You are here

  • Home
  • Archive
  • Volume 8, Issue 7
  • Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study

Article Text

Article menu

Download PDFPDF

XML
General practice / Family practice
Research
Functional decline and associated factors in patients with multimorbidity at 8 months of follow-up in primary care: the functionality in pluripathological patients (FUNCIPLUR) longitudinal descriptive study
  1. Iñaki Martín Lesende1,
  2. Luis Ignacio Mendibil Crespo2,
  3. Sonia Castaño Manzanares3,
  4. Anne-Sophie Denise Otter3,
  5. Irati Garaizar Bilbao4,
  6. Jakobe Pisón Rodríguez3,
  7. Ion Negrete Pérez5,
  8. Iraide Sarduy Azcoaga6,
  9. María Jesús de la Rua Fernández7
  1. 1 San Ignacio Health Centre, Bilbao-Basurto Integrated Healthcare Organisation (IHO), Basque Health Service (Osakidetza), Bilbao, Spain
  2. 2 Bizkaia Unit for Multiprofessional Training in Family and Community Care, Basque Health Service, Bilbao, Spain
  3. 3 Bilbao-Basurto IHO, Osakidetza, Bilbao, Spain
  4. 4 Emergency Department, Urduliz Hospital, Osakidetza, Urduliz, Spain
  5. 5 Emergency Department, Basurto University Hospital, Bilbao-Basurto IHO, Osakidetza, Bilbao, Spain
  6. 6 Internal Medicine Department, Santa Marina Hospital, Osakidetza, Bilbao, Spain
  7. 7 Internal Medicine Department, Basurto University Hospital, Bilbao-Basurto IHO, Osakidetza, Bilbao, Spain
  1. Correspondence to Dr Iñaki Martín Lesende; INAKI.MARTINLESENDE{at}osakidetza.eus

Abstract

Objective To analyse short-term functional decline and associated factors in over 65-year-olds with multimorbidity.

Design and setting Prospective multicentre study conducted in three primary care centres, over an 8-month period. During this period, we also analysed admissions to two referral hospitals.

Participants Of the 241 patients ≥65 years included randomly in the study, 155 were already part of a multimorbidity programme (stratified by ‘Adjusted Clinical Groups’) and 86 were newly included (patients who met Ollero’s criteria and with ≥1 hospital admission the previous year). Patients who were institutionalised, unable to complete follow-up or receiving dialysis were excluded.

Outcomes and variables The primary outcome was the decrease in functional status category (Barthel Index or Lawton Scale). Other variables considered were sociodemographic characteristics, comorbidity, medications, number of admissions and functional status on discharge.

Results Patients had a median age of 82 years (P75 86) and of five selected chronic conditions (IQR 4–6), and took 11 (IQR 9–14) regular medications; 46.9% were women; 38.2% had impaired function at baseline.

Overall, 200 persons completed the follow-up; 10.4% (n=25) of the initial sample died within the 8 months. In 20.5% (95% CI 15.5% to 26.6%) of them we recorded a decrease in functionality, associated with older age (OR 1.1, 95% CI 1.0 to 1.2) and with having ≥1 admission during the follow-up (OR 3.6, 95% CI 1.6 to 7.7). There were 133 hospital admissions in total during the follow-up considering all the patients included, and a functional decline was observed in 35.5% (95% CI 25.7% to 46.7%) of the 76 discharges in which functional status was assessed.

Conclusions A fifth of patients showed functional decline or loss of independence in just 8 months. These findings are important as functional decline and the increasing care needs are potentially predictable and modifiable. Age and hospitalisation were closely associated with this decline

  • comorbidity
  • activities of daily living
  • primary care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-022377

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Contributors All authors have been involved from the beginning in all phases of the study with varying intensity according to the study’s successive needs. IML, as the principal investigator (PI), participated in all aspects of the project, coordinating the different stages of the study too. IML and LIMC have had a transcendental role in the methodological and analytical aspects. SCM, ASDO, IGB, JPR and INP have made the clinical assessments of most patients and managed their clinical data. ISA and MJRF made the clinical assessments of most patients at hospital discharge. All authors have read and approved the final version of this manuscript.

    • Funding This work was supported by a Bilbao-Basurto IHO grant (OSIBB17/002).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Clinical Research Ethics Committee of Euskadi (PI2016082, 24 June 2016).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Being the first article of the FUNCIPLUR study, there are no additional data available directly by now. However, we are willing to complete or give more information or data to other authors who require it.