Identification of Chronic Conditions Associated with Fragmentation of Care in the Very Old Population in Japan.

Context Fragmentation of care is known to be associated with frequent tests, emergency visits, hospitalizations, and increased healthcare costs. Patients with multimorbidity are more likely to experience care fragmentation, but it is not yet clear which chronic conditions pose a higher risk for care fragmentation.

Objective To identify the chronic condition that pose a higher risk for the occurrence of care fragmentation in the very old population.

Study Design and Analysis An observational cross-sectional study was conducted using the baseline survey and claims data of the Cohort study. (The Kawasaki Aging and Wellbeing Project)

Setting or Dataset Community-dwelling people in Kawasaki city, Japan.

Population Studied Independent elderly aged 85-89 living in Kawasaki city, Japan.

Individuals with two or more chronic conditions.

Intervention/Instrument The presence of each chronic condition was assessed, including hypertension, diabetes, dyslipidemia, stroke, heart disease, digestive disease, respiratory disease, kidney disease, prostate disease, thyroid disease, Parkinson’s disease, collagen disease, cancer, osteoporosis, joint pain, hyperuricemia, and dementia.

Outcome Measures Care fragmentation was defined as visiting two or more medical institutions regularly. (Regularly Visited Institution; RVI ≥ 2).

Results Of the 1024 participants, 968 were included in the analysis. The median RVI was 2. After adjusting for sex and frailty, the odds (95% CI) for care fragmentation were significantly higher in participants with osteoporosis (2.27; 1.44-3.57), cancer (2.07; 1.32-3.23), prostate disease (1.79; 1.15-2.80), and ophthalmic disease (1.67; 1.16-2.41). In the adjusted model, there was no significant association between care fragmentation and sex or frailty.

Conclusions Among the very old population with multimorbidity, the presence of osteoporosis, cancer, ophthalmic disease, and prostate disease was associated with care fragmentation.