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Health related quality of life and multimorbidity in community-dwelling

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Introduction
Multimorbidity is more common in the elderly population and negatively affects health-related quality of life (QoL). The aims of the study were to report the QoL of users of the Basque telecare public service (BTPS) and to establish its relationship with multimorbidity.

Methods
The EuroQol questionnaire was administered to 1125 users of the service. Their sociodemographic and healthcare characteristics were obtained from BTPS databases and the Basque healthcare service. Multiple regression analysis was performed on the overall questionnaire index to determine the effect of chronic diseases and sociodemographic. Moreover, the effects of the different diseases on specific dimensions of the test were explored by logistic regression.

Results
Of the users interviewed, 82% were women, 88% ≥75 years and 66% lived alone. The average of chronic pathologies was higher among men (5.3 vs. 4.6), for the lower age range and among those not living alone (P < 0.001).>< 0.001).

Conclusions
This study reveals that for the population covered by BTPS the impact of chronic pathologies, multimorbidity and their social context affects QoL very diversely. These diverse social and healthcare needs of community-dwelling elders allow the development and implementation of personalised services, such as telecare that facilitate them to remain at home.

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Health related quality of life and multimorbidity in community-dwelling

  1. 1. Original Article Health-related quality of life and multimorbidity in community-dwelling telecare-assisted elders in the Basque Country Edurne Alonso-Morán a, ⁎, Roberto Nuño-Solinís a , Juan F. Orueta b , Begoña Fernandez-Ruanova c , Alfredo Alday-Jurado c , Enrique Gutiérrez-Fraile c a O+berri, Basque Institute for Healthcare Innovation, Torre del BEC (Bilbao Exhibition Centre), Ronda de Azkue 1, 48902 Barakaldo, Spain b Osakidetza, Basque Health Service, Astrabudua Health Centre, Mezo 35, 48950 Erandio, Spain c Osatek S.A., Public Society of the Basque Government, Alameda de Urquijo 36, Edificio Plaza de Bizkaia, 48011 Bilbao, Spain a b s t r a c ta r t i c l e i n f o Available online xxxx Keywords: Chronic diseases Health-related quality of life Multimorbidity Telecare Introduction: Multimorbidity is more common in the elderly population and negatively affects health-related quality of life (QoL). The aims of the study were to report the QoL of users of the Basque telecare public service (BTPS) and to establish its relationship with multimorbidity. Methods: The EuroQol questionnaire was administered to 1125 users of the service. Their sociodemographic and healthcare characteristics were obtained from BTPS databases and the Basque healthcare service. Multiple regression analysis was performed on the overall questionnaire index to determine the effect of chronic diseases and sociodemographic. Moreover, the effects of the different diseases on specific dimensions of the test were explored by logistic regression. Results: Of the users interviewed, 82% were women, 88% ≥75 years and 66% lived alone. The average of chronic pathologies was higher among men (5.3 vs. 4.6), for the lower age range and among those not living alone (P b 0.001). For QoL, men and people aged over 84 obtained better scores (0.64 and 0.61, respectively). Worse QoL was associated with being a woman, multimorbidity, and living with one or more people. The existence of multimorbidity meant impaired QoL of 2.6 points for each additional disease over the overall score (P b 0.001). Conclusions: This study reveals that for the population covered by BTPS the impact of chronic pathologies, multimorbidity and their social context affects QoL very diversely. These diverse social and healthcare needs of community-dwelling elders allow the development and implementation of personalised services, such as telecare that facilitate them to remain at home. © 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. 