Differences in chronic illness between older and younger people

Although ME/CFS was not listed as one of the chronic conditions* reported in a recent study of the differences in how older and younger people live with multiple chronic conditions (MCC, >2 co-occurring chronic conditions), there still were interesting findings. The study was performed by Mary L. Adams, MS, MPH and published in Preventing Chronic Disease, a CDC publication, and republished on Medscape.com, a site for health care professonals.

The study was robust, with over 200,000 records examined. Naturally, there were differences arising from life lessons learned and also from lifestyle choices, like smoking tobacco and obesity. Typically, MCCs increase with age, resulting in increasing Medicare costs. The study measured disability status, quality of life measures, chronic conditions, risk factors, and access to health care.

Surprisingly, people younger than 65 represented the majority (>60%) with MCCs. Among adults with two MCCs there were significant differences by age group in 18 measures, indicating that adults younger than 65 were worse off than adults aged 65 or older. Results were similar whether diabetes, depression, hypertension, high cholesterol (which could also be risk factors) were included.

Most uninsured adults are younger than 65 years, and younger adults with MCCs were more likely than older ones to report a cost barrier to their health care in the past year. Younger adults with MCCs were also less likely to report a recent routine check-up than adults aged 65 or older with MCCs. Taking preventive health measures, like seeing a healthcare practitioner or eating real food, is a learned skill and one I hope to teach through this blog.

Annual medical care expenditures for chronic conditions in adults aged 18 to 44, 45 to 64, and 65 or older with MCCs were similar at approximately $9,000 for those with 4 or more chronic conditions and approximately $4,000 for those with 2 or 3. Frankly, this surprised me. MM running-snake toyI probably spend $9,000 in out of pocket costs when I add up just my supplements and the costs associated with my service dog, The Divine Miss Em, like food, toys, and gear (just kidding).

Consistent with common sense, people with 3 or more chronic conditions and those with CVD (cardiovascular disease) or diabetes [OR ME/CFS] were more likely to report poorer quality of life than those with fewer or different chronic conditions. This analysis did not compare age groups and could have been influenced by higher rates of depression in younger people.

Differences in reported quality of life could also result from different contexts, because younger adults are more likely to be employed than older adults. For example, interpretation of activity limitations may depend on age, employment status, or both. However, even when controlling for measures including employment status and depression, these age differences remained for 14 measures representing a range of outcomes. The results may also reflect the direct or indirect impact of other factors such as smoking or obesity that are also higher among younger adults and may affect health and disability status.

An unexpected finding was the high rate of cognitive impairment among younger adults with MCCs. This could result from lower rates of other chronic conditions or factors such as lack of sleep, side effects of medication, or use of illicit drugs and may not be associated with future risk of dementia. Whatever the cause, being cognitively impaired may affect someone’s ability to self-manage other chronic conditions. Younger adults were also more likely than older ones to report risk factors that can increase the chance of developing additional chronic conditions in the future.

Age-related differences in MCCs using hospital discharge data indicated, for example, that among adults 18 to 44 years, depression and substance abuse were most common. This old-young comparison study’s results, which did not collect information on substance abuse, are consistent with the earlier finding by showing that depression was more common among working age adults with or without MCCs. Along with depression, risk factors of obesity and smoking were also higher among younger adults with and without MCCs. Whatever the cause of the differences, results highlight the current impact of MCCs on younger adults as opposed to Boomers. This study also supports the finding that teenagers now are the first generation to be less healthy than their parents.

How do you feel about this? Do you think a younger person with ME/CFS has a harder time than someone over 65?




*MCCs were based on up to 12 chronic conditions (heart disease, stroke, asthma, arthritis, chronic obstructive pulmonary disease, high cholesterol, cognitive impairment, diabetes, depression, chronic kidney disease, cancer other than skin, and hypertension).