Published 2025-09-30
Keywords
- Multimorbidity,
- Older Adults,
- Patterns,
- Determinants,
- Risk Factors
- Consequences ...More
Copyright (c) 2025 Brunilda Subashi, Fatjona Kamberi, Erlini Kokalla, Rezarta Lalo, Glodiana Sinanaj

This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Introduction. Multimorbidity is an increasing global concern, particularly among older populations, affecting 55-98% of those aged ≥ 65 and above. This study aims to provide a comprehensive global overview of research on multimorbidity in older adults. It will assess the quantity and types of studies focused on the prevalence, patterns, determinants, risk factors, and consequences of multimorbidity, while also identifying key research gaps for future studies.
Methods. This mapping review study was conducted using the PubMed, Scopus and Web of Science databases in December 2024. Only full-text papers published in English were included. The search terms included ‘aged’, ‘multimorbidity’, ‘multiple chronic conditions’, ‘prevalence’, ‘cost of illness’, ‘social determinants’, ‘risk factors’, and ‘Albania’. After filtering, all results were exported to Rayyan reference management software. Duplicates were removed, and the remaining papers were evaluated for suitability based on their titles and abstracts.
Results. After the full text screening the final set for data extraction includes seven observational studies on multimorbidity in older adults. Europe has the highest number of studies, with four, followed by Asia with three studies. Despite this, Asia has a greater coverage of studies on multimorbidity in older populations. North and South America are represented by two studies from each. Six of included studies examine the prevalence of multimorbidity, with four exploring its patterns and consequences, and one investigating its determinants and its risk factors.
Discussions. There are notable gaps in research on multimorbidity in older adults, particularly regarding its determinants, and risk factors. No studies on multimorbidity in older adults were found for Africa and Australia in the period 2019-2024.
References
- Seghieri C, Tortù C, Tricò D, Leonetti S. Learning prevalent patterns of co-morbidities in multichronic patients using population-based healthcare data. Sci Rep. 2024;14(1):2186. https://doi.org/10.1038/s41598-024-51249-7
- Piotrowicz K, Ryś M, Perera I, et al. Factors associated with mortality in hospitalised, non-severe, older COVID-19 patients - the role of sarcopenia and frailty assessment. BMC Geriatr. https://doi.org/10.1186/s12877-022-03571-w
- Kabir A, Conway DP, Ansari S, Tran A, Rhee JJ, Barr M. Impact of multimorbidity and complex multimorbidity on healthcare utilisation in older Australian adults aged 45 years or more: a large population-based cross-sectional data linkage study. BMJ Open. 2024;14(1):e078762. https://doi.org/10.1136/bmjopen-2023-078762
- Rudnicka E, Napierała P, Podfigurna A, Męczekalski B, Smolarczyk R, Grymowicz M. The World Health Organization (WHO) approach to healthy ageing. Maturitas. 2020;139:6-11. https://doi.org/10.1016/j.maturitas.2020.05.018
