Examining multimorbidity in older adults living in naturally occurring retirement communities, in Ontario, Canada, using latent class analysis

Background — Multimorbidity, ≥ 2 chronic conditions as per the World Health Organization, can complicate aging in place and lead to earlier transitions to nursing homes. To inform supportive service intervention planning in naturally occurring retirement communities (NORCs), which are areas where large proportions of older adults reside, we examined clustering patterns of specific chronic conditions among NORC residents.

Methods — We conducted a cross-sectional analysis of a population-based cohort of community-dwelling NORC residents aged ≥ 66 years as of January 1, 2022, in Ontario, Canada. A provincial NORC registry of high-rise buildings was linked with individual-level health administrative records by postal code to identify NORC residents. Multimorbidity (≥ 2 of 17 measured chronic conditions), sociodemographic, clinical, and health service use (HSU) characteristics in NORC residents were assessed. Baseline descriptive statistics of the NORC cohort were compared by multimorbidity status, overall, and by sex, using standardized differences (STD). Latent class analysis (LCA) identified groups (known as classes) with similar patterns of co-occurring chronic conditions.

Results — Among 200,565 older NORC residents (63% female, 89% in urban settings), 84% lived with multimorbidity. Multimorbid residents were older (mean 78 vs. 74 years; STD 0.58) and more had low-income status (19% vs. 9%; STD 0.27) than non-multimorbid counterparts. LCA resulted in a 6-class solution. Class 1 (13% of the cohort with multimorbidity) was characterized by conditions including osteoarthritis, osteoporosis, cancer, and mood disorders, class 2 (36%) by hypertension, osteoarthritis, osteoporosis, cancer, and mood disorders, class 3 (23%) by diabetes, class 4 (10%) by cardiovascular conditions, class 5 (8%) by respiratory conditions, and class 6 (10%) contained above average prevalences for 16 conditions and had increased HSU, including unscheduled emergency visits (48%).

Conclusion — Findings suggest a substantial burden of multimorbidity in NORC residents and reinforce the importance of designing programs in NORCs to help older adults with multimorbidity age in place.