Healthcare Task Difficulty Among Older Adults With Multimorbidity

• Published in: Medical care 2014-03, Vol.52 (3), p.S118-S125
• Main Authors: Boyd, Cynthia M., Wolff, Jennifer L., Giovannetti, Erin, Reider, Lisa, Weiss, Carlos, Xue, Qian-li, Leff, Bruce, Boult, Chad, Hughes, Travonia, Rand, Cynthia
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Caregivers; Chronic Disease - epidemiology; Chronic Disease - psychology; Chronic diseases; Chronic illnesses; Comorbidity; Cost of Illness; Cross-Sectional Studies; Diabetes; Female; Geriatric Assessment; Health care industry; Health outcomes; Health Status; Humans; Longitudinal Studies; Male; Medical treatment; Medications; Mental Health - statistics & numerical data; Older adults; Older people; Patient assessment; Physical health; Physicians; Primary care; Self Report; Surveys and Questionnaires - standards; United States - epidemiology
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0b013e3182a977da

Background: Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden. Objectives: To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity. Research Design: Cross-sectional and longitudinal secondary data analysis. Subjects: Multimorbid adults aged 65 years or older from primary care clinics. Measures: We generated a scale (0–16) of self-reported difficulty with 8 HCTD and conducted factor analysis to assess its dimensionality and internal consistency. To assess predictive ability, cross-sectional associations of HCTD and number of chronic diseases, and conditions that add to health status complexity (falls, visual, and hearing impairment), patient activation, patient-reported quality of chronic illness care (Patient Assessment of Chronic Illness Care), mental and physical health (SF-36) were tested using statistical tests for trend (n = 904). Longitudinal analyses of the effects of change in HCTD on changes in the outcomes were conducted among a subset (n = 370) with ≥ 1 follow-up at 6 and/or 18 months. All models were adjusted for age, education, sex, race, and time. Results: Greater HCTD was associated with worse mental and physical health [Cuzick test for trend (P < 0.05)], and patient-reported quality of chronic illness care (P < 0.05). In longitudinal analysis, increasing patient activation was associated with declining HCTD over time (P < 0.01). Increasing HCTD over time was associated with declining mental (P < 0.001) and physical health (P = 0.001) and patient-reported quality of chronic illness care (P < 0.05). Conclusions: The findings of this study establish the construct validity of the HCTD scale.