- Hakimi S, Kaur S, Ross-White A, Martin LJ, Rosenberg MW. A systematic review examining associations between physical activity, sedentary behaviour, and sleep duration with quality of life in older adults aged 65 years and above. Appl Physiol Nutr Metab. 2023;48(2):97-162. https://doi.org/10.1139/apnm-2022-0298
- Centers for Disease Control and Prevention (CDC). Chronic Disease Indicators: Older Adults. 2024 Jun 3 . Available from: https://www.cdc.gov/cdi/indicator-definitions/older-adults.html
- National Institutes of Health (NIH). Age. 2024 Jan 17. Available from: https://www.nih.gov/nih-style-guide/age
- International Organization for Standardization (ISO). Age groups. [date unknown] [cited 2025 Sep 29]. Available from: https://www.iso.org/foresight/age-groups.html
- Zhang L, Ma L, Sun F, Tang Z, Chan P. A Multicenter Study of Multimorbidity in Older Adult Inpatients in China. J Nutr Health Aging. 2020;24(3):269-276. https://doi.org/10.1007/s12603-020-1311-x
- Ahmed A, Khan HTA, Lawal M. Systematic Literature Review of the Prevalence, Pattern, and Determinant of Multimorbidity Among Older Adults in Nigeria. Health Serv Res Manag Epidemiol. 2023;10:23333928231178774. https://doi.org/10.1177/23333928231178774
- Wang YP, Nunes BP, Coêlho BM, et al. Multilevel Analysis of the Patterns of Physical-Mental Multimorbidity in General Population of São Paulo Metropolitan Area, Brazil. Sci Rep. 2019;9(1):2390. https://doi.org/10.1038/s41598-019-39326-8
- Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ. Update on Prevalence of Pain in Patients with Cancer 2022: A Systematic Literature Review and Meta-Analysis. Cancers (Basel). 2023;15(3):591. https://doi.org/10.3390/cancers15030591
- Marengoni A, Roso-Llorach A, Vetrano DL, et al. Patterns of Multimorbidity in a Population-Based Cohort of Older People: Sociodemographic, Lifestyle, Clinical, and Functional Differences. J Gerontol A Biol Sci Med Sci. 2020;75(4):798-805. https://doi.org/10.1093/gerona/glz137
- Skou ST, Mair FS, Fortin M, et al. Multimorbidity. Nat Rev Dis Primers. 2022;8(1):48. https://doi.org/10.1038/s41572-022-00376-4
- Tazzeo C, Zucchelli A, Vetrano DL, et al. Risk factors for multimorbidity in adulthood: A systematic review. Ageing Res Rev. 2023;91:102039. https://doi.org/10.1016/j.arr.2023.102039
- Zhang J, Sun Y, Li A. The prevalence of disability in older adults with multimorbidity: a meta-analysis. Aging Clin Exp Res. 2024;36(1):186. https://doi.org/10.1007/s40520-024-02835-2
- Mitchell E, Walker R. Global ageing: successes, challenges and opportunities. Br J Hosp Med (Lond). 2020;81(2):1-9. https://doi.org/10.12968/hmed.2019.0377
- Tan MMC, Barbosa MG, Pinho PJMR, et al. Determinants of multimorbidity in low- and middle-income countries: A systematic review of longitudinal studies and discovery of evidence gaps. Obes Rev. 2024;25(2):e13661. https://doi.org/10.1111/obr.13661
- Álvarez-Gálvez J, Ortega-Martín E, Carretero-Bravo J, Pérez-Muñoz C, Suárez-Lledó V, Ramos-Fiol B. Social determinants of multimorbidity patterns: A systematic review. Front Public Health. 2023;11:1081518. https://doi.org/10.3389/fpubh.2023.1081518
- Zhang Q, Han X, Zhao X, Wang Y. Multimorbidity patterns and associated factors in older Chinese: results from the China health and retirement longitudinal study. BMC Geriatr. 2022 Jun 1;22(1):470. https://doi.org/10.1186/s12877-022-03154-9.