1. Introduction As the main causes of morbidity and mortality in elderly societies are chronic diseases, there is a growing interest in cost-effective ways of caring for this population. Moreover, multimorbidity is turning into an increasingly more common reality and is especially frequent in some groups such as women, elderly people and those bearing more unfavourable socio-economic conditions [1–3]. Some consequences of morbidity are already known: they are asso- ciated with worse healthcare outcomes in people, a high degree of disability, functional impairment and worse quality of life [2,4,5]. In addition, it has been broadly demonstrated that multimorbidity has a negative impact on healthcare-related quality of life (HRQoL) [2,6]. However, understanding the effects of multimorbidity in detail is not an easy task. Individual chronic conditions may vary in regard to their impact on patients' daily quality of life and their function [7,8]. HRQoL offers a multidimensional perspective ranging from patients' physical, emotional and social function [9]. In general, patients with more than one comorbid condition report a poorer score HRQoL [10], but some chronic diseases are more significantly associated with a worse HRQoL score than others. The severity of individual chronic con- ditions is also a factor that has an impact on this quality [10]. Moreover, it has a significant financial impact; therefore, for exam- ple 64% of the annual healthcare budget in the Basque Country is earmarked for caring for people with multimorbidity; this represents 24% of the total population [11]. These figures are compatible to those published by the public insurance system Medicare for those aged over 65 in the USA [12]. Being familiar with the sociodemographic and healthcare character- istics, in addition to their impact on quality of life variables is useful to provide personalised care, especially when technology is involved. The telecare service is increasingly popular for the provision of services to elderly populations in the OECD. In the Basque Country, the Basque government telecare public service (hereinafter BTPS) provides domiciliary care to dependent and other populations and is connected European Journal of Internal Medicine xxx (2015) xxx–xxx ⁎ Corresponding author. Tel.: +34 650718526. E-mail address: edurne.almo@gmail.com (E. Alonso-Morán). EJINME-02879; No of Pages 7 http://dx.doi.org/10.1016/j.ejim.2015.02.013 0953-6205/© 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved. Contents lists available at ScienceDirect European Journal of Internal Medicine journal homepage: www.elsevier.com/locate/ejim Please cite this article as: Alonso-Morán E, et al, Health-related quality of life and multimorbidity in community-dwelling telecare-assisted elders in the Basque Country, Eur J Intern Med (2015), http://dx.doi.org/10.1016/j.ejim.2015.02.013
  2. 2. in a coordinated manner with healthcare devices which enables the development of integrated social and healthcare provision models. One of the main aims of BTPS is to encourage users to remain in their usual social setting. The main aim of this study was to analyse the influence of demo- graphics', chronic healthcare problems, social characteristics and multimorbidity on quality of life, recorded by means of the EuroQol questionnaire, for users of a telecare service. The second aim was to determine the relative impact of a predetermined number of “chronic conditions” on the specific dimensions of HRQoL in the same group. 2. Materials and methods 2.1. Ethics committee The study protocol was approved by Euskadi Clinical Research Ethics Committee (PI2014106). The teleoperators of BTPS's own service requested the user's informed consent prior to administration of the questionnaire. 2.2. Study population: sample and procedures In the Basque Country, the inhabitants over 65 years in 2012 were 452,698 (20.0% of the total population) and 145,780 (8.2%) over 80 years [13]. At 1 September 2012, the Basque government telecare public service responding to requests from 25,757 individual users (79.55% women). The BTPS is the result of cooperation between the Department of Health and Department of Social Services. This service is part of a com- prehensive care model focused on the person, whose fundamental aspect is to address the social and health needs of people in a coordinat- ed manner, both in preventive and in care aspect. Its connection with health care devices allows having information of systems which share data on health and social issues. This makes possible a characterization of the target population and the development of integrated health and social care provision models. The socio-health coordination has been turned into the adoption of various measures and it addresses objec- tives and actions for active ageing, coordination of socio-health space, adequate health care for the elderly, promotion of autonomy and respect for personal wills, the new technologies for quality of life, wel- fare, promotion of volunteering, and