The burden of frailty in older people visiting GPs in Veneto and Sicily, Italy

Context: In Italy, little is known about the territorial distribution of the frailty status. Aims: To compare frailty- and multimorbidity-prevalence in the elderly population of two Italian regions. Methods: This study examined randomized samples of elderly (both community dwelling and institutionalized) assisted by general practitioners. Frailty was evaluated through the CSHA-Scale, multimorbidity through the Charlson-Score. The relation between frailty and multimorbidity was studied through a logistic model. Both crude and standardized prevalences were calculated. Results: One hundred and sixteen physicians assisted 176,503 patients highly representative of Italian people. In a randomized sample of 4,531 older people, the sex–age-standardized prevalence of Frailty (standard population: Italy) was 25.74% (24.63–26.85%). Age-standardized prevalence for males was 20.08% (18.46–21.71%) and 30.00% (28.54–31.57%) for females. Using the sex–age-standardization pooled sample, the prevalence of frailty was significantly higher in Sicily than Veneto (28.74% [27.03–30.46%] vs 22.30% [20.94–23.67%]. This study did not find differences in the prevalence of multimorbidity: Veneto 20.76% (19.21–22.31%); Sicily 22.05% (20.33–23.77%). Both “to be female” and “to live in Sicily” were shown to be predictors of frailty OR for being female = 1.64 (1.42–1.88); OR for living in Sicily = 1.27 (1.11–1.46). Multimorbidity was an independent frailty-predictor only for those aged < 85: OR of Charlson Index ≥ 4 for ages < 85 = 3.44 (2.88–4.11), OR for ages ≥ 85 = 1.44 (0.97–2.12). Limitations: (1) This study considered patients assisted by doctors, not a random sample of the general population. (2) The cross-sectional nature of the study limits the interpretation of the relationships between frailty and multi-morbidity. (3) Few covariates were available for our multivariate models. Conclusions: More than 1/4 of elderly persons are shown to be frail (1/5 of males and 1/3 of females). Frailty is more frequent in Sicily, while multimorbidity does not differ between the two regions. This could be due to regional differences in the organization of care networks dedicated to elderly patients.