- Laires PA, Perelman J. The current and projected burden of multimorbidity: a cross-sectional study in a Southern Europe population. Eur J Ageing. 2018;16(2):181-192. https://doi.org/10.1007/s10433-018-0485-0
- Chen R, Xu P, Song P, Wang M, He J. China has faster pace than Japan in population aging in next 25 years. Biosci Trends. 2019;13(4):287-291. https://doi.org/10.5582/bst.2019.01213
- Canever JB, de Souza Moreira B, Danielewicz AL, de Avelar NCP. Are multimorbidity patterns associated with fear of falling in community-dwelling older adults?. BMC Geriatr. 2022;22(1):192. https://doi.org/10.1186/s12877-022-02889-9
- Akugizibwe R, Calderón-Larrañaga A, Roso-Llorach A, et al. Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults. J Clin Med. 2020;9(12):4001. https://doi.org/10.3390/jcm9124001
- Ni W, Yuan X, Zhang Y, Zhang H, Zheng Y, Xu J. Sociodemographic and lifestyle determinants of multimorbidity among community-dwelling older adults: findings from 346,760 SHARE participants. BMC Geriatr. 2023;23(1):419. https://doi.org/10.1186/s12877-023-04128-1
- Chowdhury SR, Chandra Das D, Sunna TC, Beyene J, Hossain A. Global and regional prevalence of multimorbidity in the adult population in community settings: a systematic review and meta-analysis. EClinicalMedicine. 2023;57:101860. https://doi.org/10.1016/j.eclinm.2023.101860
- Gabrani J, Schindler C, Wyss K. Health Seeking Behavior Among Adults and Elderly With Chronic Health Condition(s) in Albania. Front Public Health. 2021;9:616014. https://doi.org/10.3389/fpubh.2021.616014
- Lin WQ, Luo LY, Li YH, et al. Trends in prevalence of multimorbidity for chronic diseases in China: serial cross-sectional surveys from 2009 to 2018. J Nutr Health Aging. 2024;28(8):100260. https://doi.org/10.1016/j.jnha.2024.100260
- Alamnia TT, Sargent GM, Kelly M. Patterns of Non-Communicable Disease, Multimorbidity, and Population Awareness in Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study. Int J Gen Med. 2023;16:3013-3031. https://doi.org/10.2147/IJGM.S421749
- Chauhan S, Patel R, Kumar S. Prevalence, factors and inequalities in chronic disease multimorbidity among older adults in India: analysis of cross-sectional data from the nationally representative Longitudinal Aging Study in India (LASI). BMJ Open. 2022;12(3):e053953. https://doi.org/10.1136/bmjopen-2021-053953
- Tan MMC, Prina AM, Muniz-Terrera G, et al. Prevalence of and factors associated with multimorbidity among 18 101 adults in the South East Asia Community Observatory Health and Demographic Surveillance System in Malaysia: a population-based, cross-sectional study of the MUTUAL consortium. BMJ Open. 2022;12(12):e068172. https://doi.org/10.1136/bmjopen-2022-068172
- Melo LA, Braga LD, Leite FP, Bittar BF, Oséas JM, Lima KC. Factors associated with multimorbidity in the elderly: an integrative literature review. Revista Brasileira de Geriatria e Gerontologia. 2019 Jun 10;22(01):e180154. https://doi.org/10.1590/1981-22562019022.180154
- Beaney T, Clarke J, Woodcock T, Majeed A, Barahona M, Aylin P. Effect of timeframes to define long term conditions and sociodemographic factors on prevalence of multimorbidity using disease code frequency in primary care electronic health records: retrospective study. BMJ Med. 2024;3(1):e000474. https://doi.org/10.1136/bmjmed-2022-000474
- Hazell M, Kengne AP, Gill P, Taylor D, Uthman OA. A multilevel analysis of the prevalence and factors associated with multimorbidity in South Africa using 2016 Demographic and Health Survey data. medRxiv. 2024 Jun 13:2024-06. https://doi.org/10.1101/2024.06.13.24308889