personal and intergenerational relationships. The inclusion criterion in BTPS is one of the following characteristics: a) persons aged over 75 who live alone, b) persons older than 65 who are in a situation of recognised dependence or vulnerability recognised by social services, c) persons with intellectual, physical or sensorial disability and any degree of recognised dependence and d) persons who suffer from diagnosed mental disease and present a situation of recognised dependence or risk of social exclusion. A representative sample of all BTPS users was selected by means of stratified random sampling by historic areas, by applying the formula already reported by other authors [14]. A 95% confidence interval was selected, that is z = 1.96, an error of 3% was considered and equal prob- abilities of p and q and equal to 0.5 were selected. A sample of 1125 users of the services was subsequently estimated. The study period was from 1 September 2012 to 31 August 2013. A total of 1554 interviews were performed, 14.7% of these interviewees opted not to take part in the study and 8.6% of the interviews could not be fully completed, whereby they were excluded from the sample. Of the 1192 full interviews, 94.4% could be linked to healthcare data, whereby the final sample was 1125 users. 2.3. Sources of information For this study, there was a combination of information in regard to social variables such as marital status and cohabitation unit, from the BTPS database, demographic variables and clinical variables from the electronic clinical history and other computerised sources from the Basque Health Department (Osakidetza). To detect the existence of chronic diseases, diagnosis and pres- cription data were reviewed during the last 6 years for each one of the people included and a methodology similar to that reported by other authors was adopted [15]. A list of 52 diseases was defined; specific criteria for each one of them were agreed to be considered as active. For this study multimorbidity was considered as the coexistence of two or more diseases in the same person. To obtain measurements on healthcare-related quality of life, the EuroQol 5D-3L telephone questionnaire was used. This is a multidimen- sional, self-administered scale with a total score in regard to the quality of life perceived by the patient. It has five dimensions to evaluate quality of life (mobility, self-care, usual activities, pain/discomfort and anxiety/ depression) each with three possible answers (no problems, moderate problems and severe problems with the dimension at issue). The overall index values are between 0 and 1 where 1 is the best health condition possible and 0 is the worst health condition possible. 2.4. Analysis To analyse the effects of multimorbidity and individual conditions on HRQoL in general and on specific dimensions, multiple regression of ordinary least squares (OLS) and multiple logistic regression were used. All models were adjusted for demographic variables, taking male sex and youngest age range as a reference; the overall index was scaled (dependent variable) by 100. For the first model, OLS regression was used to estimate the effect of multimorbidity, measured as the sum of chronic diseases, on the overall EuroQol index. In the second model, OLS was used to estimate the effect of the different chronic pathologies on the overall index. Moreover, sev- eral logistic regression models were estimated to explore the effects of the individual condition in the five specific dimensions of the question- naire using dichotomous variables (0 for those who answered no prob- lems and 1 for those who answered moderate or severe problems) for each dimension as a dependent variable. For the second OLS regression model and logistics models they included those chronic pathologies whose prevalence was greater than 1%. Statistical calculations were performed using Stata, Data Analysis and Statistical Software, Release 12 (StataCorp, LP, College Station, TX, USA). 3. Results 3.1. Demographic, healthcare and social characteristics of the survey respondents The survey sample was comprised of 82.13% women, 87.82% users aged over 74; almost half of the users were widows and 66.22% lived alone. Both for men and women 92% of the users were multimorbid. The average number of chronic pathologies was higher in men, for the lower age range (64–74) and for those who lived with at least one person. The total average was 4.7 chronic pathologies per person (Table 1). It was verified by means of the ANOVA test that the differences in the average of chronic pathologies between sexes, age ranges, cohabitation unit and marital status were all statistically sig- nificant (P b 0.001). The most prevalent chronic diseases for both sexes were hyperten- sion, anxiety, dyspepsia and diabetes. Men added prostatic hypertrophy, atrial fibrillation, chronic obstructive pulmonary disease, cancer, stroke and ischaemic heart disease as most prevalent; and women added mus- culoskeletal degeneration, depression and osteoporosis (additional ma- terial A). 