Skip to main content
SpringerLink
Log in

Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter

  • Original Investigation
  • Published:
European Journal of Ageing Aims and scope Submit manuscript

Abstract

Studies of health trends in older populations usually focus on single health indicators. We include multiple medical and functional indicators, which together indicate the broader impact of health problems experienced by individuals and the need for integrated care from several providers of medical and long-term care. The study identified severe problems in three health domains (diseases/symptoms, mobility, and cognition/communication) in three nationally representative samples of the Swedish population aged 77+ in 1992, 2002, and 2011 (n ≈ 1900; response rate >85 %). Institutionalized people and proxy interviews were included. People with severe problems in two or three domains were considered to have complex health problems. Results showed a significant increase of older adults with complex health problems from 19 % in 1992 to 26 % in 2002 and no change thereafter. Changes over time remained when controlling for age and sex. When stratified by education, complex health problems increased significantly for people with lower education between 1992 and 2002 and did not change significantly between 2002 and 2011. For higher-educated people, there was no significant change over time. Among the people with severe problems in the symptoms/disease domain, about half had no severe problems in the other domains. People with severe mobility problems, on the other hand, were more likely to also have severe problems in other domains. Even stable rates may imply an increasing number of very old people with complex health problems, resulting in a need for improved coordination between providers of medical care and social services.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  • Agborsangaya CB, Lau D, Lahtinen M, Cooke T, Johnson JA (2012) Multimorbidity prevalence and patterns across socioeconomic determinants: a cross-sectional survey. BMC Public Health 12:201. doi:10.1186/1471-2458-12-201

    Article  Google Scholar 

  • Agerholm J, Bruce D, de Leon AP, Burström B (2013) Socioeconomic differences in healthcare utilization, with and without adjustment for need: an example from Stockholm, Sweden. Scand J Public Health 41:318–325

    Article  Google Scholar 

  • Andersen M (ed) (2003) Mat och näring för sjuka inom vård och omsorg [Diet and nutrition for persons receiving social services or medical care]. Livsmedelsversket, Uppsala

  • Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43. doi:10.1016/S0140-6736(12)60240-2

    Article  Google Scholar 

  • Boyd CM et al (2007) Guided care for multimorbid older adults. Gerontologist 47:697–704

    Article  Google Scholar 

  • Chatterji S, Byles J, Cutler D, Seeman T, Verdes E (2015) Health, functioning, and disability in older adults-present status and future implications. Lancet 385:563–575. doi:10.1016/s0140-6736(14)61462-8

    Article  Google Scholar 

  • Christensen K, Doblhammer G, Rau R, Vaupel JW (2009) Ageing populations: the challenges ahead. Lancet 374:1196–1208

    Article  Google Scholar 

  • Crimmins EM, Beltrán-Sánchez H (2011) Mortality and morbidity trends: is there compression of morbidity? J Gerontol B Psychol Sci Soc Sci 66:75–86

    Article  Google Scholar 

  • Dowd JB, Hamoudi A (2014) Is life expectancy really falling for groups with low socio-economic status? Lagged selection bias and artefactual trends in mortality. Int J Epidemiol 43:983–988

    Article  Google Scholar 

  • Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    Article  Google Scholar 

  • Forma L, Rissanen P, Aaltonen M, Raitanen J, Jylha M (2009) Age and closeness of death as determinants of health and social care utilization: a case-control study. Eur J Public Health 19:313–318

    Article  Google Scholar 

  • Formiga F, Ferrer A, Sanz H, Marengoni A, Alburquerque J, Pujol R (2013) Patterns of comorbidity and multimorbidity in the oldest old: the Octabaix study. Eur J Intern Med 24:40–44. doi:10.1016/j.ejim.2012.11.003

    Article  Google Scholar 

  • Fors S, Lennartsson C, Agahi N, Parker MG, Lundberg O, Thorslund M (2013) Äldre har fått fler hälsoproblem, men klarar vardagen bättre [Increased prevalence of health problems among older people but increased ability to manage activities of daily living]. Lakartidningen 110:1403–1405

    Google Scholar 

  • Freid VM, Bernstein AB, Bush MA (2012) Multiple chronic conditions among adults aged 45 and over: trends over the past 10 years. NCHS data brief, no 100. National Center for Health Statistics Hyattsville, MD

  • Fried LP (2003) Establishing benchmarks for quality care for an aging population: caring for vulnerable older adults. Ann Intern Med 139:784–786

    Article  Google Scholar 

  • Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G (2004) Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol Biol Sci Med Sci 59:255–263

    Article  Google Scholar 

  • Galenkamp H, Braam AW, Huisman M, Deeg DJ (2013) Seventeen-year time trend in poor self-rated health in older adults: changing contributions of chronic diseases and disability. Eur J Public Health 23:511–517. doi:10.1093/eurpub/cks031

