Evaluation of Multimorbidity Burden in Frailty Transitions in Costa Rican Older Adults Using Multistate Markov Models

Area of Science:

• Gerontology and Public Health
• Chronic Disease Epidemiology
• Aging Research

Background:

• Accumulation of non-communicable chronic diseases (NCDs) is a major factor in health decline among older adults.
• NCDs can significantly impact an individual's frailty status over time.
• Understanding the link between multimorbidity and frailty is crucial for geriatric health interventions.

Purpose of the Study:

• To assess the influence of multimorbidity on frailty phenotype transitions.
• To evaluate the impact of multimorbidity on frailty-related mortality risk.
• To analyze longitudinal changes in frailty states among older adults with multiple chronic conditions.

Main Methods:

• Utilized data from the Costa Rican Longevity and Healthy Aging Study Cohort (2005-2010).
• Included 2660 individuals aged 60 and above.
• Defined multimorbidity as having ≥3 NCDs from 13 chronic conditions and assessed frailty using Fried criteria. Employed Markov-based multistate models for analysis over 5 years.

Main Results:

• Multimorbidity accelerates the transition to frailty, leading to an earlier onset by approximately 30 months.
• Individuals with multimorbidity and a pre-frail state had a lower chance of recovery to robustness (HR:0.73) and a higher risk of becoming frail (HR:1.83).
• Multimorbidity increased all-cause mortality risk in pre-frail individuals (HR:1.83) but not in those already frail (HR:0.88).

Conclusions:

• Multimorbidity is a significant predictor of transitions to frailty and mortality in older adults.
• The presence of multiple chronic diseases favors progression to frailty over death.
• Interventions targeting pre-frail individuals with multimorbidity are essential to mitigate mortality risk.