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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. [ABSTRACT FROM AUTHOR]

The World Health Organization definition for active ageing and the approach and measurement made by the UNECE/EC to define an Active Ageing Index (AAI) are the starting points for this work. This paper reflects on the proposed methodology of the European AAI for measuring and adapting it to sub-national spaces, in this case Spain and its regions. Consistently, evaluation of specific data sources and indicators that can be built from them, trying to homogenise with the national-level AAI, according to its calculation methodology, are also essential objectives of this paper. In general, Spanish data sources are broadly similar to those which have been used for calculating the AAI in Europe, while some limitations, difficulties for homogenization and distortions are inevitable due to the AAI specificity. These factors have conditioned the calculation of some indicators, tentatively replaced by other alternatives and approximations. The AAI for Spain, calculated on the basis of Spanish data sources, is consistent with the European AAI, although slightly lower. However, it is closely connected with other general indicators in Spain (Gross Domestic Product, Synthetic Quality of Life Index, New Index of Human Development) to differentiate the level of economic and social development of the Spanish regions. The future development of the AAI in Spain requires delving into the use of more adequate indicators and weights, and more crucially advancing its usefulness to assess the public policies for the elderly in Spain. In addition, it aims to extend its use to certain Latin American countries. [ABSTRACT FROM AUTHOR]