Healthcare task difficulty among older adults with multimorbidity

Med Care. 2014 Mar;52 Suppl 3(0 3):S118-25. doi: 10.1097/MLR.0b013e3182a977da.


Background: Applying disease-specific guidelines to people with multimorbidity may result in complex regimens that impose treatment burden.

Objectives: To describe and validate a measure of healthcare task difficulty (HCTD) in a sample of older adults with multimorbidity.

Research design: Cross-sectional and longitudinal secondary data analysis.

Subjects: Multimorbid adults aged 65 years or older from primary care clinics.

Measures: We generated a scale (0-16) of self-reported difficulty with 8 HCTD and conducted factor analysis to assess its dimensionality and internal consistency. To assess predictive ability, cross-sectional associations of HCTD and number of chronic diseases, and conditions that add to health status complexity (falls, visual, and hearing impairment), patient activation, patient-reported quality of chronic illness care (Patient Assessment of Chronic Illness Care), mental and physical health (SF-36) were tested using statistical tests for trend (n=904). Longitudinal analyses of the effects of change in HCTD on changes in the outcomes were conducted among a subset (n=370) with ≥1 follow-up at 6 and/or 18 months. All models were adjusted for age, education, sex, race, and time.

Results: Greater HCTD was associated with worse mental and physical health [Cuzick test for trend (P<0.05)], and patient-reported quality of chronic illness care (P<0.05). In longitudinal analysis, increasing patient activation was associated with declining HCTD over time (P<0.01). Increasing HCTD over time was associated with declining mental (P<0.001) and physical health (P=0.001) and patient-reported quality of chronic illness care (P<0.05).

Conclusions: The findings of this study establish the construct validity of the HCTD scale.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Chronic Disease / epidemiology*
  • Chronic Disease / psychology*
  • Comorbidity
  • Cost of Illness*
  • Cross-Sectional Studies
  • Female
  • Geriatric Assessment
  • Health Status
  • Humans
  • Longitudinal Studies
  • Male
  • Mental Health / statistics & numerical data*
  • Self Report*
  • Surveys and Questionnaires / standards*
  • United States / epidemiology