Factors Affecting the Functional Status of Multimorbid Elderly Patients With Essential Hypertension

BACKGROUND: Increasing life expectancy is closely related to the increasing burden of polymorbidity, as well as the number of medications per patient of elderly and senile age (polypharmacy). These factors can have a direct and indirect impact on the cognitive and functional status of patients, which is of utmost importance for preserving both, the duration and the quality of life of older patients.

AIM: Assessment of functional status of multimorbid elderly patients with essential arterial hypertension depending on the burden and structure of multimorbidity and its possible relationship with cognitive function condition.

METHODS: 330 patients aged ≥ 60 years with arterial hypertension (median age 79 years, 50.6% women) were included in the study. All patients underwent assessment of functional status using the Functional Activities Questionnaire (FAQ) and cognitive functions using the Montreal Cognitive Assessment Scale, Mini-Mental State Examination, Alzheimer’s Disease Assessment Scale (Cognitive Subscale).

RESULTS: The median total score on the FAQ questionnaire was statistically significantly higher in the atrial fibrillation group [12 (9–14) points] compared to the arterial hypertension group without atrial fibrillation [10 (6–12) points; p = 0.001], in the chronic kidney disease group [11 (8–14) points] than in the group without chronic kidney disease [10 (6–13) points; p = 0.002). The median final FAQ questionnaire score was statistically significantly (p < 0.001) higher in the group of patients with a Charlson comorbidity index ≥ 8 points [12 (9–15) points] compared to that in the group of patients with a Charlson index score of 0–4 points [9 (6–11) points].

According to linear regression analysis, there was a statistically significant relationship between the number of FAQ scores, on the one hand, and the patients’ age (R² = 0.175; β = 0.422), Charlson comorbidity index (R² = 0.044; β = 0.216), and the results of cognitive functions testing [Mini-Mental State Examination (R² = 0.348; β = −0.591), Montreal Cognitive Assessment Scale (R² = 0.286; β = −0.537), Alzheimer’s Disease Assessment Scale (Cognitive Subscale; R² = 0.345; β = 0.589; p < 0.001 in all cases).

CONCLUSION: In elderly patients with essential arterial hypertension, the presence of concomitant atrial fibrillation and chronic kidney disease has a negative impact on their functional activity and cognitive status. Decrease in functional activity and deterioration of cognitive functioning of elderly patients with arterial hypertension is also associated with increasing age and burden of multimorbidity (Charlson index).