The impact of chronic multimorbidity and disability on functioning and survival. A community-based, longitudinal study

Abstract. Marengoni A, von Strauss E, Rizzuto D,
Winblad B, Fratiglioni L (Aging Research Center,
Gerontology Research Center and Karolinska Institutet,
Stockholm, Sweden, and University of Brescia
and Civili Hospital, Brescia, Italy). The impact of
chronic multimorbidity and disability on functional
decline and survival in elderly persons. A communitybased,
longitudinal study. J Intern Med 2009;
265: 288–295.
Objective. We aimed to disentangle the effect of
chronic multimorbidity and disability on 3-year functional
decline and survival in the elderly.
Design. Prospective cohort study with a mean of follow-
up of 2.8 years.
Setting. Swedish elderly persons from the Kungsholmen
Project (1987–2000).
Subjects. A total of 1099 subjects, 77–100 years old,
living in the community and institutions.
Main outcome measurements. Medical diagnoses (based
on clinical examination, drug use, medical records
and blood tests), and functional assessment (according
to Katz Index) at baseline were investigated in relation
to functional decline and death occurring during
follow-up.
Results. At baseline, 12.1% of participants had disability,
and 52.3% were affected by multimorbidity. During
follow-up, 363 persons died and 85 worsened in
functioning. The number of chronic conditions incrementally
increased the risk of functional decline [hazard
ratio (HR) increased from 1.5 in subjects with one
disease to 6.2 in persons with 4+ diseases]. However,
this was not the case for mortality, as the HR of death
was the same for people with one disease as well as 4+
diseases (HR = 2.3). Baseline disability had the highest
impact on survival, independently of number of diseases
[HR = 8.1; 95% confidence interval (CI) = 4.8–
13.7 in subjects with one disease and HR = 7.7; 95%
CI = 4.7–12.6 in those with 2+ diseases].
Conclusions. In the elderly subjects, chronic disability
rather than multimorbidity emerged as the strongest
negative prognostic factor for functionality and
survival.