Patterns of physical, cognitive, and mental functioning among older primary care patients and differences in coping styles

Ljiljana Majnaric, Tomislav Kurevija, Sanja Bekić

Keywords: aging, chronic diseases, multimorbidity, functional decline, coping with chronic stress, prevention

Background:
Chronic diseases tend to accumulate (multimorbidity), which accelerates the age-related decline in older individuals' physical, mental, and cognitive functioning. Older patients with chronic diseases are highly heterogeneous, which hampers delivering of individualized care and preventive strategies. Inadequate coping with chronic stress can accelerate aging and the development of comorbidities and functional decline.

Research questions:
How physical frailty, mental disorders, and cognitive impairment cluster together, and how these clusters are associated with comorbidities and coping styles.

Method:
Participants (N=263, F=172) were older individuals (≥60), PC attendees, who were mobile and not suffering from dementia. For screening participants on physical frailty, cognitive impairment, and mental disorders, we used Fried`s phenotype model, the Mini-Mental State Examination, the Geriatric Anxiety Scale, and the Geriatric Depression Scale. We used the 14-scale questionnaire Brief COPE to test participants on coping styles. To identify clusters, we used the fuzzy algorithm k-means. To further describe the identified clusters, we examined differences in age, gender, a number of chronic diseases, and some diagnoses of chronic diseases, in medications prescribed, body mass index, renal function decline (expressed as the glomerular filtration rate), and coping styles.

Results:
The most appropriate cluster solution was the one with three clusters, termed: functional (FUN) (N=139), dysfunctional (DFUN) (N=81), and cognitively impaired (COG-IMP) (N=43). The cluster FUN was associated with a positive reframing coping style. Religion and self-blame were coping mechanisms specifically associated only with cluster DFUN; self-distraction only with cluster COG-IMP; and these two latter clusters shared the mechanisms of behavioral disengagement and denial. Participants in particular clusters demonstrated significant variations in some other features, indicating differences in health status.

Conclusions:
Screening older individuals in coping styles can be used to predict the levels of physical, mental, and cognitive health decline, and to improve personalized prevention and treatment strategies.

Points for discussion:
Can we set up research protocols to support an integrated model of care?