2 E. Alonso-Morán et al. / European Journal of Internal Medicine xxx (2015) xxx–xxx Please cite this article as: Alonso-Morán E, et al, Health-related quality of life and multimorbidity in community-dwelling telecare-assisted elders in the Basque Country, Eur J Intern Med (2015), http://dx.doi.org/10.1016/j.ejim.2015.02.013
  3. 3. 3.2. Results of the health-related quality of life survey (EQ-5D) A total of 72% of users surveyed considered that they did not have problems for their self-care even when 61% had mobility problems and 56% had their physical activity conditioned (13% severely). Pain or discomfort was present in 69% of cases; 19% with severe cases (see Fig. 1). Stratified by age ranges and sex (Table 2) it was observed that men obtained better scores on health-related quality of life than women and elderly people. Observing by dimension, age had a special emphasis on mobility, self-care and activities of daily living (which is where higher scores were obtained). However, the eldest persons presented less pain and discomfort and less anxiety and depression than younger age groups. Men reported worse mobility and self-care values than women. Consequently, women reported worse values for activities of daily living, pain or discomfort and anxiety or depression. By means of the ANOVA test statistically significant differences were verified for the different dimensions of the EuroQol between sexes for pain/discomfort (P b 0.001) and between sexes and age range for anxi- ety/depression (both P b 0.001). Moreover, statistically significant dif- ferences were obtained between sexes for the overall questionnaire score (P b 0.01). 3.3. Effects of multimorbidity and chronic pathologies on the overall questionnaire index Table 3 reveals the association between quality-of-life and multimorbidity. It was observed that female sex accounted for more negative scores than men, 9.3 points less on the scale. The sum of chron- ic pathologies as a continuous variable had the effect of subtracting 2.57 from the scale for each chronic disease suffered by the individual, that is, if an individual presented six chronic pathologies they would have at least 15.6 points less on the total scale of 100 points. Age did not come out significantly for the model. Cohabitation unit negatively affected the scale, the more members in the family unit the worse the values obtained. The prior analyses were repeated by switching the number of chron- ic conditions for chronic diseases in themselves (Table 4). Sex was sig- nificant in the model; women reported worse results, up to 6 points less out of 100. Age groups were not statistically significant in the model. The chronic diseases for which worse health-related quality of low scores (statistically significant) were reported were: Parkinson's disease, muscular dystrophy or paralysis, peripheral vascular disease, and hepatopancreatic chronic diseases. Moreover, heart failure, ischae- mic heart disease, rheumatoid arthritis and others, musculoskeletal degeneration, depression, dyspepsia and lumbago presented between five and 10 points less than the overall index. 3.4. Effects of the chronic pathologies on each one of the EuroQol dimensions Table 5 only presents those variables that were statistically signifi- cant in the model although the full table (B) is presented as additional material. In regard to the mobility dimension, the risk of having moder- ate or severe problems was greater in people with Parkinson's disease or muscular dystrophy or paralysis, just as for the self-care dimension. For activities of daily living, the same pattern was repeated and periph- eral vascular disease was also added. In regard to pain, those who had peripheral vascular disease presented a higher risk of moderate or severe problems. Anxiety and depression are related to this dimension. 