[Comorbidity, disability, frailty]

Abstract

In Italy, life expectancy at birth has reached 80 years in men and 85 in women; in about 50 years, life expectancy at the age of 80 has increased by an extraordinary 61% and 55%, respectively, due to more effective therapies and lower mortality of many diseases. Yet, chronic diseases are nowadays more important, and often coexist as comorbidity or multimorbidity, depending on whether an index condition has been considered. These conditions increase the risk of death and reduce functional autonomy in the elderly and, therefore, should be carefully considered within comprehensive geriatric assessment. In particular, functional assessment has a crucial role in identifying older persons with disabilities in basic and instrumental activities of daily living, as well as frail elderly subjects. Frailty results from the progressive inefficiency of homeostatic mechanisms as manifested by reduced physical performance. Acute and chronic diseases may contribute to frailty by reducing functional reserves, thus unmasking previously latent functional deficits. Consequently, the care of the elderly, who is often affected by multimorbidity, disability, and frailty, cannot be confined solely to the evaluation and treatment of single organ diseases, but should follow a global approach.