LAUSR

Multimorbidity and frailty are highly prevalent and emerging conditions [1–5]. Contrary to patients' and primary care providers' perceptions [6], multimorbidity does not necessarily imply the onset of frailty. However, both these conditions are determined by a wide and dynamic spectrum of potential causes [5,7,8] and they share several common aspects. For example, chronic diseases represent a key component of the frailty vicious cycle [9], and both conditions are associated with increased risk of negative outcomes for the individual as well as higher healthcare costs for public health [4,5]. Patients presentingwith these complex conditions often have special and unmet clinical needs, requiring an adaptation of traditional care organization and services. In a recent issue of the European Journal of Internal Medicine, two articles highlight the enhanced consumption of healthcare resources by persons with multimorbidity and/or frailty, and the importance of the frailty status in the risk prediction of acutely ill patients. Hopman et al. analyzed a large, Dutch primary care database (includingmore than 50,000 persons) tomeasure the healthcare costs ofmultimorbidity [10]. Persons affected by multiple diseases had a slightly higher consumptionof healthcare resources and used more medications compared with those with one single chronic disease. For example, on average, multimorbid patients visited primary care facilities eight times a year, whereas those with one chronic disease attended these services five times a year. However, healthcare utilization considerably differed across groups of multimorbid patients. Over half of multimorbid patients actually had a relatively low consumption of healthcare resources. Less than 10% had a heavy use, especially women and persons with more advanced age or lower income, and those living alone or in small households. Specific diseases such as chronic obstructive pulmonary disease, diabetes, and chronic heart failure were also related to higher healthcare utilization among multimorbid patients. The second paper focused on frailty in persons with acute illnesses. Romero-Ortuno et al. examined the association between frailty and 30day mortality in persons with non-elective acute illnesses in the UK National Health Service [11]. The severity of the acute illnesswas directly associated with mortality risk in persons with severe frailty at hospital admission. Indeed, the assessment of frailty status in addition to the severity of the acute illness improved the prediction of mortality in this group of patients. Thus, the paper highlights the importance of assessing the severity of the acute illness (as already routinely done in clinical practice) in combination with frailty for a better risk stratification. Due to the relevant burden in terms of negative outcomes and high expenditure of multimorbidity and/or frailty, the definition of new care pathways for these increasingly prevalent conditions is needed. Although novel approaches have been proposed for single chronic diseases [12,13], adapted pathways for multimorbid and frail persons are specifically necessary because these individuals still present special and heterogeneous needs requiring personalized interventions.