The current aging trends accompanying the increasing prevalence of multiple chronic conditions (MCCs) and decreasing participation in physical activity (PA) have swept the United States. In light of the magnitude of this phenomenon, this study seeks to identify the most common MCC combinations and their relationships with PA level. A cross-sectional study, Brazos Valley Health Assessment, was conducted between October 2009 and July 2010. All data analyses were performed by STATA 12.0. The overall sample which met the inclusion criteria is 2,603. Among people older than 45 years, chronic conditions of cardiovascular, endocrine, and musculoskeletal systems were the most prevalent. Participants with three chronic conditions were less likely to meet the PA standard than those with only two chronic conditions. Younger age, women, rural residence, and unsafe environments were related to the lower PA level. After adjusting for seven covariates, all MCCs combinations adversely affect the level of PA ( , ). People with MCCs were among the least active subgroups despite the health benefits of doing exercise. Given the well-documented benefits of physical activity for delaying the onset or progression of MCCs, public health efforts to enhance regular PA in middle-aged and older adults are recommended. 1. Introduction As seen globally [1], the population in the US is aging [2]. There were approximately 120.1 million adults aged 45 years or older (39.30% of the total US population) in 2011, and this number is expected to rise to 162.8 million (42.96% of the total US population) by 2030 [3]. The rapid escalation of the aging population has been accompanied by an increase in the prevalence of multiple chronic conditions (MCCs) [4, 5]. The recent national emphasis on MCCs (defined as two or more chronic conditions) can be attributed, in part, to studies documenting the association of MCC with increased risks of adverse health outcomes, higher health care use, and associated costs [6–8]. Recent national data reported that around 63 million Americans had MCCs, and this number is projected to grow to 81 million by 2020 [9, 10]. For people aged 45–64 years old, the percentage of adults with two or more of nine selected chronic conditions has increased 5 percent from 1999 to 2009 [11]. This number is more than 8 percent for the group of people older than 65 years of age. The prevalence of MCCs in Medicare or veteran populations has been further explored. Two-thirds of Medicare beneficiaries (around 21.4 million) had at least two or more chronic conditions which were
References
[1]
World Health Organization (WHO), “Health Topics: Aging,” 2012, http://www.who.int/topics/ageing/en/.
[2]
Administration on Aging (AOA), “Aging Statistics,” 2011, http://www.aoa.gov/aoaroot/aging_statistics/index.aspx.
[3]
US Census Bureau, “Age and Sex,” 2012, http://www.census.gov/.
[4]
T. Bodenheimer, E. Chen, and H. D. Bennett, “Confronting the growing burden of chronic disease: can the U.S. health care workforce do the job?” Health Affairs, vol. 28, no. 1, pp. 64–74, 2009.
[5]
US Department of Health and Human Services (HHS), “HHS Initiative on Multiple Chronic Conditions,” 2010, http://www.hhs.gov/ash/initiatives/mcc/.
[6]
Center for Medicare and Medicaid (CMS), Chronic Conditions Among Medicare Beneficiaries, Chartbook, 2012, CMS Innovation, Baltimore, Md, USA, 2012.
[7]
S. L. Norris, K. High, T. M. Gill et al., “Health care for older Americans with multiple chronic conditions: a research agenda,” Journal of the American Geriatrics Society, vol. 56, no. 1, pp. 149–159, 2008.
[8]
J. L. Wolff, B. Starfield, and G. Anderson, “Prevalence, expenditures, and complications of multiple chronic conditions in the elderly,” Archives of Internal Medicine, vol. 162, no. 20, pp. 2269–2276, 2002.
[9]
Partnership for Solutions, “Chronic Conditions: Making the Case for Ongoing Care,” 2004, http://www.partnershipforsolutions.org/DMS/files/chronicbook2004.pdf.
