title: Age, frailty, disability, institutionalization, multimorbidity or comorbidity. Which are the main targets in older adults?
abstract: OBJECTIVE
  Age, frailty, disability, institutionalization, multimorbidity or comorbidity are main risk factors for serious health adverse outcomes in older adults. However, the adjusted relevance of each of them in order to determine which characteristics must be of importance for health policies in this population group, has not been established.
  
  
  METHODS
  Concurrent population-based cohort study.
  
  
  METHODS
  Albacete city, Spain.
  
  
  METHODS
  842 participants over age 70 from the FRADEA Study.
  
  
  METHODS
  Age, gender, institutionalization, frailty (Fried's criteria), previous disability in basic activities of daily living (BADL) (Barthel index), comorbidity (Charlson index), and multimorbidity (≥ 2 from 14 selected diseases) were recorded in the basal visit. The combined event of mortality or incident disability in BADL was determined in the follow-up visit. The risk of presenting adverse events was determined by Kaplan-Meier analysis and logistic regression adjusted for age, sex, and institutionalization.
  
  
  RESULTS
  Mean follow-up 520 days. 63 participants died (7.5%). Among the remaining 779, 191 lost at least one BADL (24.5%). The combined event of mortality or disability was present in 254 participants (30.2%). Age (OR 1.10, 95%CI 1.06-1.14), frailty (OR 3.07, 95%CI 1.63-5.77), disability (OR 2.19, 95%CI 1.43-3.36) and institutionalization (OR 2.73, 95%CI 1.68-4.44) were independently associated with the combined adverse event, but not comorbidity or multimorbidity. In subjects younger than 80, only frailty, disability and institutionalization were risk factors, and in those aged ≥ 80, only age, disability and institutionalization were.
  
  
  CONCLUSIONS
  Health policies for older adults must take into account mainly frailty and disability in subjects younger than 80 and disability in those older than 80.
authors.affiliation: Pedro Abizanda, Hospital Perpetuo Socorro, C/ Seminario 4, 02006 Albacete, Spain, Tel.: +34967597651, Fax: +34967597635, Email: pabizanda@sescam.jccm.es.
authors.forename: P
authors.initials: P
authors.lastname: Abizanda
authors.forename: L
authors.initials: L
authors.lastname: Romero
authors.forename: P M
authors.initials: PM
authors.lastname: Sánchez-Jurado
authors.forename: M
authors.initials: M
authors.lastname: Martínez-Reig
authors.forename: S A
authors.initials: SA
authors.lastname: Alfonso-Silguero
authors.forename: L
authors.initials: L
authors.lastname: Rodríguez-Mañas
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D015897:Comorbidity; D006233:Persons with Disabilities; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007326:Institutionalization; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D012307:Risk Factors; D013030:Spain