4. Discussion The public telecare in the Basque Country serves an elderly age group that resides in their home and which is predominantly women. This study reveals that in this population there is a high prevalence of chronic diseases and multimorbidity that has a negative impact on their HRQoL. Orueta et al. [16] revealed that this prevalence of multimorbidity is higher than the remaining Basque Country citizens of their same sex and age. In our study, the prevalence of multimorbidity was 92% and the average for chronic pathologies was higher among men, in the lower age ranges (65–74) and for those who lived with at least one person. Because of the method used to capture BTPS users, an increase in mor- bidity in regard to ageing was not observed. In relation to answers given by BTPS users, although these revealed less problems for the self-care dimension, moderate or severe problems were observed in regard to pain and/or discomfort, just as for the study performed by Brettschneider et al. [17]. Other authors that have used the EuroQol have also found that multimorbidity is negatively associated with HRQoL [17–21]. At the same time women presented lower levels for quality of life which is con- sistent with other studies performed [20,22]. Similarly, people who do not live alone presented worse quality of life which may suggest that the existence of family carers enables keeping people with health prob- lems that significantly affect HRQoL in non-institutionalised settings. The highest quality of life was among the oldest users, which op- poses most of the results from other studies where quality-of-life re- duces with age [17,20,23]. However, this result is in accordance with the characteristics of the population which benefits from the telecare service in the Basque Country, in which younger groups are people with disability and related problems [15]. Parkinson's disease, muscular dystrophy or paralysis, peripheral vas- cular disease, hepato-pancreatic chronic diseases, heart failure, rheuma- toid arthritis and depression, in this order, were the chronic diseases which most negatively affected quality of life. Other authors found a negative association between quality of life and Parkinson's disease [17,20], in addition to depression and arthritis [22]. However, more eye-catching is the fact that pathologies such as stroke, malignant neo- plasia, schizophrenia and dementia are not statistically significant. This may be because in some of these pathologies the most serious cases are institutionalised and the cognitive impairment hinders giving an Table 1 Demographic features and average of chronic pathologies of BTPS users included in the study by sex, age ranges, cohabitation unit and marital status. Characteristics N (%) Average of chronic pathologies (SD) Differences between groups: F-statistics (P value) Sex Males 201 (17.87) 5.32 (2.81) 13.4 (0.0003) Women 924 (82.13) 4.59 (2.53) Age ranges 65–74 137 (12.18) 5.10 (2.73) 4.70 (0.0029) 75–79 304 (27.02) 4.92 (2.69) 80–84 401 (35.64) 4.76 (2.49) 85 or more 283 (25.16) 4.26 (2.51) Cohabitation unit Lives alone 745 (66.22) 4.43 (2.37) 6.75 (b0.0001) Lives with 1 person 319 (28.36) 5.13 (2.76) Lives with 2 people 38 (3.38) 6.16 (3.58) Lives with 3 or more people 23 (2.04) 6.00 (3.33) Marital status . 363 (32.27) 5.58 (0.0002) Married 184 (16.36) 5.34 (2.90) Separated or divorced 15 (1.33) 4.67 (3.09) Single 44 (3.91) 3.80 (2.74) Widow 519 (46.13) 4.46 (2.31) Total average (SD) 1125 (100) 4.72 (2.59) N represents the size of the subgroup, % the percentage represented by each subgroup of the sample, SD the standard deviation and "." no data available. 3E. Alonso-Morán et al. / European Journal of Internal Medicine xxx (2015) xxx–xxx Please cite this article as: Alonso-Morán E, et al, Health-related quality of life and multimorbidity in community-dwelling telecare-assisted elders in the Basque Country, Eur J Intern Med (2015), http://dx.doi.org/10.1016/j.ejim.2015.02.013
  4. 4. answer to the questionnaire at issue. The results obtained for stroke and malignant neoplasia differ from those of Hunger et al. [23] in which a deteriorated quality of life in these patients was revealed. Comparing the results of a study on the association of chronic pathologies with each one of the specific dimensions of the EuroQol with those of the study by Brettschneider et al. [17], it was observed that they obtained similar odds ratios for the dimensions self-care and activities of daily living for Parkinson's disease; and for the dimensions mobility and activities of daily living for heart failure. One of the strengths of this study compared with others on HRQoL lies in the fact that a list of 52 chronic pathologies was used whilst other authors considered a lower number: from 6 [23] to 42 [17] con- ditions. Conversely, the sources of information used connect social ser- vices and healthcare