Increases in life expectancy and advances in healthcare have led to increasing numbers of people living with multiple long-term health conditions (commonly referred to as 'multi-morbidity'). This has significant implications for the appropriate management of these conditions. There are also increases in the number of people who are frail - those who are less able to cope and recover from accidents, physical illness or other stressful events. People may be assessed as having mild, moderate or severe frailty.

We intend to develop measures of multi-morbidity and frailty in the Productive Healthy Ageing Profile in due course. Meanwhile, the following selected 'Data sources & developments', 'Guidance, recommendations & resource collections', 'Review & research publications by year' and 'Related topics' sections can provide insights into the scale of the issues and inform appropriate management and interventions: 

Data sources & developments

• Multi-morbidity prevalence estimates at region, local authority and ward level (2019) published on Public Health England's 'National Intelligence Knowledge Hub’ website (need to register). Summary details are provided here.
• NICE-advised indicators for primary care - select subject=multiple long-term conditions. However, not yet adopted across the system and other indicators are being consulted on. 
• GP Contract Service data - annual and quarterly reports containing 'electronic Frailty Index' data published by NHS Digital. See NHS England guidance on identifying frailty. A 'data dictionary' accompanying each dataset explains the content. Note: the current extract approach which generates quarterly counts presents a challenge for developing prevalence measures.
  
• Multiple medicines prescribing in ePACT2 ‘Medicines Optimisation - Polypharmacy' Dashboard - GP prescribing comparator measures published by NHS Business Services Authority (need to register). 
• Various GP practice-based anonymised datasets are available to researchers (subject to stringent access protocols) based on either routine or ad hoc extracts from selected GP practice systems. These include Clinical Practice Research Datalink (CPRD), The Health Improvement Network (THIN), QResearch, ResearchOne, Research and Surveillance Centre (RSC) and General Practice Extraction Service (GPES). NHS Digital manages GPES, has developed the national dataset - GPES data for pandemic planning and research (COVID-19) - and is also developing the national dataset - General Practice Data for Planning and Research (GPDPR).
• GP Patient Survey - online reports at national, CCG and GP practice level provide information such as problem with mobility, had 2 or more falls requiring medical attention, the prevalence and types of health conditions, the effects on day-to-day activities and being able to manage these. However, authorised access to the underlying dataset would be required to explore multi-morbidity.
• Projecting Older People Population Information (POPPI) (need register) - provides current and projected data at national, regional and local authority level for a range of heath and wellbeing topic by age group including have a long-term limiting illness, have a problem with mobility, need help with at least one self-care activity and need help with at least one domestic activity
• English Longitudinal Survey of Ageing (ELSA) – a survey of thosed aged over 50 covering a range of topics, e.g. the Wave 9 report includes national data by age group & gender, & by ‘wealth group’ & gender, on limiting long-standing illness, mean walking speed and limitations with one or more activities of daily living.
• Authorised access would be required to accessing underlying data on hospital episode statistics (HES), emergency care data set ('new' A&E collection), ONS data on deaths and linked HES-ONS mortality data. Further details on hospital-based data can be found via NHS Digital's Secondary Uses Service (SUS) pages.
• Some local authorities have their own local integrated datasets which they are using to measure the prevalence of multi-morbidity and/or frailty. For example, see Kent Integrated Dataset - frailty analysis (2018) showing 'fit' and frailty levels by age group. To make relevant contacts, please use the Forum on the PHE National Intelligence Knowledge Hub.
• See also the various research-based estimates and 'related topics' data signposted below.

