Entete 3

Multimorbidity and functional decline: a systematic review



By Áine Ryan, Emma Wallace, Paul O’Hara, Susan M. Smith

Multimorbidity is recognised internationally as having a negative impact on patient outcomes. Functional decline is defined as developing difficulties with activities of daily living and is also independently associated with poorer health outcomes. We recently published a systematic review examining the association between multimorbidity and functional decline. We also examined the extent to which multimorbidity predicts future functional decline [1].
The review retrieved 37 relevant studies (nine cohort and 28 cross-sectional).The majority of studies (n= 31) demonstrated a consistent association between multimorbidity and poorer functional status. Future functional decline was more likely with increasing numbers of conditions and was also linked to condition severity.
We can be reasonably confident of the findings of this systematic review; as overall, there was minimal risk of bias in the included studies. However, variation in study participants, multimorbidity definitions, follow-up duration and outcome measures resulted in meta-analysis not being possible.
The findings of this systematic review are consistent with existing evidence linking multimorbidity and poorer health related quality of life. It also highlights a potential cumulative effect, in that both multimorbidity and functional decline independently predict poorer patient outcomes. This review examines one direction of effect, i.e. that baseline multimorbidity predicts future functional decline. Conversely, it is also possible that poor physical functioning will lead to worsening of multimorbidity, a relationship that our study group plans to examine in an ongoing prospective cohort study in Ireland [2].
This review suggests that functional decline needs to be carefully considered in patients with multimorbidity. Future research should focus on the development and testing of interventions which prioritise physical function in this patient group, particularly for patients with higher numbers of conditions and greater disease severity.

The complete article can be accessed at:
http://hqlo.biomedcentral.com/articles/10.1186/s12955-015-0355-9

References
[1] Ryan A, Wallace E, O’Hara P, Smith SM. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health and Quality of Life Outcomes. DOI: 10.1186/s12955-015-0355-9.
[2] The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland. www.tilda.ie

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