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

Figures & data

Table 1. Study sample characteristics of the BELFRAIL cohort (12).

	Total population (n = 567)	Disability^a (n = 112)	Frailty^b (n = 41)
Age, mean ± SD	85 ± 4	86 ± 4^c	87 ± 5^c
Female, n (%)	356 (62.8%)	75 (67.0%)	24 (58.5%)
Charlson comorbidity index score, n (%)
0–4	189 (33.3%)	6 (14.6%)^d	22 (19.6%)^d
5–6	225 (39.7%)	18 (43.9%)^d	45 (40.2%)^d
> 6	153 (27.0%)	17 (41.5%)^d	45 (40.2%)^d
Cumulative illness rating scale score, n (%)
0–3	275 (48.5)	12 (29.3)^d	26 (23.2)^d
4	221 (21.5)	9 (22.0)^d	29 (25.9)^d
> 4	170 (30.0)	20 (48.8)^d	57 (50.9)^d
Disease count, n (%)
0–3	246 (43.4)	15 (36.6)^d	33 (29.5)
4–5	187 (33.0)	12 (29.3)^d	35 (31.3)
> 5	134 (23.6)	14 (34.1)^d	44 (39.3)
Crude hCRP, mean (SD)	0.55 (1.78)	0.92 (2.6)^c	0.66 (1.57)
MMSE < 25, n (%)	214 (21.9)	39 (34.8)^d	12 (29.3)

SD, standard deviation; hCRP, high-sensitivity C-reactive protein; MMSE, mini-mental state examination.

^aDisability defined as the lowest gender-specific quintile of ADL.

^bFrailty defined as meeting > 3/5 Fried frailty criteria.

^cP < 0.05 with independent sample t-test.

^dP < 0.05 with chi-square test.

Table 2. Crude and adjusted ORs for the associations of multimorbidity measures (CCI, CIRS and DC) with disability and frailty (n = 567).

	Disability Crude OR	Frailty Adjusted OR^a	Crude OR	Adjusted OR^b
Charlson comorbidity index score > 5	1.8 (1.2–2.7)	1.5 (0.8–2.6)	2.4 (1.2–4.6)	1.9 (0.9–4.0)
Cumulative illness rating scale score > 3	4.0 (2.5–6.5)	3.2 (1.7–5.8)	2.6 (1.3–5.3)	1.5 (0.7–3.4)
Disease count > 3	2.1 (1.4–3.3)	1.5 (0.9–2.6)	1.5 (0.78–2.9)	1.6 (0.8–3.4)

CCI, Charlson comorbidity index; DC, disease count; CIRS, cumulative illness rating scale.

^aAdjusted for age, gender, loghCRP, MMSE and frailty.

^bAdjusted for age, gender, loghCRP, MMSE and disability. (Logarithmic transformation of the high sensitive C-reactive protein (LoghCRP) was used as a proxy to adjust correlations for chronic inflammation.)

Figure 1. Overlap of frailty (> 3/5 of the frailty Fried criteria), disability (the lowest gender specific quintile of ADL) and multimorbidity (> 5 chronic diseases reported by the GP). The cut-off used within this analysis was based on the count of all diseases that could be identified on the problem lists of the patients and, therefore, is not related to the DCs of 22 diseases or to the CCI or CIRS score.

Table 3. Comparison of the ability of different measures of multimorbidity to define patients with disability or frailty: NRI values.

	Disability NRI	P-value	Frailty NRI	P-value
CCI compared with DC	–0.03	0.48	0.11	0.44
CIRS compared with DC	0.14	0.42	0.16	0.42
CIRS compared with CCI	0.18	0.42	0.02	0.49

CCI, Charlson comorbidity index (cut-off at CCI > 5); DC, disease count (cut-off at DC > 3); CIRS, cumulative illness rating scale (cut-off at CIRS > 3); NRI, net reclassification improvement.

Vaes B, Pasquet A, Wallemacq P, Rezzoug N, Mekouar H, Olivier PA, et al. The BELFRAIL (BFC80+) study: A population-based prospective cohort study of the very elderly in Belgium. BMC Geriatr. 2010;10:39.

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