| Objective Under the background of population aging,the health problems of the elderly are more prominent.Aging is not only reflected in the number of diseases increasing,but also in the degradation of body organ function and cognitive decline.Multimorbidity can lead to a variety of adverse health outcomes.Foreign studies on multimorbidity have been carried out earlier and more,while related domestic studies are immature.Therefore,this article aims to conducte a research on multimorbidity,cognition and physical function in the elderly population in China.The specific goals are to:(1)understand current status of multimorbidity,mining associations and strengths between chronic diseases;(2)explore the impacts of multimorbidity on cognitive decline and physical functional limitations,and the combined effects of multimorbidity and cognitive decline on physical functional limitations;(3)assess the impact of multimorbidity,cognitive decline,and physical limitation on the risk of death in the elderly;(4)based on the results of the above research,using the relevant theories of health management,establish a health management model for comorbid elderly people to provide targeted prevention and control strategies for improving the health status of comorbid and disabled elderly people.Methods Firstly,this study described the current status of multimorbidity in the elderly in China.Use association rule methods to explore the association and intensity of multimorbidity,and use association rules to explore the patterns of multimorbidity.Secondly,this study analyzed the distribution characteristics of multimorbidity,cognitive dysfunction and physical limitations in the elderly,used Logistic regression to assess the association of multimorbidity with cognitive dysfunction and physical limitations,then analyzed the interaction between multimorbidity and cognitive dysfunction on functional limitations.Third,the COX proportional hazard regression model was used to analyze the impact of multimorbidity,cognitive dysfunction,and physical limitation on the risk of death in the elderly.Finally,health management theory and system science theory are used to establish a health management model for the elderly with multimorbidity,and prevention and control strategies are proposed.Results Among 18,129 respondents,the number of multimorbidity patients was5276(29.10%).The most three common multimorbidity patterns are heart disease and hypertension,cerebrovascular disease and hypertension,cataracts and arthritis.The rule support are 5.38%、3.70% and 3.61%,the rule confidence is 48.87%,47.72%,28.91%.Association rule results point to hypertension,arthritis,and heart disease.There were significant difference in multimorbidity patterns among different ages,genders,and different places of residence.Risk factors for multimorbidity include non-literacy,poor economic status,past smoking,past drinking,past and present exercise,irregular physical activity,overweight and obesity.After adjusting the related confounding factors for 15899 people in 2008,patients with multimorbidity have a 16% increased risk of cognitive impairment compared with non-commonly disease.Compared those without chronic diseases,suffering from 1,2 and above 3 with chronic diseases,the risk of cognitive impairment of increased by 10%,21%,and 20%,respectively.There was a positive correlation between multimorbidity and physical limitations,the risk of functional limitation increased with the number of chronic diseases.Compared with the elderly without chronic diseases,elderly people with 1,2,and 3 or more chronic diseases,The risks of multiple functional limitations(MFLs)are 1.33,1.90,and 3.52 times,respectively,and the activities of daily living(ADL)are 1.43,2.08,and 3.59 times,and the instrumental activities of daily living(IADL)are 1.33,1.92,and 3.94 times,respectively.The risk of MFLs was 11.23 times that of the elderly who had both multimorbidity and cognitive dysfunction,and the risk was higher than that of senile multimorbidity(OR = 2.37)or cognitive impairment(OR = 5.46)people.The 2008-2014 follow-up data showed that after adjusting for confounding factors,the risk of death in the multimorbidity group was 1.08 times that in the non-multimorbidity group(HR=1.08,95% CI: 1.02-1.14,P <0.001).After adjusting cognitive and physical functions,the risk of multimorbidity and death was non-meaningful.The association was not statistically significant;after adjusting for confounding factors,the risk of death from cognitive impairment was 1.45 times that of the non-cognitive impairment group(HR=1.45,95% CI: 1.38-1.53,P <0.001).Adjusting for multimorbidity and physical function,cognitive impairment was stillassociated with a high risk of death(HR=1.26,95% CI: 1.19-1.34,P <0.001);physical dysfunction also had a significant impact on the risk of death.And the death risk of elderly people with MFLs,ADL,and IADL disorders was increased by 71%,68%,and 78%,respectively,compared to those without disabilities.Conclusions The prevalence of multimorbidity is high.The results of association rules point to hypertension,arthritis,and heart disease.There are differences in multimorbidity models of different ages,genders,residence.Multimorbidity is an influencing factor of cognitive dysfunction and physical limitation in the elderly,and the risk gradually increases with the increase in the number of diseases;multimorbidity and cognitive dysfunction have a strong additive interaction with limited physical function effect.Multimorbidity,cognitive dysfunction,and limited physical function all increase the death risk of the elderly.But after adjusting for confounding factors,the risk of multimorbidity is meaningless.A health management model for multimorbidity elderly should be established,from the perspective of lifestyle management and disease management to prevent the development of diseases to cognitive and physical disorders,to maximize the overall health of the elderly and reduce the risk of death. |
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