Do frailty and multimorbidity go hand in hand?

Nearly half of the elderly population is frail or has multiple diseases

  • Frailty and multimorbidity uncommon in the general population
  • Frail elderly regularly also present multimorbidity
  • Causal association possibly works bidirectional

The majority of frail elderly are also multimorbid, but only a minority of multimorbid elderly tend to be frail. This conclusion has been drawn by an international research team which analysed the data of 48 studies involving 78,122 participants, of which 25 were included in the meta analyses.


Most studies utilised the Fried-criteria (see frame) to qualify elderly people as frail, and defined the concept of multimorbidity as ‘the presence of two or more diseases’. Even so, there was a wide variety in criteria for frailty and (especially) multimorbidity, and the authors therefore plead to establish more standardised definitions. Although the analysed studies were executed methodologically accurate – with a low to moderate risk of bias – not all studies could be included in the meta analyses because of the variety of definitions. Upon execution of the meta analyses, this diversity led to heterogeneity on a methodological and statistical level, and the varying results weakened the conclusions.


The researchers searched for studies that provided insights in the association between frailty and multimorbidity in all adults. They did not restrict themselves to the elderly population, but despite the fact that mean age varied from 52 to 85 years, only three studies included participants younger than 60 years of age. Therefore, the conclusions are mainly based on elderly people.

> From: Vetrano et al., J Gerontol A Biol Sci Med Sci 74 (2019) 659-666 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.

Frailty criteria according to Fried et al.

A person is diagnosed with frailty when three or more criteria, out of a total of five, are met:

  • Weight reduction; unintentional weight loss of 4.5 kilograms or 5 percent of the total body weight in the previous year; 
  • Reduction of walking velocity; taking more than six seconds for a 4-metre walking test;
  • Positive answer on the following questions: 'Does everything you do require effort?' or 'Does it require effort to get yourself going?';
  • Energy consumption; less than 393 (men) and 280 (women) kcal per week, or sitting more than 4 hours per day during the last three months, less than 1 walk per month and no activities like cycling or jogging;
  • Limited hand grip force: males with a score equal to or less than 30 kg, and women with a score equal to or less than 18 kg.

Expert opinion by

Both frailty as well as multimorbidity are related to health care factors like risk for disability, hospitalisation, mortality, and also to health care costs. Frailty and multimorbidity can be identified in several ways. In this study alone, a total of 10 assessment tools can be found to measure frailty, whereas several cut-off values and indexes are used to assess multimorbidity. Furthermore, assessment of both conditions also leads to reported prevalence being widespread, between 0 to 76 percent for frailty and between 2 to 70 percent for multimorbidity. Comparison of the studies, as stated by the authors, is challenging and underlines the need for standardised diagnostics.

The current study establishes the presence of multimorbidity in 70 percent of frail, adult humans, whereas only 16 percent of multimorbid people are frail. This shows that adults with multiple diseases are not always frail, and that other factors may play a role. General health obviously means more than just the presence or absence of diseases and impairments. According to the definition of positive health (M. Huber), health is the ability to adapt yourself and make autonomous decisions towards the social, physical and emotional challenges of life.

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