    Article  Google Scholar 

  • Galenkamp H, Huisman M, Braam AW, Schellevis FG, Deeg DJ (2014) Disease prevalence based on older people’s self-reports increased, but patient-general practitioner agreement remained stable, 1992–2009. J Clin Epidemiol 67:773–780. doi:10.1016/j.jclinepi.2014.02.002

    Article  Google Scholar 

  • Gatz M et al (2005) Complete ascertainment of dementia in the Swedish Twin Registry: the HARMONY study. Neurobiol Aging 26:439–447

    Article  Google Scholar 

  • Gijsen R, Hoeymans N, Schellevis FG, Ruwaard D, Satariano WA, van den Bos GA (2001) Causes and consequences of comorbidity: a review. J Clin Epidemiol 54:661–674

    Article  Google Scholar 

  • Glendinning C (2008) Increasing choice and control for older and disabled people: a critical review of new developments in England. Soc Policy Adm 42:451–469

    Article  Google Scholar 

  • Hallstrom B, Jonsson AC, Nerbrand C, Norrving B, Lindgren A (2008) Stroke incidence and survival in the beginning of the 21st century in southern Sweden: comparisons with the late 20th century and projections into the future. Stroke 39:10–15. doi:10.1161/strokeaha.107.491779

    Article  Google Scholar 

  • Hanratty B, Zhang T, Whitebreac M (2007) How close have universal health systems come to achieving equity in use of curative services? A systematic review. Int J Health Serv 37:89–109

    Article  Google Scholar 

  • Hung WW, Ross JS, Boockvar KS, Siu AL (2011) Recent trends in chronic disease, impairment and disability among older adults in the United States. BMC Geriatr 11:47. doi:10.1186/1471-2318-11-47

    Article  Google Scholar 

  • Larsson K, Kåreholt I, Thorslund M (2008) Care utilisation in the last years of life in relation to age and time to death; results from a Swedish urban population of the oldest old. Eur J Ageing 5:349–357

    Article  Google Scholar 

  • Lennartsson C et al (2014) Data resource profile: the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). Int J Epidemiol. doi:10.1093/ije/dyu057

    Google Scholar 

  • Link BG, Phelan J (1995) Social conditions as fundamental causes of disease. J Health Soc Behav 35:80–94

    Article  Google Scholar 

  • Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM (2003) Patterns of functional decline at the end of life. JAMA 289:2387–2392

    Article  Google Scholar 

  • Mackenbach JP (2012) The persistence of health inequalities in modern welfare states: the explanation of a paradox. Soc Sci Med 75:761–769. doi:10.1016/j.socscimed.2012.02.031

    Article  Google Scholar 

  • Marengoni A, Rizzuto D, Wang HX, Winblad B, Fratiglioni L (2009) Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc 57:225–230

    Article  Google Scholar 

  • Marengoni A et al (2011) Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev 10:430–439. doi:10.1016/j.arr.2011.03.003

    Article  Google Scholar 

  • Martin LG, Schoeni RF, Andreski PM, Jagger C (2012) Trends and inequalities in late-life health and functioning in England. J Epidemiol Community Health 66:874–880. doi:10.1136/jech-2011-200251

    Article  Google Scholar 

  • Meinow B, Parker MG, Kåreholt I, Thorslund M (2006) Complex health problems in the oldest old in Sweden 1992–2002. Eur J Ageing 3:98–106

    Article  Google Scholar 

  • Meinow B, Parker MG, Thorslund M (2010) Complex health problems and mortality among the oldest old in Sweden: decreased risk for men between 1992 and 2002. Eur J Ageing 7:81–90

    Article  Google Scholar 

  • Meinow B, Parker MG, Thorslund M (2011) Consumers of eldercare in Sweden: the semblance of choice. Soc Sci Med 73:1285–1289

    Article  Google Scholar 

  • National Board of Health and Welfare (2014) Tillståndet och utvecklingen inom hälso- och sjukvård och socialtjänst. Lägesrapport 2014 [The situation and the development of medical care and social services in Sweden. Report 2014]. National Board of Health and Welfare, Stockholm

  • OECD (2009) Health at a Glance 2009. OECD Publishing, Paris

  • OECD/European Union (2013) A good life in old age? OECD health policy studies. OECD Publishing, Paris

    Google Scholar 

  • Parker MG, Thorslund M (2007) Health trends in the elderly population: getting better and getting worse. Gerontologist 47:150–158

    Article  Google Scholar 

  • Phelan JC, Link BG, Tehranifar P (2009) Social conditions as fundamental causes of health inequalities theory, evidence and policy implications. J Health Soc Behav 51:28–40

