VARIABLE EFFECT OF COMORBIDITY ON THE ASSOCIATION OF CHRONIC CARDIAC-FAILURE WITH DISABILITY IN COMMUNITY-DWELLING OLDER PERSONS

The effect of cardiac failure (CF) and comorbidity on disability in ol der persons was studied in a cross-sectional survey. The whole populat ion aged 65 + years (n = 652; 528 eligible) living in a small town nea r Florence (Italy) was enrolled. Finally, 459 individuals (73.0% of el igible) underwent a multidimensional evaluation. CF was defined as a N YHA II-IV class in the presence of an obviously abnormal EGG. Disabili ty was assessed by the 14-item WHO scale. Comorbid conditions that had a prevalence > 5% and might be considered pathophysiologically unrela ted to CF were also identified. The univariate association of CF with disability was analyzed. Multivariate associations were estimated as w ell, by taking simultaneously into account the effect of comorbid cond itions that had an independent effect on disability and were considere d as either confounders or effect modifiers of that association. Preva lence of CF [6.1% in the whole study population) was higher with advan cing age (greater than or equal to 75 years: 8.3 versus 65-74 years: 4 .5%, odds ratio, OR: 1.93, 95% confidence interval, CI: 1.02 4.18), in the presence of hypertension (OR: 2.87, 95% CI: 1.32-6.23), and among individuals who were living alone (OR: 2.44, 95% CI: 1.10-5.56). CF w as associated with a higher prevalence of disability (35.5 versus 19.5 %; OR 2.67. 95%, CI: 1.21-5.42). Comorbidity modified the association of CF with disability following two patterns: while the independent ef fect of CF on the prevalence of disability was similar in the absence or in the presence of chronic obstructive pulmonary disease. healing i mpairment, gastrointestinal tract disease, or osteoarthritis, such eff ect was much larger in the presence than in the absence of: visual imp airment, previous stroke. or urinary incontinence. The composite patho physiological pathways of such different interactions are still to be elucidated. Copyright (C) 1996 Elsevier Science Ireland Ltd