Most multimorbid over-75s here were not frail

Multimorbidity is usually defined as having two or more chronic conditions, which sweeps up an enormous and wildly varied group of people — from someone with well-controlled asthma and high blood pressure to someone barely managing at home. That heterogeneity makes it hard to know who integrated, proactive care should actually target, and services risk being spread too thin or aimed at the wrong people. This paper set out to describe the baseline profile of a cohort recruited using narrower, more pragmatic criteria, and to ask whether those criteria identify a coherent subgroup worth targeting.

Participants in the Geriatric Mobile Team trial were aged 75 years or older, had made 3 or more Emergency Department visits in the previous 18 months, had 3 or more diseases diagnosed across different ICD-10 chapters, and lived in their own home. The trial itself is a randomised controlled comparison of proactive outpatient care based on Comprehensive Geriatric Assessment against usual care, but this report covers baseline characteristics only. At entry, the researchers recorded living arrangements, frailty, grip strength, cognition, physical activity, activities of daily living, quality of life and physical performance.

The 450 participants had a mean age of 83 years, ranging from 75 to 100, and 54% were female. Just over half, 54%, lived alone, and 44% needed some home adaptation to manage. Disease burden was substantial, averaging 7.2 (SD 2.5) diagnoses in different ICD-10 chapters per person, with pain reported by 80% and mobility issues by 64%. Yet functional status was better than that burden might suggest: 60% were classed as non-frail and only 13% as severely frail, while 90% were independent or partially independent in basic activities of daily living. Diagnoses and function clearly did not move in lockstep.

The findings complicate the assumption that heavy multimorbidity and frequent emergency use automatically mean frailty and dependence. Using emergency attendance plus diagnoses across multiple ICD-10 chapters appears to select people who are medically complex and symptomatic yet still largely functionally independent — arguably a group with the most to gain from proactive care, precisely because decline has not yet set in. Because this is a baseline description, it says nothing about whether the Comprehensive Geriatric Assessment intervention helps. Whether the same criteria would select a similar profile in other health systems, with different emergency care thresholds, is unknown.

For anyone thinking about later life, this is a useful separation of two things often conflated: how many diagnoses you carry and how well you function. A long problem list, frequent hospital visits, pain and mobility difficulty coexisted here with independence in everyday tasks in the great majority. It also highlights how common pain and mobility limitation are in this age group even among the non-frail. The report describes who was recruited into a trial; it does not show that any particular care model improves outcomes for them.