Multimorbidity daily life activities and socio-economic classification in the Central Portugal primary health care setting: an observational study

Background
Multimorbidity (MM) is associated with decreased quality of life, mainly due to decreased functional capacity and increased use of health care.

Objectives
Evaluate the prevalence of MM in older people of Central Portugal and understand the impact of MM on daily life activities (DLA) and how socio-economic level influences the prevalence of MM.

Material and methods
Observational study of data on age, sex, number of ICPC2 codes and Barthel (Bt) and Graffar (Gr) Indexes in clinical records of individuals aged between 65 to 99 years enrolled in the Health Centres of the Central Region of Portugal. The Bt was used to assess the dependence on DLA, and the Gr the socio-economic level.

Results
Population of 190,025, mean age of 80.16 ± 8.03 years. MM prevalence of 80%, out of which 52.9% were female, and the majority was aged between 76–85 years (39.1%). Average number of health problems: 8.7 problems for males and 9.5 for females. Bt and Gr Indexes we filled in 7.4% and 4.9% of the population. Older people without MM have higher dependency rates than those with MM (total dependence 7.4% vs. 6.2% and severe dependence 20.1% vs. 9.6%). MM in older people is mainly in the middle (55.3% vs. 27.5%) and low (31.8% vs. 19.6%) Graffar class, while the older people without MM are mainly in middle to upper (35.3%) and upper (17.6%) Graffar classes.

Conclusions
Multimorbidity is mainly associated with lower social classes. The dependence for DLA appears unrelated to MM. Individuals with multimorbidity need special attention based on socio-economic contexts.