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Original Article

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

, , , , &
Pages 39-44 | Received 03 Apr 2013, Accepted 04 Apr 2014, Published online: 01 Jul 2014
 

Abstract

Background: Ageing people show increasing morbidity, dependence and vulnerability.

Objectives: To compare the relationships of different measures of multimorbidity with dependence (operationalized as disability) and vulnerability (operationalized as frailty).

Method: A cross-sectional analysis within the BELFRAIL cohort (567 subjects aged ≥ 80). Multimorbidity was measured using a disease count (DC), the Charlson comorbidity index (CCI) and the cumulative illness rating scale (CIRS), respectively. Associations with disability (based on activities of daily living) and frailty (defined by the Fried frailty criteria) were assessed using bivariable and multivariable analyses. Net reclassification improvement (NRI) values were calculated to compare the abilities of the DC, CCI and CIRS to identify patients with disability or frailty.

Results: Disability was associated with the DC (crude odds ratio, OR: 2.1; 95% confidence interval, CI: 1.4–3.4), CCI (crude OR: 1.8; 95% CI: 1.2–2.7) and CIRS (crude OR: 4.0; 95% CI: 2.5–6.5); only the association with CIRS was independent of age, sex, chronic inflammation, impaired cognition and frailty (adjusted OR: 3.2; 95% CI: 1.7–5.8). Frailty was associated with CCI (crude OR: 2.4; 95% CI: 1.2–4.6) and CIRS (crude OR: 2.6; 95% CI: 1.3–5.3); adjusted for age, sex, chronic inflammation, impaired cognition and disability. These associations were not statistically significant. The NRIs demonstrated a similar ability of the DC, CCI, and CIRS to identify patients with disability or frailty, respectively.

Conclusion: The associations of different measures of multimorbidity with disability and frailty differ but their ability to identify patients with disability or frailty is similar. Generally, multimorbidity scores incompletely reflect dependence and vulnerability in this age group.

This article is part of the following collections:
The EJGP Collection on Multimorbidity

ACKNOWLEDGEMENTS

This study was possible thanks to the participating GPs and the patients.

FUNDING

The BELFRAIL study (B40320084685) was supported by an unconditional grant from the Foundation Louvain. The Foundation Louvain is the support unit of the Université catholique de Louvain and is responsible for developing the education and research projects of the university by soliciting gifts from corporations, foundations and alumni. PB is a fellow of the Research Foundation Flanders (FWO).

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper

SUPPLEMENTARY MATERIAL AVAILABLE ONLINE

Supplementary Appendix

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