Chronic disease and changes in quality of life in older adults: The Rancho Bernardo Study

Background: Although older adults often have more than one chronic disease, no community-based studies report the sex-specific impact of multiple co-morbidities on change in health-related quality of life (HRQoL) over time. This 11-year study examines associations of the nine most common chronic diseases with HRQoL change. Methods: Participants were 914 women and 625 men (median ages=74; 72). HRQoL was assessed with SF-12 in 1995, 2000, and 2006; physician-diagnosed disease was indirectly validated. Results: At baseline, 38% of women and men reported none of these common diseases; 10.5% and 8.4% reported ≥3. Eleven years later, 15.7% of women and 19.8% of men reported none; 30.3% and 26.0% reported ≥3 of these diseases. Significant sex differences in physical (PCS) and mental component summary (MCS) scores were observed at all evaluations. In women, significant PCS declines were associated with arthritis, pulmonary disease, and osteoporosis (parameter estimates [PE] =-5.81, -4.42, and -4.05). In men, significant declines were associated with angina, pulmonary disease, arthritis, and diabetes (PE = -4.70, -4.68, -3.69, and –3.25). Those with ≥3 conditions at baseline (1995) had steeper PCS declines than those with fewer conditions. Depression was associated with worsening MCS (P<0.001) in both sexes. Conclusions: Interventions are known to sustain or improve HRQoL in the elderly with one chronic disease; interventions appropriate for multiple conditions have not been reported, but theoretically would enhance the lives of many of the rapidly growing number of the oldest-old.