Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people
Summary: Background: Prevalence of both multimorbidity and frailty increases with age, but more evidence is needed to elucidate their relationship and their association with other health-related outcomes. We analysed the dynamics of both conditions as people age and calculate the associated risk of...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-10-01
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| Series: | EClinicalMedicine |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589537022003406 |
| _version_ | 1811309822860066816 |
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| author | Lucía A. Carrasco-Ribelles Albert Roso-Llorach Margarita Cabrera-Bean Anna Costa-Garrido Edurne Zabaleta-del-Olmo Pere Toran-Monserrat Francesc Orfila Pernas Concepción Violán |
| author_facet | Lucía A. Carrasco-Ribelles Albert Roso-Llorach Margarita Cabrera-Bean Anna Costa-Garrido Edurne Zabaleta-del-Olmo Pere Toran-Monserrat Francesc Orfila Pernas Concepción Violán |
| author_sort | Lucía A. Carrasco-Ribelles |
| collection | DOAJ |
| description | Summary: Background: Prevalence of both multimorbidity and frailty increases with age, but more evidence is needed to elucidate their relationship and their association with other health-related outcomes. We analysed the dynamics of both conditions as people age and calculate the associated risk of death, nursing home admission, and need for home care. Methods: Data were drawn from the primary care electronic health records of a longitudinal cohort of people aged 65 or older in Catalonia in 2010–2019. Frailty and multimorbidity were measured using validated instruments (eFRAGICAP, a cumulative deficit model; and SNAC-K, respectively), and their longitudinal evolution was described. Cox regression models accounted for the competing risk of death and adjusted by sex, socioeconomical status, and time-varying age, alcohol and smoking. Findings: We included 1 456 052 patients. Prevalence of multimorbidity was consistently high regardless of age, while frailty almost quadrupled from 65 to 99 years. Frailty worsened and also changed with age: up to 84 years, it was more related to concurrent diseases, and afterwards, to frailty-related deficits. While concurrent diseases contributed more to mortality, frailty-related deficits increased the risk of institutionalisation and the need for home care. Interpretation: The nature of people’s multimorbidity and frailty vary with age, as does their impact on health status. People become frailer as they age, and their frailty is more characterised by disability and other symptoms than by diseases. Mortality is most associated with the number of comorbidities, whereas frailty-related deficits are associated with needing specialised care. Funding: Instituto de Salud Carlos III through PI19/00535, and the PFIS Grant FI20/00040 (Co-funded by European Regional Development Fund/European Social Fund). |
| first_indexed | 2024-04-13T09:48:42Z |
| format | Article |
| id | doaj.art-ac8b7297e02d4f71a21464bf22291583 |
| institution | Directory Open Access Journal |
| issn | 2589-5370 |
| language | English |
| last_indexed | 2024-04-13T09:48:42Z |
| publishDate | 2022-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | EClinicalMedicine |
| spelling | doaj.art-ac8b7297e02d4f71a21464bf222915832022-12-22T02:51:40ZengElsevierEClinicalMedicine2589-53702022-10-0152101610Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing peopleLucía A. Carrasco-Ribelles0Albert Roso-Llorach1Margarita Cabrera-Bean2Anna Costa-Garrido3Edurne Zabaleta-del-Olmo4Pere Toran-Monserrat5Francesc Orfila Pernas6Concepción Violán7Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain; Department of Signal Theory and Communications, Universitat Politécnica de Catalunya (UPC), Barcelona, Spain; Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, SpainFundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain; Departament de Pediatria, d’Obstetrícia i Ginecologia i de Medicina Preventiva, Universitat Autónoma de Barcelona, Bellaterra, SpainDepartment of Signal Theory and Communications, Universitat Politécnica de Catalunya (UPC), Barcelona, SpainUnitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, SpainFundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, Spain; Geréncia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; Nursing Department, Faculty of Nursing, Universitat de Girona, Girona, SpainUnitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain; Fundació Institut d’Investigació en ciéncies de la salut Germans Trias i Pujol (IGTP), Badalona, Spain; Medicine Department, Faculty of Medicine, Universitat de Girona, Girona, SpainGeréncia Territorial de Barcelona, Institut Català de la Salut, Barcelona, Spain; Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Barcelona, SpainUnitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l’Atenció Primària de Salut Jordi Gol I Gurina (IDIAPJGol), Mataró, Spain; Direcció d’Atenció Primària, Metropolitana Nord Institut Català de Salut, Badalona, Spain; Fundació Institut d’Investigació en ciéncies de la salut Germans Trias i Pujol (IGTP), Badalona, Spain; Universitat Autónoma de Barcelona, Cerdanyola del Vallés, Spain; Corresponding author.Summary: Background: Prevalence of both multimorbidity and frailty increases with age, but more evidence is needed to elucidate their relationship and their association with other health-related outcomes. We analysed the dynamics of both conditions as people age and calculate the associated risk of death, nursing home admission, and need for home care. Methods: Data were drawn from the primary care electronic health records of a longitudinal cohort of people aged 65 or older in Catalonia in 2010–2019. Frailty and multimorbidity were measured using validated instruments (eFRAGICAP, a cumulative deficit model; and SNAC-K, respectively), and their longitudinal evolution was described. Cox regression models accounted for the competing risk of death and adjusted by sex, socioeconomical status, and time-varying age, alcohol and smoking. Findings: We included 1 456 052 patients. Prevalence of multimorbidity was consistently high regardless of age, while frailty almost quadrupled from 65 to 99 years. Frailty worsened and also changed with age: up to 84 years, it was more related to concurrent diseases, and afterwards, to frailty-related deficits. While concurrent diseases contributed more to mortality, frailty-related deficits increased the risk of institutionalisation and the need for home care. Interpretation: The nature of people’s multimorbidity and frailty vary with age, as does their impact on health status. People become frailer as they age, and their frailty is more characterised by disability and other symptoms than by diseases. Mortality is most associated with the number of comorbidities, whereas frailty-related deficits are associated with needing specialised care. Funding: Instituto de Salud Carlos III through PI19/00535, and the PFIS Grant FI20/00040 (Co-funded by European Regional Development Fund/European Social Fund).http://www.sciencedirect.com/science/article/pii/S2589537022003406MultimorbidityFrailtyMortalityAgingCohortPrimary health care |
| spellingShingle | Lucía A. Carrasco-Ribelles Albert Roso-Llorach Margarita Cabrera-Bean Anna Costa-Garrido Edurne Zabaleta-del-Olmo Pere Toran-Monserrat Francesc Orfila Pernas Concepción Violán Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people EClinicalMedicine Multimorbidity Frailty Mortality Aging Cohort Primary health care |
| title | Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people |
| title_full | Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people |
| title_fullStr | Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people |
| title_full_unstemmed | Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people |
| title_short | Dynamics of multimorbidity and frailty, and their contribution to mortality, nursing home and home care need: A primary care cohort of 1 456 052 ageing people |
| title_sort | dynamics of multimorbidity and frailty and their contribution to mortality nursing home and home care need a primary care cohort of 1 456 052 ageing people |
| topic | Multimorbidity Frailty Mortality Aging Cohort Primary health care |
| url | http://www.sciencedirect.com/science/article/pii/S2589537022003406 |
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