Epidemiological strategies for adapting Disease Management Programs to older persons with multimorbidity

Principal investigator: Helle Gybel Juul-Larsen

Principal supervisor: Ove Andersen

Co-supervisor(s): Janne Petersen and Thomas Bandholm

Research initiative: Optimed, Clinical Research Centre, Copenhagen University Hospital, Hvidovre. 

Time frame: 2015-2018

Background: The Danish Health and Medicines Authority has recommended Disease Management Programs based on specific patient groups tailored to the Danish health care system to constitute an improved strategy for treatment of chronic diseases. However, the evidence underlying the choice of treatment and rehabilitation is based on studies where patients with co-morbidity are excluded. This PhD-project will examine strategies to develop new generations of Disease Management Programs that require knowledge of development of different chronic disease patterns and the prognosis of these by grouping older people into more homogenous groups with the use of statistical latent-class models.

Purpose: To investigate the hypothesis that older persons can be grouped into homogenies patterns of multimorbidity, and that these patterns are related to the ageing process when measured as time to death and as functional decline.

Experimental approach: Study I will identify homogeneous patterns of multimorbidity in the older population. It will be conducted as a national registry study of people 65 years and over (N approx. 1 million).

Study II will describe biological age (time to death) from the rate of development of chronic diseases within patterns of multimorbidity. It will be conducted as a longitudinal study in persons, who have died from non-traumatic causes and are over the age of 65 years (N approx. 60.000).

Study III will associate older medical patients' functional level and muscle strength with biological age, as described by patterns of multimorbidity. It will be conducted as a prospective cohort study of patients 65 years and over (N=119).

Contact: helle.juul-larsen@regionh.dk