Guidance, recommendations & resource collections

• NICE guidance on multi-morbidity assessment and management published by the National Institute for Health and Care Excellence
• Rising to the challenge of multimorbidity (Whitty, C.J.M. et al, 2020) – recommendations from the UK Chief Medical Officers published in the British Medical Journal 
• Ageing well and supporting people with frailty and Frailty resources published by NHS England
• NHS RightCare Frailty Toolkit 
• Long Term Condition scenarios, including multimorbidity and frailty published by NHS Right Care. Narratives based on fictional patients to show the difference between a suboptimal, but realistic, pathway of care compared to an optimal one.
• The Taskforce on Multiple Conditions – resources published by the Richmond Group of Charities

Review & research publications by year

• Inequalities in incident and prevalent multimorbidity in England, 2004-2019: a population based, descriptive study (Head,A., Fleming, K., Kypridemos, C., et al, 2021). The Lancet Healthy Longevity 2(8) E489-E497. https://doi.org/10.1016/S2666-7568(21)00146-X.
• Prevalence and early-life determinants of mid-life multimorbidity: evidence from the 1970 British birth cohort (Gondek, D., Bann, D., Brown, M. et al, 2021). BMC Public Health 21, 1319. https://doi.org/10.1186/s12889-021-11291-w
• The experience of older people with multimorbidity during the COVID-19 pandemic (2020) - report from University College London (UCL) and the University of East Anglia based on findings from the English Longitudinal Study of Ageing (ELSA) COVID-19 Substudy
• The health and social care costs of a selection of health conditions and multi-morbidities (2020) published by Public Health England in collaboration with Imperial College London and the UK Health Forum
• Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort (McQueenie R, Foster HME, Jani BD, Katikireddi SV, Sattar N, Pell JP, et al, 2020). PLoS ONE 15(8): e0238091. https://doi.org/10.1371/journal.pone.0238091 
• Association between socioeconomic status and the development of mental and physical health conditions in adulthood: a multi-cohort study (Kivimaki, M. et al, 2020) published in the Lancet. See also the accompanying Lancet Editorial
• Development and validation of the Cambridge Multimorbidity Score (Payne, R.A. et al, 2020) - UK primary care data based analysis published in the Canadian Medical Association Journal
• Multimorbidity—a defining challenge for health systems (Pearson-Stuttard, J., 2019) – published in the Lancet
  
• Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting (Ashworth, M. et al, 2019) - published in BMJ Open
• Briefing: Understanding the health care needs of people with multiple health conditions (Stafford, M. et al, 2018) published by the Health Foundation 
• Forecasting the care needs of the older population in England over the next 20 years: estimates from the Population Ageing and Care Simulation (PACSim) modelling study (Kinston, A. et al, 2018) – published in the Lancet 
• Increasing Trajectories of Multimorbidity Over Time: Birth Cohort Differences and the Role of Changes in Obesity and Income (Canizares, M., 2018) published in the Journals of Gerontology
• From one to many. Exploring people’s progression to multiple long-term conditions in an urban environment (2018) published by Guy's and St Thomas' Charity
• The epidemiology of multimorbidity in primary care: a retrospective cohort study (Cassell, A. et al, 2018) published in the British Journal of General Practice 
• Multimorbidity: a priority for global health research (2018) published by the Academy of Medical Sciences
• Multimorbidity – the biggest clinical challenge facing the NHS? (2016) – blog published by NHS England 
  
• Policy Brief 23: How to improve care for people with multimorbidity in Europe? (2016) published by the World Health Organisation with input from several European agencies
• The Importance of Multimorbidity in Explaining Utilisation and Costs Across Health and Social Care Settings: Evidence from South Somerset’s Symphony Project (Kasteridis, P. et al, 2014) published by the University of York Centre for Health Economics
• Long-term conditions and multi-morbidity (from 2012/13 programme of work) published by the Kings Fund
• Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study (Barnett, K. et al, 2012)  published in The Lancet
  
• Analysis of multimorbidity in individual elderly nursing home residents. Development of a multimorbidity matrix (Akner, G., 2009) published in the Archives of Gerontology and Geriatrics

Related topics

• The Productive Healthy Ageing Profile contains a range of relevant indicators at local, regional and national level such as those relating to life and health expectancy, various long-term conditions (including musculoskeletal problems and depression co-morbidity), falls and fractures, and enhanced care and support. The available indicators are summarised in the Excel workbook Geographies & Inequalities and this also includes signposting to further sources of small area data. The following Further Resources sections may also be useful:
• Physical health conditions 
• Mental health & wellbeing
• Falls & fractures 
• Care & support services 
• Inequalities - see the Disabilities section