Disease keeps accumulating at 95, and the frailty index does not care which deficits you count

The edition in brief

Nationwide Swedish register data followed everyone born in 1920-1922 who reached 70. Multimorbidity accumulated fastest up to age 80, plateaued between 80 and 90, and slowed after that without ever reversing: mean disease count at 90 was 3.9 in men and 3.5 in women, and more than half of those aged 95 and over carried five or more diseases. Most accumulation happened in non-terminal years rather than in a final decline, with cardiovascular disease the dominant contributor throughout and musculoskeletal and neurosensorial disease growing in importance with age. In 3,669 adults with cardiovascular disease from a national survey, random survival forest and Cox models tested whether the frailty index's assumption that deficits are interchangeable holds: 200 randomly built indices converged with importance-ranked ones by about 35 items for all-cause mortality and 20 for cardiovascular mortality, while keeping all 46 items as separate predictors outperformed any composite (C-index 0.71 against 0.64-0.67). Among 460 participants aged 40 and over with actigraphy, higher serum vitamin D was associated with 23.6 more minutes of total sleep (95% CI 9.6-37.6) and shorter wake bouts, with deficiency associated with 23 minutes less sleep; B12 associations ran in opposite directions in men and women. A cluster randomised trial across 77 care communities and 434 staff found a six-month dementia care coaching programme improved employee satisfaction and person-centred workplace practices but not caregiver-resident relationships or dementia care confidence. And a controlled pre-post study of an Aboriginal co-designed falls programme improved functional mobility by 0.8 points on the Short Physical Performance Battery (95% CI 0.4-1.1), without changing fall rates.