- Akintayo-Usman NO. Fragmentation of care: a major challenge for older people living with multimorbidity. Geriatrics, Gerontology and Aging. 2021;15:1-4. https://doi.org/10.53886/gga.0210030
- Dorr DA, Markwardt S, Bobo M, et al. The extent and burden of high multimorbidity on older adults in the US: a descriptive analysis of Medicare beneficiaries. BMC Geriatr. 2024;24(1):777. https://doi.org/10.1186/s12877-024-05329-y
- Soley-Bori M, Ashworth M, Bisquera A, et al. Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature. Br J Gen Pract. 2020;71(702):e39-e46. https://doi.org/10.3399/bjgp20X713897
- Zhong J, Chen L, Li C, et al. Association of lifestyles and multimorbidity with mortality among individuals aged 60 years or older: Two prospective cohort studies. SSM Popul Health. 2024;26:101673. https://doi.org/10.1016/j.ssmph.2024.101673
- Tran PB, Kazibwe J, Nikolaidis GF, Linnosmaa I, Rijken M, van Olmen J. Costs of multimorbidity: a systematic review and meta-analyses. BMC Med. 2022;20(1):234. https://doi.org/10.1186/s12916-022-02427-9
- van Blarikom, E., Fudge, N. & Swinglehurst, D. The emergence of multimorbidity as a matter of concern: a critical review. BioSocieties 18, 614–631 (2023). https://doi.org/10.1057/s41292-022-00285-5
- Lu J, Wang Y, Hou L, Zuo Z, Zhang N, Wei A. Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study. BMC Geriatr. 2021;21(1):372. https://doi.org/10.1186/s12877-021-02292-w
- Khorrami Z, Rezapour M, Etemad K, et al. The patterns of Non-communicable disease Multimorbidity in Iran: A Multilevel Analysis. Sci Rep. 2020;10(1):3034. https://doi.org/10.1038/s41598-020-59668-y
- Chen S, Wang S, Jia W, et al. Spatiotemporal Analysis of the Prevalence and Pattern of Multimorbidity in Older Chinese Adults. Front Med (Lausanne). 2022;8:806616. Jan 20. https://doi.org/10.3389/fmed.2021.806616
- Nguyen QD, Wu C, Odden MC, Kim DH. Multimorbidity Patterns, Frailty, and Survival in Community-Dwelling Older Adults. J Gerontol A Biol Sci Med Sci. 2019;74(8):1265-1270. https://doi.org/10.1093/gerona/gly205
- Bhagavathula AS, Seid MA, Adane A, Gebreyohannes EA, Brkic J, Fialová D. Prevalence and Determinants of Multimorbidity, Polypharmacy, and Potentially Inappropriate Medication Use in the Older Outpatients: Findings from EuroAgeism H2020 ESR7 Project in Ethiopia. Pharmaceuticals (Basel). 2021;14(9):844. https://doi.org/10.3390/ph14090844
- Marengoni A, Roso-Llorach A, Vetrano DL, et al. Patterns of Multimorbidity in a Population-Based Cohort of Older People: Sociodemographic, Lifestyle, Clinical, and Functional Differences. J Gerontol A Biol Sci Med Sci. 2020;75(4):798-805. https://doi.org/10.1093/gerona/glz137
- Blanco-Reina E, Aguilar-Cano L, García-Merino MR, et al. Assessing Prevalence and Factors Related to Frailty in Community-Dwelling Older Adults: A Multinomial Logistic Analysis. J Clin Med. 2021;10(16):3576. https://doi.org/10.3390/jcm10163576
- Mino-León D, Giraldo-Rodríguez L, Rojas-Huerta A, Prado-Galbarro FJ, Reyes-Morales H. Multimorbidity, Functionality, Socioeconomic and Behavioral Conditions Linked with Mortality in a Cohort of Adults: A Latent Class Analysis. Arch Med Res. 2023;54(6):102869. https://doi.org/10.1016/j.arcmed.2023.102869
- Álvarez-Gálvez J, Carretero-Bravo J, Suárez-Lledó V, et al. Social inequalities in multimorbidity patterns in Europe: A multilevel latent class analysis using the European Social Survey (ESS). SSM Popul Health. 2022;20:101268. https://doi.org/10.1016/j.ssmph.2022.101268
- Booth A. EVIDENT Guidance for Reviewing the Evidence: a compendium of methodological literature and websites. Sheffield: University of Sheffield. 2016 Feb. https://doi.org/10.13140/RG.2.1.1562.9842
