BackgroundMultimorbidity and frailty are relevant conditions among older adult population. There is growing evidence about their association with poor health outcomes like disability, worst quality of life, and death. Nonetheless, the independent associations of both conditions have been studied, and few evidence exists about an interaction between them. Our aims were to assess the association of frailty and multimorbidity with the disability, quality of life and all-cause mortality as well as to analyze a potential interaction between these conditions.MethodsAnalytical samples included 1410 respondents for disability and quality of life, and 1792 for mortality. We performed a longitudinal analysis with older Mexican adults aged 50, using data collected from the WHO’s Study on global AGEing and Adult Health Waves 1 and 2. Disability was measured using the World Health Organization Disability Assessment Schedule (WHODAS 2.0), and quality of life using the WHOQOL (WHO Quality of Life) instrument. All-cause mortality was determined by reviewing death certificates. Associations of frailty and multimorbidity with disability, quality of life and mortality were estimated using linear regression and Cox proportional hazards models.ResultsMultimorbidity assessed through three patterns (cardiopulmonary, vascular-metabolic, and mental-musculoskeletal) was associated with the three outcomes in this study. Cardiopulmonary and mental-musculoskeletal patterns increased the WHODAS mean score (β = 5.05; p < 0.01 and β = 5.10; p < 0.01, respectively) and decreased WHOQOL score (β = − 1.81; p < 0.01 and β = − 2.99; p < 0.01, respectively). Vascular-metabolic was associated with mortality (HR = 1.47; p = 0.04), disability (β = 3.27; p < 0.01) and quality of life (β = − 1.30; p = 0.02). Frailty was associated with mortality (pre-frail: HR = 1.48; p = 0.02 and frail: HR = 1.68; p = 0.03), disability (pre-frail: β = 5.02; p < 0.01; frail: β = 13.29; p < 0.01) and quality of life (pre-frail: β = − 2.23; p < 0.01; frail: β = − 4.38; p < 0.01). Interaction terms of frailty and multimorbidity were not statistically significant.ConclusionsMultimorbidity and frailty are important predictors of poor health outcomes. These results highlight the importance of carrying out health promotion and prevention actions as well as specific interventions aimed at older adults who suffer from multimorbidity and frailty, in such a way that deleterious effects on health can be avoided.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-0928-7) contains supplementary material, which is available to authorized users.

Background Recent evidence from cross‐sectional and longitudinal studies supports the hypothesis that sarcopenia is associated with worsening cognitive function. However, primary evidence largely comes from high‐income countries, whereas in low‐ and middle‐income countries, this association has been underexplored. This study aimed to estimate the longitudinal association between sarcopenia and mild cognitive impairment in a sample of older Mexican adults. Methods Data come from the three waves of the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE) in Mexico (2009, 2014, 2017). Four hundred ninety‐six older adults, aged ≥50, were included. Sarcopenia was defined as having low muscle quantity and either/both slow gait speed and weak handgrip strength. Mild cognitive impairment was determined based on the recommendations of the National Institute on Aging‐Alzheimer's Association. Cognitive function was evaluated by a composite cognitive score of five different cognitive tests: immediate and delayed recall, forward and backward digit span and semantic verbal fluency. Three‐level mixed‐effects models (logistic and linear) were used to estimate the longitudinal associations between sarcopenia, mild cognitive impairment and cognitive function. Results The prevalence of mild cognitive impairment (8.9%, 12.9%, 16.0%) and sarcopenia (10.5%, 20.7%, 23.3%) showed a significant temporal increase for Waves 1, 2 and 3 (P‐value < 0.01, respectively). The presence of sarcopenia was significantly associated with mild cognitive impairment (OR = 1.74; CI95% 1.02, 2.96; P = 0.04) and worse cognitive function (β = −0.57; CI95% ‐0.93, −0.21; P < 0.01). We observed significant associations between sarcopenia and immediate verbal recall (β = −0.14; CI95% −0.28, −0.01; P = 0.04), delayed verbal recall (β = −0.12; CI95% −0.23, −0.01; P = 0.03) and semantic verbal fluency (β = −0.17; CI95% −0.28, −0.05; P = 0.01). The prevalence of mild cognitive impairment increased at an annual rate of 0.8% for non‐sarcopenic older adults, but nearly 1.5% for sarcopenic adults. Conclusions Significant longitudinal associations were observed between sarcopenia, mild cognitive impairment and cognitive function among older Mexican adults. Public health strategies, including policy research and clinical interventions, must be implemented in low‐ and middle‐income countries in order to reduce or delay the onset of sarcopenia and thus improve population‐level cognitive health among older adults.

Background: Recent studies suggest the importance of distinguishing the severity levels of disability in the older adult population. However, there is still no consensus regarding an optimal classification. Few studies have estimated the prevalence of severe disability, and the results have been confined to high-income countries. There is no evidence for low-and middle-income countries (LMICs). Therefore, the aim of this study was to provide estimates of the levels of severity associated with disability in older adult populations in LMICs and to examine their relationship with health and socioeconomic factors. Methods: We used data from the Study on global AGEing and adult health (SAGE), wave 1 (2007-2010). Nationally representative samples of adults over 50 years from China, Ghana, India, Mexico, Russian Federation, and South Africa were analyzed (n = 33,641). We measured disability using the World Health Organization Disability Assessment Instrument version 2.0 (WHODAS 2.0). Disability levels according to severity were identified through the use of latent class analysis. Socioeconomic and health factors associated with severe disability were estimated using ordinal logistic regression models. Results: We identified four groups of older adult: (1) without disability, 43.4%; (2) mild disability, 33.3%; (3) moderate disability, 15.3%; and (4) severe disability, 8.0%. These results were heterogeneous for the six countries analyzed. Education and socioeconomic status were significantly associated with severe disability along with the following chronic conditions: angina, arthritis, asthma, cataracts, chronic obstructive pulmonary disease, depression, diabetes, and stroke. Severe disability was also associated with the frailty status, sarcopenia, and mild cognitive impairment. Conclusions: In this study, we estimated severity levels of disability for the older adult population in LMICs. Our results show that severe disability affects 8% of older adult, and that there are important socioeconomic and health factors associated with this condition. Measuring the severity of disability is a critical element to study the Salinas-Rodríguez et al. Severe Disability in Older Adults causes and consequences of aging. Moreover, the identification of older adult with severe disability is vital to design prevention programs, modify interventions, or develop enabling environments.

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