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Monthly Archives: November 2020

Role of clinical, functional and social factors in the association between multimorbidity and quality of life: Findings from the Survey of Health, Ageing and Retirement in Europe (SHARE)

By Tatjana T. Makovski (picture on the left), Gwenaëlle Le Coroller, Polina Putrik, Yun Hee Choi, Maurice P. Zeegers, Saverio Stranges, Maria Ruiz Castell, Laetitia Huiart, Marjan van den Akker (picture on the right)

Quality of life (QoL) is often mentioned among the main consequences of multimorbidity and it has been set as one of the core outcomes in multimorbidity research [1].

In exploring the association between multiple conditions and quality of life, researchers most often account for socio-economic factors [2], although it has been recognised a while ago that other aspects such as perceived social support [3] and limitation with activities of daily living [4] play a significant role in this relationship.

With the current study, we intended to underline the relevance of some of these factors, as well as to test other elements for significance. Factors of interest were: symptoms; indicators of treatment burden such as polypharmacy, unmet care needs and frequency of utilisation of care; size of social network, participation in social activities, personal and financial help, loneliness as a proxy for perceived social support [5]; and activities of daily living (ADL) with instrumental activities (IADL).

The study included individuals aged 50+ (n = 67 179) in 18 countries who participated in wave 6 of the population-based Survey of Health, Ageing and Retirement in Europe (SHARE). Wave 6 measured presence of 17+ conditions and applied the Control, Autonomy, Self-Realization and Pleasure (CASP-12v1) QoL questionnaire. We used 3-level random slope linear regression model to test for the association between number of diseases and QoL. The base model adjusted for socio-economic factors only, while factors of interest were subsequently added in the base model, one at the time. A change of ≥15% in the β-coefficient of the number of conditions compared to the β-coefficient in the base model indicated a relevant effect on the association.

Symptoms, loneliness, ADL/IADL and polypharmacy instigated a set change of the coefficient in the models individually. Adding all relevant factors together in the final model attenuated the strength of the association between number of diseases and QoL, as demonstrated with QoL slope of -2.44 [95% CI: -2.72; -2.16] in the base model and much lesser but still statistically significant decline of -0.76 [95%CI: -0.97; -0.55] in the final model.

The study confirmed that other factors beyond socio-economic circumstances explain the relationship between multimorbidity and QoL, and should be considered when further exploring this question. Maybe one of the most interesting contributions of the paper is including elements of the treatment burden as an adjustment factor in the analyses. Treatment burden is gaining increasingly on research interest. It is abundant in patients with multimorbidity and is likely to take its share in the association between multiple conditions and QoL.

The findings may be useful in supporting a comprehensive assessment of patient’s health status and needs during a personalised care planning.

SHARE countries also displayed interesting differences in the findings.

The article can be assessed at the following link:

  1. Smith SM, Wallace E, Salisbury C, Sasseville M, Bayliss E, Fortin M. A Core Outcome Set for Multimorbidity Research (COSmm). Ann Fam Med. 2018;16(2):132-138.
  2. Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: Systematic literature review and meta-analysis. Ageing Res Rev. 2019;53:100903.
  3. Fortin M, Bravo G, Hudon C, et al. Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res. 2006;15(1):83-91.
  4. Barile JP, Thompson WW, Zack MM, Krahn GL, Horner-Johnson W, Haffer SC. Activities of daily living, chronic medical conditions, and health-related quality of life in older adults. J Ambul Care Manage. 2012;35*(4):292-303.
  5. Bernardon S, Babb KA, Hakim-Larson J, Gragg M. Loneliness, attachment, and the perception and use of social support in university students. Can J Behav Sci. 2011;43(1):40-51.