Association between frailty and multimorbidity in ageing populations: evidence from the SHARE study

Background: Frailty and multimorbidity are increasingly prevalent in ageing populations, posing significant challenges to health systems. Frailty—characterised by reduced strength, endurance, and physiological function—may predispose individuals to multimorbidity, defined as the presence of two or more chronic conditions. This study examines the relationship between frailty and multimorbidity among older adults in Latvia compared with the broader European population.
Methods: Data from 28 European countries were obtained from Wave 9 (2022) of the Survey of Health, Ageing and Retirement in Europe (SHARE). Participants aged 50 years and older with available data on frailty status and multimorbidity were included in the analyses. Frailty was assessed using the validated SHARE Frailty Instrument (SHARE-FI) according to the criteria proposed by Fried et al. Multimorbidity was defined in line with the World Health Organisation. Descriptive and multivariate analyses were performed, adjusting for age, household composition, difficulty in making ends meet, self-perceived health, and country.
Results: The sample comprised 30,641 participants from Europe (57.3% female; mean age 71.6 ± 8.5 years) and 526 from Latvia (61.6% female; mean age 69.8 ± 8.9 years). The prevalence of frailty was 10.8% in Europe and 8.2% in Latvia, and pre-frailty was 44.5% and 52.1%, respectively (p < 0.001). The mean number of chronic diseases increased with frailty status (p < 0.001). After adjustment for age, household composition, financial status, self-perceived health, and country, the odds of multimorbidity were 1.9 (95% CI: 1.6–2.2) for frail and 1.4 (95% CI: 1.2–1.5) for pre-frail males, and 2.1 (95% CI: 1.8–2.3) for frail and 1.5 (95% CI: 1.4–1.6) for pre-frail females.
Conclusion: This study highlights the association between frailty and multimorbidity among older adults in Europe. Individuals with frailty or pre-frailty are more likely to experience multimorbidity, with the average number of chronic conditions increasing progressively with frailty status, a pattern more marked for females. The findings emphasise the need for targeted and coordinated frailty screening and management strategies in public health, reflecting the increasing prevalence of multimorbidity, as these factors jointly shape quality of life in older adults.