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The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65 years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan–Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5 years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan–Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions.

Purpose of the Study: The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire in which participants rate the disease burden caused by a number of medical conditions. This paper studies the measurement properties of the DBMA, using Rasch analysis. Design and Methods: We used data of 1,400 community-dwelling adults aged 50 years and older participating in the Ageing in Spain Longitudinal Study, Pilot Survey (ELES-PS). Test of fit to the Rasch model, reliability, unidimensionality, response dependency, category structure, scale targeting, and differential item functioning (DIF) were studied in an iterative way. Construct validity of the linear measure provided by the Rasch analysis was subsequently assessed. Results: To achieve an adequate fit to the Rasch model, all items were rescored by collapsing response categories. Reliability (Person Separation Index) was low. The scale was unidimensional and neither response dependency nor relevant DIF were found. The linear measure had a correlation of −0.48 with physical functioning, −0.47 with perceived health, 0.32 with depression, and −0.24 with quality of life (QoL) and displayed satisfactory known-groups validity by sex and age groups. Relative precision analysis showed that the linear measure discriminated better between age groups than the original raw score, but for sex no difference was found. Implications: Despite some limitations, support was found for the validity of the DBMA in older adults. Its linear scores may be useful to assess strategies aimed at improving the QoL of patients with multimorbidity. More research is needed in a hospital-based sample.

Purpose As life expectancy increases, a progressively higher number of older adults have to cope with multiple chronic diseases, which cause functional deterioration and impaired quality of life and may impede ageing at home with autonomy and independence. Therefore, it is im-portant to have a reliable, valid and easy-to-apply measure of disease burden morbidity, cen-tered in the person. This study describes the metric properties of the disease burden morbidity assessment (DBMA) using Rasch analysis, which allows developing linear measures that may be applied using computerized test assessment. Method Participants were 1400 adults aged 50 years and over from the Longitudinal Study Aging in Spain Pilot Survey (ELES-PS). The DBMA asked about the impact of several chronic health problems on activities of daily liv-ing, with a 5-point response scale. Rasch analysis was applied. Results & Discussion The par-ticipants¿ mean age was 65.5±10.40 years, 55.4% were women, and reported a mean number of chronic conditions of 2.5±2.25. After adjusting the response scale, a good fit to the Rasch model was achieved, with items local independence and unidimensionality, no differential item functioning, though with low reliability. The linear measure showed moderate correlations with physical function and self-rated health. In conclusion, after adjustment the DBMA offers results in a linear measure, with an adequate internal and construct validity. This measure allows as-sessing the impact of illness according to the patients perspective and supports its application through computerized test assessment.

Aim. To carry out an analysis of the psychometric properties of the Disease Burden Morbidity Assessment (DBMA) according to the assumptions of the Classical Test Theory. Methods. A sample of 707 community‐dwelling adults aged 65 years and older, living in Spain, completed the DBMA. Psychometric properties of the scale (feasibility, acceptability, scaling assumptions, reliability and construct validity) were analyzed. Results. The mean DBMA score was 6.8. Feasibility and acceptability were satisfactory, except for large floor effects (>50%), as well as a skewed distribution (1.8). Item‐total corrected correlation ranged 0.10–0.49, item homogeneity index was 0.09 and Cronbach's alpha was 0.72. Disease burden correlated strongly with physical functioning (r = –0.56) and perceived health (r = –0.56), and moderately with depression (r = 0.41) and the Personal Wellbeing Index (r = –0.41). Exploratory factor analysis extracted five factors, explaining 44% of the variance. Conclusions. The DBMA is an acceptable and valid instrument for measuring disease burden in older adults. Future studies should include Rasch analysis to further assess dimensionality and explore other measurement properties