[10]
C. Vogeli, A. E. Shields, T. A. Lee et al., “Multiple chronic conditions: prevalence, health consequences, and implications for quality, care management, and costs,” Journal of General Internal Medicine, vol. 22, supplement 3, pp. 391–395, 2007.
[11]
V. M. Freid, A. B. Bernstein, and M. A. Bush, “Multiple chronic conditions among adults aged 45 and over: Trends over the past 10 years,” 2012, http://www.cdc.gov/nchs/data/databriefs/db100.pdf.
[12]
M. A. Steinman, S. J. Lee, W. J. Boscardin et al., “Patterns of multimorbidity in elderly veterans,” Journal of the American Geriatrics Society, vol. 60, no. 10, pp. 1872–1880, 2012.
[13]
Partnership to Fight Chronic Disease, “Need great, evidence lacking for people with multiple chronic conditions,” 2012, http://www.fightchronicdisease.org/sites/fightchronicdisease.org/files/docs/MCC%20White%20paper%20October%202012%20-%20final%20draft.pdf.
[14]
A. C. King and D. K. King, “Physical activity for an aging population,” Public Health Reviews, vol. 32, no. 2, pp. 401–426, 2010.
[15]
Federal Interagency Forum on Aging-Related Statistics, “Older Americans 2012: Key Indicators of Well-Being,” 2012, http://agingstats.gov/agingstatsdotnet/Main_Site/Data/2012_Documents/Docs/EntireChartbook.pdf.
[16]
B. Elsawy and K. E. Higgins, “Physical activity guidelines for older adults,” American Family Physician, vol. 81, no. 1, pp. 55–59, 2010.
[17]
D. H. Paterson, G. R. Jones, and C. L. Rice, “Ageing and physical activity: evidence to develop exercise recommendations for older adults,” Canadian Journal of Public Health, vol. 98, pp. S69–108, 2007.
[18]
B. L. Willis, A. Gao, D. Leonard, L. F. DeFina, and J. D. Berry, “Midlife fitness and the development of chronic conditions in later life,” Archives of Internal Medicine, vol. 172, no. 17, pp. 1333–1340, 2012.
[19]
Leading Health Indicators (LHIs), “Healthy People 2020: Nutrition, Physical Activity, and Obesity,” 2011, http://www.healthypeople.gov/2020/LHI/nutrition.aspx?tab=data#PA_2_4.
[20]
CDC, “Behavioral Risk Factor Surveillance System (BRFSS): Prevalence and Trends Data,” 2011, http://apps.nccd.cdc.gov/brfss/page.asp?yr=2011&state=US&cat=CH#CH.
[21]
A. K. Parekh, R. A. Goodman, C. Gordon, and H. K. Koh, “Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life,” Public Health Reports, vol. 126, no. 4, pp. 460–471, 2011.
[22]
US Department of Health and Human Services (HHS), “2008 Physical Activity Guidelines for Americans,” 2008, http://www.health.gov/PAGuidelines/pdf/paguide.pdf.
[23]
M. C. Ashe, W. C. Miller, J. J. Eng, and L. Noreau, “Older adults, chronic disease and leisure-time physical activity,” Gerontology, vol. 55, no. 1, pp. 64–72, 2009.
[24]
T. Troosters, F. Sciurba, S. Battaglia et al., “Physical inactivity in patients with COPD, a controlled multi-center pilot-study,” Respiratory Medicine, vol. 104, no. 7, pp. 1005–1011, 2010.
[25]
E. A. Bayliss, J. F. Steiner, D. H. Fernald, L. A. Crane, and D. S. Main, “Descriptions of barriers to self-care by persons with comorbid chronic diseases,” Annals of Family Medicine, vol. 1, no. 1, pp. 15–21, 2003.
[26]
K. McFarlin, Experiences of physical activity among older adults with multiple chronic conditions [M.S. thesis], The University of British Columbia, Vancouver, Canada, 2009.