    Article  Google Scholar 

  • Puts MT (2005) The effect of frailty on residential/nursing home admission in the Netherlands independent of chronic diseases and functional limitations. Eur J Ageing 2:264–274

    Article  Google Scholar 

  • Rau R, Soroko E, Jasilionis D, Vaupel JW (2008) Continued reductions in mortality at advanced ages. Popul Dev Rev 34:747–768

    Article  Google Scholar 

  • Robine JM, Michel JP (2004) Looking forward to a general theory on population aging. J Gerontol Biol Sci Med Sci 59:M590–M597

    Article  Google Scholar 

  • Rockwood K, Mitnitski A (2011) Frailty defined by deficit accumulation and geriatric medicine defined by frailty. Clin Geriatr Med 27:17–26. doi:10.1016/j.cger.2010.08.008

    Article  Google Scholar 

  • Rodriguez-Manas L et al (2012) Searching for an operational definition of frailty: a Delphi method based consensus statement. The frailty operative definition-consensus conference project. J Gerontol Biol Sci Med Sci 68:62–67. doi:10.1093/gerona/gls119

    Article  Google Scholar 

  • Rosén M, Haglund B (2005) From healthy survivors to sick survivors—implications for the twenty-first century. Scand J Public Health 33:151–155

    Article  Google Scholar 

  • Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K (2008) A standard procedure for creating a frailty index. BMC Geriatr 8:24. doi:10.1186/1471-2318-8-24

    Article  Google Scholar 

  • Seidell JC, Visscher TL (2000) Body weight and weight change and their health implications for the elderly. Eur J Clin Nutr 54(Suppl 3):S33–S39

    Article  Google Scholar 

  • Sole-Auro A, Alaniz M (2014) Are we living longer but less healthy? Trends in mortality and morbidity in Catalonia (Spain), 1994–2011. Eur J Ageing 12:61–70

    Article  Google Scholar 

  • Sourial N et al (2013) Implementing frailty into clinical practice: a cautionary tale. J Gerontol Biol Sci Med Sci 68:1505–1511. doi:10.1093/gerona/glt053

    Article  Google Scholar 

  • Statistics Sweden (2015) Population projections. http://www.statistikdatabasen.scb.se/pxweb/sv/ssd/START__BE__BE0401__BE0401A/BefolkprognRev2014/table/tableViewLayout1/?rxid=3c44ab37-4535-42f0-b8bc-2f13926a5add. Accessed 15 February 2015

  • Stegmayr B, Asplund K (2003) Improved survival after stroke but unchanged risk of incidence. Lakartidningen 100:3492–3498

    Google Scholar 

  • Uijen AA, van de Lisdonk EH (2008) Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract 14(Suppl 1):28–32

    Article  Google Scholar 

  • Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M (2009) Defining comorbidity: implications for understanding health and health services. Ann Fam Med 7:357–363

    Article  Google Scholar 

  • Verbrugge LM, Jette AM (1994) The disablement process. Soc Sci Med 38:1–14

    Article  Google Scholar 

  • Walston J et al (2006) Research agenda for frailty in older adults toward a better understanding of physiology and etiology: summary from the American Geriatrics Society/National Institute on Aging Research Conference on Frailty in Older Adults. J Am Geriatr Soc 54:991–1001

    Article  Google Scholar 

  • Whitson HE, Purser JL, Cohen HJ (2007) Frailty thy name is… Phrailty? J Gerontol Biol Sci Med Sci 62:728–730

    Article  Google Scholar 

Download references

Acknowledgments

This work was supported by the Swedish Council for Working Life and Social Research (FAS) (grant number 2010-0583).

Author information

Authors and Affiliations

  1. Aging Research Center, Karolinska Institute & Stockholm University, Gävlegatan 16, 113 30, Stockholm, Sweden

    Bettina Meinow, Ingemar Kåreholt, Mats Thorslund & Marti G. Parker

  2. Institute of Gerontology, School of Health Sciences, Jönköping University, Jönköping, Sweden

    Ingemar Kåreholt

Authors
  1. Bettina Meinow
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ingemar Kåreholt
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mats Thorslund
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marti G. Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Bettina Meinow.

Ethics declarations

Conflict of interest

The authors have no conflicts of interest.

Additional information

Responsible editor: D.J.H. Deeg.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meinow, B., Kåreholt, I., Thorslund, M. et al. Complex health problems among the oldest old in Sweden: increased prevalence rates between 1992 and 2002 and stable rates thereafter. Eur J Ageing 12, 285–297 (2015). https://doi.org/10.1007/s10433-015-0351-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10433-015-0351-2

Keywords

Search

Navigation