Multimorbidity in older adults

RESEARCH ARTICLE

Open Access

Multimorbidity in older adults: magnitude

and challenges for the Brazilian health

system

Bruno Pereira Nunes1,2*,, Elaine Thumé1,3and Luiz Augusto Facchini2,3

Abstract

Background:

Multimorbidity is a public health problem with high prevalence and important consequences. The

aim of this paper was to verify the prevalence and distribution of multimorbidity in Brazilian older adults.

Methods:

A population-based survey was carried out in 2008 through face-to-face interviews with 1593 older

adults (aged 60 or over) living in Bagé, a medium-sized city in Southern Brazil. Multimorbidity was evaluated by 17

morbidities and operationalized according to two cutoff points: 2 or more and 3 or more morbidities. Descriptive

analysis examined the occurrence of multimorbidity by demographic, socioeconomic and health services variables.

Observed and expected dyads and triads of diseases were calculated.

Results:

From total sample, 6 % did not have morbidities. Mean morbidity was 3.6. Morbidities showing higher

prevalence were high blood pressure (55.3 %) and spinal column disease (37.4 %). The percent of

participants with multimorbidity was 81.3 % (95 % CI: 79.3; 83.3) for 2 or more morbidities and 64.0 % (95 % CI: 61.5;

66.4) for 3 or more morbidities. In both measures occurrence was higher among women, the more elderly, less

socioeconomic status, the bedridden, those who did not have a health private plan, those who used health services

and those living in Family Health Strategy catchment areas. We found 22 dyads of morbidities with prevalence

10 % or more and 35 triads with prevalence 5 % or more. The most prevalent observed pair and triplet of

morbidities were HBP and spinal column disease (23.6 %) and HBP, rheumatism/arthritis/arthrosis and spinal column

disease (10.6 %), respectively.

Conclusions:

Multimorbidity frequency was high in the sample studied, in keeping with percentage found in other

countries. The social inequities identified increase the health system challenges for the management of

multimorbidity, requiring a comprehensive and multidimensional care. The combinations of diseases can provide

initial input to include multimorbidity in Brazilian clinical protocols.

Keywords:

Comorbidity, Multimorbidity, Chronic diseases, Aged, Elderly, Cross-sectional studies, Brazil