient’s prognosis, Wei says, but to help guide discussions about a range of decisions, including preventive care, elective surgery, living arrangements, and end-of-life care preferences.
The research that Wei and colleagues have done on the impact of high MWI scores across groups of patients could also help guide care, she says. For instance, the finding that suicide risk rose sharply as MWI score rose could help clinicians think about which patients might be most in need of depression and suicide screening.
Mental health monitoring
As patients develop more conditions with age, physicians may want to monitor their mental health more closely and offer appropriate lifestyle advice and treatment.
“As clinicians, we are more likely to assess suicide risk in people with known depression or other mental health or substance use issues, but we may not automatically consider that those with more physical conditions only could also be at higher risk,” Wei says.
“Multimorbidity has several downstream consequences. Physical impairments are just the beginning. As conditions accumulate and physical functioning deteriorates, we have found this is closely linked to worse mental health, social health and eventually premature mortality.”
In short, Wei says, “the association between the MWI score with suicide risk and overall mental well being warrants attention.”
Your ‘real’ age
Having a high MWI score, she says, makes someone functionally older than their calendar or “chronologic age” would suggest.
Clinicians can use the score to help them think about the “biologic age” of a patient based on the life span expectations for people with similar scores.
Using scores clinically could also help providers ensure that patients with high scores receive care management services or other support to help them live their best lives and keep on top of the tests, treatments, and lifestyle changes that can help them do so.
“We want patients to have good insight into how the conditions they’ve developed over the years are affecting their well being and be open to communicating with their care teams about how those conditions affect their functioning, quality of life, and overall health now and in the future,” Wei says.
“We also know that social support and having a strong purpose in life can protect against some of the detrimental effects of multiple conditions,” she says. “We need to help patients understand these connections, foster their development early on, and sustain them through each stage of life and changes in health.”
The National Institute on Aging of the National Institutes of Health funded the work.
Source: University of Michigan