Phenotypic frailty and multimorbidity are independent 18-year mortality risk indicators in older men: The Helsinki Businessmen Study (HBS)

PURPOSE: Multimorbidity, prefrailty, and frailty are frequent in ageing populations, but their independent relationships to long-term prognosis in home-dwelling older people are not well recognised. METHODS: In the Helsinki Businessmen Study (HBS) men with high socioeconomic status (born 1919–1934, n = 3490) have been followed-up from midlife. In 2000, multimorbidity (≥ 2 conditions), phenotypic prefrailty and frailty were determined in 1365 home-dwelling men with median age of 73 years). Disability was assessed as a possible confounder. 18-year mortality follow-up was established from registers and Cox regression used for analyses. RESULTS: Of the men, 433 (31.7%) were nonfrail and without multimorbidity at baseline (reference group), 500 (36.6%) and 82 (6.0%) men had prefrailty or frailty, respectively, without multimorbidity, 84 (6.2%) men had multimorbidity only, and 201 (14.7%) and 65 (4.8%) men had prefrailty or frailty together with multimorbidity. Only 30 (2.2%) and 86 (6.3%) showed signs of ADL or mobility disability. In the fully adjusted analyses (including ADL disability, mental and cognitive status) of 18-year mortality, frailty without multimorbidity (hazard ratio 1.62, 95% confidence interval 1.13–2.31) was associated with similar mortality risk than multimorbidity without frailty (1.55, 1.17–2.06). The presence of both frailty and multimorbidity indicated a strong mortality risk (2.93, 2.10–4.07). CONCLUSION: Although multimorbidity is generally considered a substantial health problem, our long-term observational study emphasises that phenotypic frailty alone, independently of disability, may be associated with a similar risk, and a combination of multimorbidity and frailty is an especially strong predictor of mortality.