databases. This is because telecare in the Basque Country is a pioneering example of an integrated socio-healthcare ser- vice platform and has enabled having a wealth of information available. Subsequently, the coordination of these two services and telecare as a service platform offers substantial opportunities for innovation in interventions on this BTPS user population. In addition, we have analysed a database containing information regarding primary, special- ized and ambulatory hospital care, as well as prescriptions. This is rele- vant given that other authors have established that the use of a single 441, 39% 676, 60% 8, 1% MOBILITY 811, 72% 253, 23% 61, 5% SELF-CARE 495, 44% 484, 43% 146, 13% USUAL ACTIVITIES 352, 31% 556, 50% 217, 19% PAIN/DISCOMFORT 653, 58% 376, 33% 96, 9% ANXIETY/DEPRESSION No problems Moderate problems Severe problems Fig. 1. Distribution of user responses by dimension (number and percentage). 4 E. Alonso-Morán et al. / European Journal of Internal Medicine xxx (2015) xxx–xxx Please cite this article as: Alonso-Morán E, et al, Health-related quality of life and multimorbidity in community-dwelling telecare-assisted elders in the Basque Country, Eur J Intern Med (2015), http://dx.doi.org/10.1016/j.ejim.2015.02.013
  5. 5. source may produce inaccurate results [24,25] whilst the complementa- ry use of various different sources helps to improve the description of people's health problems [26]. The study has some limitations. First, the administrative databases only contain treated morbidity records, whereby information is exclud- ed on diseases and problems for which patients did not request care; this is a common situation for some chronic diseases. Second, we had to consider them limitations inherent to questionnaires administered by telephone to an elderly age group; it may be the case that people with cognitive problems have answered the tests although the training of interviewers substantially limits this possibility. Finally, although the purpose of the study is not an evaluation of the telecare service, it is important to stress that authors such as Hirani et al. [27] have revealed that the telecare service potentially contributes to the improvement in the reduction of HRQoL for users of a service of this nature. 5. Conclusions This study reveals that for a specific population covered by BTPS, the impact of chronic pathologies and multimorbidity is high. Although the results of this study cannot be generalised due to specific characteristics of the population covered, it provides several useful hints. Therefore, we consider that to ascertain the sociodemographic, healthcare and quality of life features of aged populations covered by telecare services is useful to develop and implement personalised services and interventions. Table 2 Average EuroQol scores by dimension and by overall index of the study population stratified by sexes and age ranges. Mean (SD) by EuroQol dimensions Characteristics Mobility Self-care Daily activities Pain/discomfort Anxiety/depression Overall index Sex Male 1.64 (0.51) 1.36 (0.61) 1.67 (0.69) 1.64 (0.68) 1.32 (0.53) 0.64 (0.25) Female 1.61 (0.50) 1.33 (0.57) 1.69 (0.69) 1.93 (0.70) 1.54 (0.67) 0.59 (0.25) Age ranges 65–74 1.61 (0.49) 1.33 (0.57) 1.67 (0.64) 1.97 (0.72) 1.67 (0.70) 0.57 (0.25) 75–79 1.58 (0.51) 1.31 (0.55) 1.64 (0.67) 1.93 (0.68) 1.58 (0.67) 0.60 (0.25) 80–84 1.62 (0.49) 1.33 (0.58) 1.69 (0.70) 1.86 (0.72) 1.46 (0.64) 0.60 (0.25) 85 or more 1.65 (0.51) 1.36 (0.61) 1.75 (0.71) 1.81 (0.68) 1.42 (0.60) 0.61 (0.25) Total average (SD) 1.62 (0.50) 1.33 (0.58) 1.69 (0.69) 1.88 (0.70) 1.50 (0.65) 0.60 (0.25) Table 3 Linear regression on the overall index scaled by 100 adjusting by sex, age groups, sum of chronic diseases and cohabitation unit. Characteristics Beta coefficient Standard error [95% confidence interval] Sex Man (ref) Woman −9.29 1.87 −12.96 −5.62 Total of chronic pathologies −2.57 0.28 −3.12 −2.03 Age ranges 65–74 (ref) 74–79 3.60 2.43 −1.17 8.37 80–84 3.32 2.34 −1.27 7.90 Over 84 2.65 2.47 −2.20 7.49 Cohabitation unit Lives alone (ref) Lives with 1 person −11.16 1.61 −14.31 −8.01 Lives with 2 people −13.88 3.97 −21.67 −6.09 Lives at least with 3 people −1.71 5.02 −11.56 8.15 Intersection 80.45 2.94 74.67 86.22 Ref — reference group in the regression analysis. Table 4 Linear regression on the overall index scaled by 100 adjusting by sex, age groups and chronic diseases with a prevalence higher than 1%. Overall index Beta coefficient Standard error [95% confidence interval] Sex Man (ref) Woman −6.15 2.33 −10.73 −1.57 Age ranges 65–74 (ref) 74–79 2.85 