- Grant MJ, Booth A. A typology of reviews: an analysis of 14 review types and associated methodologies. Health Info Libr J. 2009;26(2):91-108. https://doi.org/10.1111/j.1471-1842.2009.00848.x
- Yu F, Liu C, Sharmin S. Performance, usability, and user experience of Rayyan for systematic reviews. Proceedings of the Association for Information Science and Technology. 2022 Oct;59(1):843-4. https://doi.org/10.1002/pra2.745
- Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Syst Rev. 2021;10(1):89. https://doi.org/10.1186/s13643-021-01626-4
- Halonen P, Raitanen J, Jämsen E, Enroth L, Jylhä M. Chronic conditions and multimorbidity in population aged 90 years and over: associations with mortality and long-term care admission. Age Ageing. 2019;48(4):564-570. https://doi.org/10.1093/ageing/afz019
- Turuba R, Pirkle C, Bélanger E, Ylli A, Gomez Montes F, Vafaei A. Assessing the relationship between multimorbidity and depression in older men and women: the International Mobility in Aging Study (IMIAS). Aging Ment Health. 2020;24(5):747-757. https://doi.org/10.1080/13607863.2019.1571018
- Baré M, Herranz S, Roso-Llorach A, et al. Multimorbidity patterns of chronic conditions and geriatric syndromes in older patients from the MoPIM multicentre cohort study. BMJ Open. 2021;11(11):e049334. https://doi.org/10.1136/bmjopen-2021-049334
- Lutomski JE, Hoekstra T, Akker MVD, et al. Multimorbidity patterns in older persons and their association with self-reported quality of life and limitations in activities of daily living. Arch Gerontol Geriatr. 2023;115:105134. https://doi.org/10.1016/j.archger.2023.105134
- Mitsutake S, Ishizaki T, Teramoto C, Shimizu S, Ito H. Patterns of Co-Occurrence of Chronic Disease Among Older Adults in Tokyo, Japan. Prev Chronic Dis. 2019;16:E11. https://doi.org/10.5888/pcd16.180170
- Bao J, Chua KC, Prina M, Prince M. Multimorbidity and care dependence in older adults: a longitudinal analysis of findings from the 10/66 study. BMC Public Health. 2019;19(1):585. https://doi.org/10.1186/s12889-019-6961-4
- Yogesh M, Makwana N, Trivedi N, Damor N. Multimorbidity, health Literacy, and quality of life among older adults in an urban slum in India: a community-based cross-sectional study. BMC Public Health. 2024;24(1):1833. https://doi.org/10.1186/s12889-024-19343-7
- Cunningham JA, O'Reilly P, Hooper D, Nepelski D, Van Roy V. The role of project coordinators in European Commission framework programme projects. https://doi.org/10.2760/709126
- Heffner K, Klemens B, Solga B. Challenges of Regional Development in the Context of Population Ageing. Analysis Based on the Example of Opolskie Voivodeship. Sustainability. 2019; 11(19):5207. https://doi.org/10.3390/su11195207
- Cristea M, Noja GG, Stefea P, Sala AL. The Impact of Population Aging and Public Health Support on EU Labor Markets. Int J Environ Res Public Health. 2020;17(4):1439. https://doi.org/doi:10.3390/ijerph17041439
- Yip W. Healthcare system challenges in Asia. Economics and Finance 2019 May 23. https://doi.org/10.1093/acrefore/9780190625979.013.245
- Mohd Rosnu NS, Singh DKA, Mat Ludin AF, Ishak WS, Abd Rahman MH, Shahar S. Enablers and Barriers of Accessing Health Care Services among Older Adults in South-East Asia: A Scoping Review. Int J Environ Res Public Health. 2022;19(12):7351. https://doi.org/10.3390/ijerph19127351
- Vatal A. Navigating the Demographic Shift – A Comparative Analysis of India and Japan’s Aging Populations. IJRESM. 2024 Apr. 29 [cited 2025 Sep. 29];7(4):149-61.
