Daily Living Geriatric Ills Overlooked by Disease-Oriented Clinicians

ANN ARBOR, Mich., Aug. 9 -- Common complaints of aging such as memory problems, falls, or incontinence may be overlooked by clinicians focused on chronic diseases, found investigators here.

A survey of more than 11,000 patients ages 65 and older found that half had one or more conditions that impaired them in their daily lives, reported Christine T. Cigolle, M.D., M.P.H., of the University of Michigan, and colleagues.

"Geriatric conditions are similar in prevalence to chronic diseases in older adults and in some cases are as strongly associated with disability," they wrote in the Aug. 7 issue of the Annals of Internal Medicine.

But the authors also found that "the high prevalence of geriatric conditions and the strength of their association with activities of daily living dependency demonstrate that these conditions go largely unrecognized in the current disease-based model of clinical care."

Cognitive impairment, falls, incontinence, weight loss, dizziness, and hearing and vision loss don't fit neatly into diagnostic pigeonholes, but such conditions "are important to the health and function of older adults and should be addressed in their care," the authors wrote.

The investigators drew their conclusions from a cross-sectional analysis of 11,093 patients who took part in the Health and Retirement Study survey administered in 2000. The sample, which included those living in the community or nursing homes, was chosen to represent 34.5 million older Americans.

The authors looked at the prevalence of seven common geriatric conditions and their association with dependence in activities of daily living such as bathing, dressing, eating, transferring/walking, and toileting.

The geriatric conditions were cognitive impairment, falls, incontinence, low body mass index, dizziness, vision impairment and hearing impairment.

The authors found that 49.9% of the respondents reported having one or more of the conditions, and that some of the conditions were comparable in prevalence to chronic diseases.

For example, falls resulting in injuries were reported by 9.6% of respondents, similar to a prevalence of 9.2% for heart disease. The prevalence of urinary incontinence was 12.7%, compared with 13.2% for diabetes, the authors noted.

They also found a strong and significant association between geriatric conditions and dependency in activities of daily living. After adjusting for demographic factors such as age, gender, marital status, race, income, and education, the risk ratio for activities of daily living dependency among patients with one of the geriatric conditions was 2.1 (95% confidence interval, 1.9 to 2.4).

The adjusted risk ratio nearly doubled with each additional geriatric condition, to 3.6 (95% CI, 3.1 to 4.1) for two conditions, and to 6.6 (95% CI 5.6 to 7.6) for three or more conditions.

The conditions most strongly associated with activities of daily living dependency were cognitive impairment, incontinence, and vision impairment. In contrast, hearing impairment was not associated with activities of daily living dependency.

"Geriatric conditions present a challenge to the clinician because they are prevalent and are associated with disability but typically lack an underlying cause that may be cured," they wrote. "Yet, identifying and assessing geriatric conditions are clinically important because these conditions can be prevented or delayed (vision impairment), managed (cognitive impairment, falls, incontinence vision impairment, hearing impairment), and sometimes treated (low BMI, dizziness), with resulting improvement in symptoms and decrease in disability."

They acknowledged that the study was limited by its cross-sectional design, use of self-reported data, and a lack of information on possible confounders such as delirium and frailty. They also noted that the estimates may have been influenced by survival bias.

The authors had no conflict of interest disclosures.