2.50 −2.05 7.76 80–84 2.35 2.42 −2.39 7.09 Over 84 0.54 2.55 −4.46 5.54 Chronic pathologies Parkinson's disease −13.42 3.17 −19.65 −7.19 Muscular dystrophy or paralysis −11.10 4.49 −19.91 −2.3 Peripheral vascular disease −10.54 5.36 −21.06 −0.02 Hepatopancreatic chronic diseases −10.11 5.00 −19.92 −0.30 Heart failure −9.10 2.68 −14.36 −3.84 Rheumatoid arthritis and others −8.90 3.18 −15.14 −2.66 Depression −7.01 1.73 −10.4 −3.61 Immunological diseases −6.84 5.76 −18.15 4.47 Musculoskeletal degeneration −6.34 1.58 −9.43 −3.24 Ischaemic heart disease −6.23 2.56 −11.25 −1.21 Lower back pain −6.10 2.50 −11.02 −1.19 Dyspepsia −5.39 1.62 −8.57 −2.21 Stroke −4.14 2.11 −8.29 0.01 Inflammatory bowel disease −4.02 6.78 −17.33 9.30 Irritable bowel syndrome −3.82 6.07 −15.73 8.10 Chronic heart failure, others −3.36 2.38 −8.03 1.30 Anxiety −3.03 1.51 −6.00 −0.06 Diverticulosis −2.45 2.66 −7.66 2.77 Psoriasis or eczema −2.24 6.10 −14.21 9.74 Deafness −1.82 2.56 −6.83 3.20 Peripheral neuropathy −1.45 2.81 −6.97 4.07 Chronic sight disorders −1.32 2.83 −6.88 4.24 Prostatic hypertrophy −1.12 3.65 −8.29 6.05 Emphysema, chronic bronchitis, COPD −0.97 2.56 −6.00 4.06 Osteoporosis −0.94 1.90 −4.66 2.78 Diabetes −0.88 1.71 −4.23 2.48 Malignant neoplasia −0.81 2.33 −5.39 3.76 Hypertension −0.43 1.87 −4.10 3.24 Glaucoma −0.30 1.95 −4.12 3.53 Chronic renal failure 0.03 2.57 −5.01 5.07 Gout 0.51 4.00 −7.33 8.36 Asthma (treated currently) 0.83 3.30 −5.64 7.30 Hypothyroidism 1.77 2.27 −2.68 6.21 Schizophrenia 1.88 6.21 −10.31 14.07 Metabolism errors and chromosomopathies 2.14 5.40 −8.46 12.74 Atrial fibrillation 3.95 2.10 −0.17 8.08 Dementia 5.36 2.64 0.18 10.53 Chronic hematological diseases 8.92 7.08 −4.98 22.82 Intersection 75.18 3.26 68.77 81.59 COPD — chronic obstructive pulmonary disease; ref — reference group in the regression analysis. 5E. Alonso-Morán et al. / European Journal of Internal Medicine xxx (2015) xxx–xxx Please cite this article as: Alonso-Morán E, et al, Health-related quality of life and multimorbidity in community-dwelling telecare-assisted elders in the Basque Country, Eur J Intern Med (2015), http://dx.doi.org/10.1016/j.ejim.2015.02.013
  6. 6. Abbreviations Basque Telecare Public Service BTPS Healthcare-related quality of life HRQoL Multiple regression of ordinary least squares OLS Conflict of interest The authors declare that they have no conflicts of interest associated with this manuscript. Acknowledgements The authors wish to acknowledge the team of teleoperators of BTPS, for calling and making all interviews to the users, as well as, those users who took part in the study. This paper arises from research conducted as part of the Joint Action addressing chronic conditions and healthy ageing across the life cycle (JA-CHRODIS), which has received funding from the European Union, under the framework of the Health Programme (2008–2013). References [1] Salisbury C, Johnson L, Purdy S, Valderas JM, Montgomery AA. Epidemiology and im- pact of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract J R Coll Gen Pract 2011;61:e12–21. http://dx.doi.org/10.3399/bjgp11X548929. 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Mobility Self-care Activities of daily living Pain/discomfort Anxiety/depression Characteristics OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) OR (95% CI) Sex Man (ref) Woman 2.68 1.75 4.11 1.69 1.09 2.61 Age ranges 65–74 (ref) 80–84 0.53 0.34 0.82 Over 84 0.52 0.33 0.83 Chronic pathologies Stroke 1.49 1.00 2.23 Rheumatoid arthritis and others 1.90 1.07 3.38 2.36 1.14 4.87 Anxiety 1.39 1.04 1.87 1.54 1.18 2.01 Ischaemic heart disease 2.22 1.30 3.80 Musculoskeletal degeneration 1.88 1.40 2.52 1.65 1.23 2.23 1.84 1.34 2.53 Dementia 0.51 0.31 0.82 0.45 0.28 0.74 Depression 1.67 1.20 2.31 1.75 1.28 2.39 2.77 2.03 3.76 Dyspepsia 1.47 1.09 1.99 1.60 1.16 2.22 Muscular dystrophy or paralysis 5.62 1.61 19.60 3.45 1.53 7.81 5.34 1.77 16.11 Chronic heart failure, others 1.56 1.01 2.43 Hepatopancreatic chronic diseases 2.47 1.02 5.98 Peripheral vascular disease 3.33 1.05 10.63 5.53 1.42 21.62 Heart failure 2.28 1.31 3.96 1.78 1.07 2.96 1.90 1.07 3.38 Lower back pain 1.84 1.12 3.03 1.92 1.09 3.36 Peripheral neuropathy 2.24 1.25 4.00 0.45 0.26 0.77 Parkinson's disease 4.22 1.99 8.97 4.56 2.58 8.08 3.84 1.93 7.67 1.28 0.68 2.44 1.13 0.64 1.98 Intersection 0.49 0.27 0.89 0.12 0.06 0.24 0.44 0.24 0.79 0.67 0.36 1.24 0.53 0.29 0.97 CI — confidence interval; COPD — chronic obstructive pulmonary disease; OR — odds ratio; ref — reference group in the regression analysis. 6 E. 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