Elderly/Long-Term Care

To capture the burden of multiple diseases on seniors, self-report should be added to data-based measures

Self-reports of seniors suffering from three or more diseases (comorbidity) provide a better picture of their disease burden than quantitative measures that simply calculate the number and severity of their conditions, concludes a new study. In this study, Elizabeth A. Bayliss, of Kaiser Permanente and the University of Colorado at Denver, and colleagues surveyed by telephone 352 elderly HMO members diagnosed with, at a minimum, diabetes, depression, and osteoarthritis. The survey asked them to rate each condition on a 5-point scale from 1 (doesn't interfere at all with daily activities) to 5 (interferes a lot). It also asked them about their confidence in managing their medical conditions and the burden of financial constraints imposed by them.

These conditions were chosen because they have potentially conflicting symptoms and treatment strategies, making them more complex for the patient to self-manage, note the researchers. They assessed self-reported disease burden based on biopsychosocial factors, demographic variables, and two data-based comorbidity indices (The QUAN index based on diagnostic codes in the medical record and the Chronic Disease Score based on pharmacy data). Survey respondents, who had an average of nine chronic diseases, also completed a depression screen and measure of health status and answered questions about potential barriers to their medical self-management. The measure of self-reported disease burden represented an amalgamation of functional capabilities, social considerations, and medical conditions not captured by the two administrative data-based measures of morbidity.

The researchers suggest that a simple count of diagnoses should be supplemented by an assessment of activity limitations imposed by these conditions. This approach is also well suited to studies of patient-centered outcomes such as quality of life.

The study was supported in part by the Agency for Healthcare Research and Quality (HS15476). More details are in "Seniors' self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures," by Dr. Bayliss, Jennifer L. Ellis, and John F. Steiner, in the May 2009 Journal of Clinical Epidemiology 62, pp. 550-557.

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