The Association of Multimorbidity with Whole Health-Centric Provider Communication among Older Adults in the US




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The Association of Multimorbidity with Whole Health-centric Provider Communication among Older Adults in the US

Shawana Shaikh, OMS II, Jahnavi Pinnamraju PharmD, MS, Usha Sambamoorthi, MA, PhD


Whole Health is a person-centered approach diverging from the biomedical focus on diseases and emphasizes nutrition, recharging, spiritual, social support, physical well-being, environmental factors, and mental health. Incorporating the central tenant of “what matters to you” is key in whole health-centric patient-provider communication. This starts with inquiring patients about health goals and life quality. Nearly, 38.0 million (73%) of Americans aged > 65 years have multimorbidity. For individuals with multimorbidity, challenges exist to implementing evidence-based practices for each disease. Therefore, it is necessary to focus on the whole person and incorporate individuals' health goals and life quality for optimal management. The purpose of this study is to examine the prevalence of whole health-centered provider communication among community-dwelling older adults aged > 65 years.


A cross-sectional study design with data on older adults (age > 65 years) from the publicly available 2020 Medicare Current Beneficiary Survey was used. Whole health variables included how often providers asked about health goals (definitely, somewhat, never) and life quality (never, sometimes, usually, always). Multimorbidity was defined as the presence of two or more chronic conditions. Rao-Scott Chi-square tests and multinomial logistic regression were used to identify the association of multimorbidity with whole health variables while controlling for age, sex, and social determinants of health such as education, poverty, food security, supplemental health insurance, problems paying medical bills, metropolitan area, and marital status. All analyses were conducted with replicate weights using SAS 9.4 survey procedures.


There were 5,516 older adults in our sample representing ~38.71 million older adults in the US. Overall, 43% reported that their healthcare providers 'definitely' inquired about their health goals while 31.1% reported they were 'not' asked. Additionally, only 17.5% reported being inquired ‘always’ about their life quality, while 46.5% reported 'never'. A higher percentage of those with multimorbidity were ‘definitely’ asked about health goals (69.5% vs 65.7%) compared to those without multimorbidity. However, a lower percentage of those with multimorbidity (16.5% vs. 21.6%) were ‘always’ asked about life quality. In adjusted multinomial logistic regressions, older adults with multimorbidity were more likely to 'definitely' be asked about their health goals (aOR = 1.56, 95% CI 1.26, 1.94, p < 0.001) and less likely to ‘always’ be asked about life quality (aOR = 0.65, 95% CI = 0.53, 0.79 p < 0.001) compared to those without multimorbidity.


Overall, whole health-centric communication was poor. Older adults with multimorbidity were more likely to be asked about health goals but less likely to be asked about life quality. Our findings suggest missed opportunities by providers to engage in whole health communication with patients including those with multimorbidity. Health encounters with patients can be an opportunity to empower patients to achieve person-centered health. Integrating health goals and quality-of-life questions into visits can assist providers in developing customized management to empower patients in achieving optimal and whole health.


Research Appreciation Day Award Winner - HSC College of Pharmacy, 2024 Clinical/Outcomes/Education Research Award - 1st Place