[27]
C. Hudon, H. Soubhi, and M. Fortin, “Relationship between multimorbidity and physical activity: secondary analysis from the Quebec health survey,” BMC Public Health, vol. 8, p. 304, 2008.
[28]
Center for Community Health Development (CCHD), “Brazos Valley Health Assessment: Executive Report,” 2010, http://www.cchd.us/content/pdfs/assessmentreports/bvreport.pdf.
[29]
Brazos Valley Council of Governments (BVCOG), “Welcome to BVCOG,” 2012, http://www.bvcog.org/.
[30]
T. Y. Liu-Ambrose, M. C. Ashe, and C. Marra, “Independent and inverse association of healthcare utilisation with physical activity in older adults with multiple chronic conditions,” British Journal of Sports Medicine, vol. 44, no. 14, pp. 1024–1028, 2010.
[31]
Partnership for Solutions, “Multiple Chronic Conditions: Complications in Care and Treatmen,” 2002, http://www.partnershipforsolutions.org/DMS/files/multiplecoitions.pdf.
[32]
Pfizer, “The health status of older adults: Findings from the National Health and Nutrition Examination Survey (NHANES) 1999–2004, the National Health Interview Survey (NHIS) 2005, and the Compressed Morality File (CMF) 2003,” 2007, http://www.pfizer.com/files/products/The_Health_Status_of_Older_Adults_2007.pdf.
[33]
National Heart Lung and Blood Institute (NHLBI), “Heart disease risk factors and lifetime risk of cardiovascular events,” 2012, http://hp2010.nhlbihin.net/joinhin/news/professional/hdrisk.asp.
[34]
CDC, “How much physical activity do older adults need?” 2012, http://www.cdc.gov/physicalactivity/everyone/guidelines/olderadults.html.
[35]
G. Warshaw, “Introduction: advances and challenges in care of older people with chronic illness,” Generations, vol. 30, no. 3, pp. 5–10, 2006.
[36]
R. F. Loeser, “Age-related changes in the musculoskeletal system and the development of osteoarthritis,” Clinics in Geriatric Medicine, vol. 26, no. 3, pp. 371–386, 2010.
[37]
CDC, “2011 National Diabetes Fact Sheet,” 2011, http://www.cdc.gov/DIABETES//pubs/estimates11.htm.
[38]
R. C. Brownson, A. A. Eyler, A. C. King, D. R. Brown, Y. Shyu, and J. F. Sallis, “Patterns and correlates of physical activity among US women 40 years and older,” American Journal of Public Health, vol. 90, no. 2, pp. 264–270, 2000.
[39]
D. J. Frenk, “Environmental barriers to activity,” 2013, http://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/physical-activity-environment/.
[40]
S. L. Martin, G. J. Kirkner, K. Mayo, C. E. Matthews, J. L. Durstine, and J. R. Hebert, “Urban, rural, and regional variations in physical activity,” Journal of Rural Health, vol. 21, no. 3, pp. 239–244, 2005.
[41]
K. A. Cotter, “Health-related social control over physical activity: interactions with age and sex,” Journal of Aging Research, vol. 2012, Article ID 321098, 10 pages, 2012.
[42]
B. Resnick, M. G. Ory, K. Hora et al., “A proposal for a new screening paradigm and tool called Exercise Assessment and Screening for You (EASY),” Journal of Aging and Physical Activity, vol. 16, no. 2, pp. 215–233, 2008.
[43]
US Department of Health and Human Services (HHS), “Healthy People 2020,” 2012, http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=33.
[44]
W. Chodzko-Zajko, A. Schwingel, and C. H. Park, “Successful Aging: the role of physical activity,” American Journal of Lifestyle Medicine, vol. 3, no. 1, pp. 20–28, 2009.
[45]
M. G. Ory, M. L. Smith, and B. Resnick, “Changing behavior throughout the life-course: translating the success of aging research,” Translational Behavioral Medicine, vol. 2, no. 2, pp. 159–162, 2012.
