1. Quantifying the magnitude and the overlap between frailty, multimorbidity and disability in the very old – results from the Newcastle 85+ Study
Michael Reid2, Andrew Kingston1,2, Barbara Hanratty1,2, Rachel Duncan1,2
1Institute of Health and Society & Newcastle University Institute for Ageing, Newcastle University, UK
2NIHR School for Primary Care Research, Newcastle University, UK
BACKGROUND
METHODS
The population continues to age and with it the number of people with multimorbidity, frailty and disability will grow.
Multimorbidity, frailty and disability are terms used interchangeably to describe the health of older people. However, these conditions are distinct, albeit with considerable overlap and interaction. (1,2)
Improved clinical outcomes could be achieved if GPs are able to clearly differentiate between these concepts and target therapies.
We will clearly define and quantify the overlap between multimorbidity, frailty and disability at baseline to set the stage for a longitudinal investigation of risk factors.
Cross sectional analysis of the baseline wave from the Newcastle 85+ Study
The three domains were assessed as follows:
Disability: [Instrumental] Activities of daily living [(I)ADL]
Multimorbidity: GP diagnosed diseases identified from medical records
Frailty: Fried phenotype (robust vs. pre-frail/frail)(3)
Quantification of the overlap between the three concepts.
Explore the association with mortality via Cox Proportional Hazards Model
RESULTS
Complete data available for 690 people, of whom 59.3% (n=409) were women and 40.7% (n=281) were men.
AIM
To quantify the prevalence of and the overlap between frailty, multimorbidity and disability in the Newcastle 85+ Study at baseline.
Figure 1: Overlap between multimorbidity, frailty and disability
Figure 2: Proportional overlap for men and women
STUDY DESIGN
Longitudinal prospective population study (recruited from general practice)
Individuals born in 1921 and aged 85 at baseline interview (2006/7)
Followed up at 18, 36, 60 and 120 months
Figure 3: Cox Proportional Hazards – Risk of death (reference: no disability, frailty or multimorbidity | gender adjusted)
CONCLUSIONS
A greater proportion of women (30%) compared to men (21%) have all three conditions. Multimorbidity or frailty alone does not infer greatest risk of death but disability alone does. Dual combinations of any of the conditions infer greater risk of death but all three together have the greatest risk of all. Future directions will examine risk factors for transitions to disease, frailty, and multimorbidity states.
REFERENCES
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. The journals of gerontology Series A, Biological sciences and medical sciences. 2004;59(3):
Boeckxstaens P, Vaes B, Legrand D, Dalleur O, De Sutter A, Degryse J-M. The relationship of multimorbidity with disability and frailty in the oldest patients: A cross-sectional analysis of three measures of multimorbidity in the BELFRAIL cohort. European Journal of General Practice. 2015;21(1):39-44.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in Older Adults: Evidence for a Phenotype. The Journals of Gerontology: Series A. 2001;56(3):M146-M57.
This research presents independent research funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.