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Authors KAtherine Coatta & A ndrew Wister

Towards a Research Agenda on Living Well with Multiple Chronic Conditions:  A Resilience Model and Multi-level Profile. Authors KAtherine Coatta & A ndrew Wister Department of Gerontology, Simon Fraser University Vancouver Campus, Canada.

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Authors KAtherine Coatta & A ndrew Wister

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  1. Towards a Research Agenda on Living Well with Multiple Chronic Conditions: A Resilience Model and Multi-level Profile AuthorsKAtherineCoatta & Andrew Wister Department of Gerontology, Simon Fraser University Vancouver Campus, Canada

  2. Age Pyramids of the Canadian Population, 2009 & 2036

  3. Purpose • Cross-cultural and generational comparative analysis of multiple chronic illness patterns • Demographic, health and social profile • “The Canadian Case” • Identify areas for multivariate analyses

  4. Background • Attention devoted to multiple chronic illnesses (multiple morbidity), given potential synergistic effects, population aging & health care discourse • Research is still in infancy • Multiple chronic conditions have been correlated with longer hospital stays, increased use of health care resources, and decreased productivity • The ‘well-being paradox’ (Windle, Woods & Markland, 2010) - life satisfaction maintained in the face of poor health • Has led to ‘living well’ with multiple chronic illnesses

  5. Defining Multiple Morbidity • 1) Simple dichotomies: 0 vs. 1+ Illnesses; OR 0,1 vs. 2+ • 2) Additive Scales (counts of illnesses) • 3) Weighted based on HRQL or diagnostic criteria (onset, severity) • 4) Comorbidity (index disease) • 5) Combinations of selected illnesses • 90% of older adults have 1+ chronic illness; 70% have 2+ (2008/09 Canadian Community Health Survey CCHS) • [asthma, arthritis, osteoporosis, back problems, blood pressure, migraine headaches, bronchitis, emphysema, COPD, diabetes, heart disease, cancer, ulcers, stroke, urinary incontinence, bowel disorder, cataracts, glaucoma and thyroid problems]

  6. Theoretical Frame for Living Well with Multiple Chronic Illnesses • Adaptation (Homeostasis; Person-environment) • Connections among individuals, community & health policies (Socio-ecological theory, e.g. Stokols, 1991) • Behavioural change and action (TOPB, Social learning, Transtheoretical model, etc.) • Interconnectedness of hardiness and resources at individual, community & policy spheres (Resilience Theory) • Population health and health care interface (Chronic Care Models)

  7. Methods • Analyses of the CCHS 4.2 Healthy Aging 2008/09 • 45+ (N = 30, 639) • Weighted to Canadian population and rescaled to limit overpowering analyses • Chronic illness additive measure (selected 8 illnesses common across CCHS and Australian HILDA survey) • Age Groups: 45-64; 65-74; 75+ • Gender

  8. Prevalence of Chronic Illnesses

  9. Prevalence of Chronic Illnesses

  10. Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender

  11. Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses

  12. Odds Ratios for Age Differences in Mean # of Chronic Illnesses for Selected Outcomes * Numbers shown in columns are age group A (older)/ age group B (younger) odds ratios for number of chronic illnesses

  13. Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender

  14. Odds Ratios for Age Differences in Mean # of Chronic Illnesses for Selected Outcomes

  15. Mean Numberof Chronic Illnesses by Selected Variables, Age Group and Gender SELF PERCEIVED HEALTH HOSPITAL ADMITTANCE

  16. Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes SELF RATED HEALTH HOSPITAL ADMITTANCE * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses

  17. Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender COUNTRY OF BIRTH VISIBLEMINORITYSTATUS

  18. Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes COUNTRY OF BIRTH VISIBLE MINORITY STATUS * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses

  19. Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender MOBILITY PERSONAL CARE ASSISTANCE

  20. Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes MOBILITY PERSONAL CARE * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses

  21. Odds Ratios for Age Differences in Mean # of Chronic Illnesses for Selected Outcomes MOBILITY PERSONAL CARE

  22. Mean Number of Chronic Illnesses by Selected Variables, Age Group and Gender

  23. Odds Ratios for Gender Differences in Mean # of Chronic Illnesses for Selected Outcomes FORMAL INFORMAL * Numbers shown in columns are female/male odds ratios for the mean number of chronic illnesses

  24. Correlations between Chronic Illnesses Scale and Selected Outcomes by Age Group and Gender

  25. Odds Ratios for Age Differences by Correlation Coefficients of Chronic Illness Scale and Selected Variables

  26. Correlations between Chronic Illnesses Scale and MOS Sub-scales Age Group and Gender

  27. Summary • Age effect on chronic illness prevalence • Gender differences depend on specific illness Analysis of Multiple Chronic Illness Patterns: • Gender difference in multiple morbidity within marital status is largest for widowed boomers (female/male OR= 1.3) • The 75+/boomer age difference is large for males in all marital categories; but only for married females • Education effect on chronic illness is largest for boomers (45-64), declines with age • Gender difference in self-rated health & hospital admittance is largest for boomers

  28. Summary – Con’t • Significantly higher gender difference in multiple morbidity for visible minority boomers • Large gender difference in multiple morbidity and personal care association for those aged 75+ • Strong correlations between multiple morbidity and medication use (r=.45 to .55); slightly higher for boomers than seniors • Gender difference in chronic illness and formal and informal care is highest for boomers, smallest for seniors • Small (r=-.15 to -.25) correlations between multiple morbidity and life satisfaction, but boomers and young-old are most likely to be negatively affected • Correlations between multiple morbidity and social support dimensions are very low

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