- Chahrour M, Assi S, Bejjani M, et al. A Bibliometric Analysis of COVID-19 Research Activity: A Call for Increased Output. Cureus. 2020;12(3):e7357. Published 2020 Mar 21. https://doi.org/10.7759/cureus.7357
- Kim K, Cho KT. A Review of Global Collaboration on COVID-19 Research during the Pandemic in 2020. Sustainability. 2021; 13(14):7618. https://doi.org/10.3390/su13147618
- Filip R, Gheorghita Puscaselu R, Anchidin-Norocel L, Dimian M, Savage WK. Global Challenges to Public Health Care Systems during the COVID-19 Pandemic: A Review of Pandemic Measures and Problems. J Pers Med. 2022;12(8):1295. https://doi.org/10.3390/jpm12081295
- Delerue Matos A, Fonseca de Paiva A, Cunha C, Voss G. Precautionary behaviours of individuals with multimorbidity during the COVID-19 pandemic. Eur J Ageing. 2022;19(4):827-835. Published 2022 Jan 4. https://doi.org/10.1007/s10433-021-00632-8
- Singhal S, Kumar P, Singh S, Saha S, Dey AB. Clinical features and outcomes of COVID-19 in older adults: a systematic review and meta-analysis. BMC geriatrics. 2021 May 19;21(1):321. https://doi.org/10.1186/s12877-021-02261-3
- Iaccarino G, Grassi G, Borghi C, Ferri C, Salvetti M, Volpe M. Age and multimorbidity predict death among COVID-19 patients: results of the SARS-RAS study of the Italian Society of Hypertension. Hypertension. 2020 Aug;76(2):366-72. https://doi.org/10.1161/HYPERTENSIONAHA.120.1532
- McQueenie R, Foster HM, Jani BD, Katikireddi SV, Sattar N, Pell JP, Ho FK, Niedzwiedz CL, Hastie CE, Anderson J, Mark PB. Multimorbidity, polypharmacy, and COVID-19 infection within the UK Biobank cohort. PloS one. 2020 Aug 20;15(8):e0238091. https://doi.org/10.1371/journal.pone.0251613
- Mair FS, Foster HM, Nicholl BI. Multimorbidity and the COVID-19 pandemic–An urgent call to action. Journal of Comorbidity. 2020 Oct 5;10:2235042X20961676. https://doi.org/10.1177/2235042X20961676
- Emami A, Javanmardi F, Pirbonyeh N, Akbari A. Prevalence of underlying diseases in hospitalized patients with COVID-19: a systematic review and meta-analysis. Archives of academic emergency medicine. 2020 Mar 24;8(1):e35. https://doi.org/10.22037/aaem.v8i1.600
- Pati S, Mahapatra P, Kanungo S, Uddin A, Sahoo KC. Managing multimorbidity (multiple chronic diseases) amid COVID-19 pandemic: a community based study from Odisha, India. Frontiers in public health. 2021 Feb 1;8:584408. https://doi.org/10.3389/fpubh.2020.584408
- Burgess R. COVID-19 mental health responses neglect social realities. Nature. 2020 May 4. https://doi.org/10.1038/d41586-020-01313-9
- Pesantes MA, Lazo-Porras M, Cárdenas MK, Diez-Canseco F, Tanaka-Zafra JH, Carrillo-Larco RM, Bernabé-Ortiz A, Málaga G, Miranda JJ. Los retos del cuidado de las personas con diabetes durante el estado de emergencia nacional por COVID-19 en Lima, Perú: recomendaciones para la atención primaria. Revista Peruana de Medicina Experimental y Salud Pública. 2020 Dec 2;37:541-6. https://doi.org/10.17843/rpmesp.2020.373.5980
- Rabeneck L, McCabe C, Dobrow M, Ruco A, Andrew M, Wong S, Straus S, Paszat L, Richardson L, Simpson C, Boozary A. Strengthening health care in Canada post-COVID-19 pandemic. FACETS. 2023 Aug 14;8:1-0. https://doi.org/10.1139/facets-2022-0225
- Xu Y, Yan M, Fu C, Xu W, Liu Y, Li Y. Complex patterns and determinants of regional multiple chronic conditions across the United States. PNAS nexus. 2024 Dec;3(12):pgae513. https://doi.org/10.1093/pnasnexus/pgae513
- Ofori-Asenso R, Chin KL, Curtis AJ, Zomer E, Zoungas S, Liew D. Recent patterns of multimorbidity among older adults in high-income countries. Population health management. 2019 Apr 1;22(2):127-37. https://doi.org/10.1089/pop.2018.006
- Rodrigues LP, de Oliveira Rezende AT, Delpino FM, Mendonça CR, Noll M, Nunes BP, De Oliviera C, Silveira EA. Association between multimorbidity and hospitalization in older adults: systematic review and meta-analysis. Age and ageing. 2022 Jul;51(7):afac155. https://doi.org/10.1093/ageing/afac155