Understanding multimorbidity, frailty and disability trajectories in the very old: A longitudinal study in primary care

Project Lead: Dr Andrew Kingston

The number of people aged over 85 is rising.  Later in life, people often have a number of different medical conditions (this is called multimorbidity).  Many older people also live with frailty.  Frailty describes the situation where bodies lose their reserves, and even a small thing, like a change in treatment or a urinary infection, can trigger a sudden worsening in health.  Along with multimorbidity and frailty, older people may also live with disability.  If older people have difficulty coping on thier own with the ordinary activities we all do in our daily lives (bathing and cooking, for example), they may be described as living with a disability.  These three states, multimorbidity, frailty and disability, are very common amongst older people, and are important because they are linked with higher use of GP services, increased risk of moving into a care home, and higher death rates.  We know that multimorbidity, frailty and disability are linked, but we do not know very much about this relationship.  It is important for primary care to understand how each of these distinct states influence, or change in relation to each other.  Then, we will have a better understanding of how treatment for one will impact the others, and how we can target treatment to get the best health outcomes for people with multimorbidity, frailty and disability.

Our study will use data from the Newcastle 85+ study.  For over 10 years, this cohort study has collected unique information from older people registered with general practices in and around Newcastle, who were born in 1921.  We will look at the data, to explore groups of diseases that occur together, and see how they influence and interact with frailty.  We will also investigate their effect on disability.  This will provide important evidence for GPs about how best to prevent worsening of health and help older people stay independent, and how to manage multimorbidity and frailty in older people.