Media Release

November 4 2009

Integrated care a key to longer life

Dr Gillian Caughey is the lead author of the 14-year South Australian study Combinations of certain chronic conditions in the elderly can significantly decrease life expectancy, a South Australian study has found.

The study, just published in the Journal of Epidemiology and Community Health, suggest primary health care which is more centred on the whole patient rather than on individual diseases improves life expectancy.

Lead author of the study, Dr Gillian Caughey from UniSA’s Sansom Institute for Health Research, says increased knowledge of the most common combinations of chronic medical conditions and treatment outcomes in the elderly will help to support better management and care of those patients.

“Between 65 to 80 per cent of the elderly have multiple chronic conditions and that is projected to rise with the increasing age of our population,” Dr Caughey said.

“We found elderly people with three or four chronic diseases have a 25 per cent increased risk of mortality, while those with five or more chronic diseases have an 80 per cent increased risk of mortality, by comparison to those with no chronic diseases.

“Mortality is also dependent on the specific disease combinations present within an individual, with cardiovascular disease and mental health problems associated with increased mortality.”

Dr Caughey said the study also found that elderly people who have arthritis along with a number of other chronic health conditions have a higher life expectancy than those who don’t have arthritis combined with those other conditions. “These results raise the hypothesis that patients who have increased likelihood of opportunity for care from their doctor are more likely to have other chronic medical conditions detected earlier and better managed,” she said.

Dr Caughey worked on the 14-year study with UniSA colleagues Professor Andrew Gilbert, Dr Libby Roughead, Dr Agnes Vitry, along with Flinders University’s Dr Mary Luszcz and the University of Adelaide’s Professor Philip Ryan and Emmae Ramsay.

The study sample included 2087 South Australian men and women aged 65 and over. Almost 90 per cent of the sample reported having at least one chronic medical condition, with 64 per cent having two or more chronic diseases. Arthritis and cardiovascular disease was the most common disease combination, followed by arthritis together with high blood pressure or gastrointestinal disease or mental health problems.

Dr Caughey said the average survival time for the elderly who had no chronic diseases at the start of the study was 10.4 years. By comparison, the average survival times of those with one chronic disease, two chronic diseases, three or four chronic diseases or greater than five chronic diseases was 10.1 years, 9.6 years, 8.9 years and 6.4 years respectively.

“Our study highlights the need for greater awareness in managing patients’ overall health status rather than a single disease,” she said.

“Patterns of care for those with multiple chronic diseases need to reflect a more patient-centred approach, integrating the individual needs of patients and their specific diseases.”

Dr Caughey said mental health problems, in particular depression, were often thought of as benign in terms of long term health outcomes, but it was becoming increasingly evident that depression could have a significant impact when comorbid with other chronic diseases.

“For example, when depression is comorbid with diabetes it results in an increase in mortality by almost 40 per cent and when comorbid with cardiovascular disease results in an almost three-fold increase in mortality,” she said.

Dr Caughey said the study results had significant implications for the awareness and formulation of management and care strategies for people with many chronic illnesses. “The development of appropriate and integrated care for the multimorbid person is one of the most critical issues that health care systems face worldwide,” she said.