Characterising Multimorbidity in Adults With Heart Failure: A Latent Class Analysis.

Clinical decision support using heterogeneous electronic health records (EHRs) is a well-established yet rapidly expanding research area. Large language model (LLM)-driven approaches have shown dominant performance in processing unstructured data such as clinical notes for disease phenotype classification. However, the absence of a unified reasoning framework capable of integrating structured laboratory results with unstructured clinical notes under zero-shot conditions limits progress in multimodal clinical decision support. To address this gap, we propose MediPhen, a novel reasoning framework that transfers LLMs for multi-morbidity disease phenotyping using multimodal clinical data. MediPhen introduces a framework for adapting LLMs to zero-shot disease phenotyping by incorporating extracted clinical entities, their relations, and lab narratives from EHRs, integrating a clinical knowledgebase to guide phenotype classification and enhance LLM transfer learning performance, and an explanation module that leverages chain-of-thought prompting to improve clinical reasoning. Comprehensive experiments conducted on MIMIC-III and MIMIC-IV benchmarks across multiple LLMs demonstrate the effectiveness of MediPhen. Notably, MedGemma-27B achieved state-of-the-art performance, improving micro averaged F1 scores by 19.92% on MIMIC-III and 16.68% on MIMIC-IV compared to fine-tuned baselines. These results highlight MediPhen as a zero-shot screening tool for multi morbidity phenotype classification, scalable within research infrastructures, advancing integration of structured and unstructured EHR data in clinical AI.

Background & Objective: Multimorbidity (MM) or the presence of additional chronic conditions in asthma, worsens disease control and increases healthcare use, but its prevalence and sociodemographic links in Pakistan are unclear. Our objectives were to assess the prevalence and patterns of MM in asthma and examine associations with key social and demographic factors. Methodology: This observational cross sectional retrospective study was carried out at nine primary care sites of Indus Hospital & Health Network (IHHN), Pakistan. Obstructive Lung Disease (OLD) program data from January 2021 to March, 2025 of 5,802 physician confirmed asthma patients aged 12 years and above were analyzed using Statistical Package for Social Sciences (SPSS). Frequencies, percentages and logistic regression assessed prevalence, patterns, and associations of MM with age, gender, location, employment in asthma. Results: Amongst 5,802 patients, 19% had MM, most commonly hypertension and diabetes mellitus. Prevalence was highest in middle-aged (22.5%) and older adults (31.2%), while 6.2% of adolescents and young adults were also affected. After adjusting for age, gender, geographical location, and employment status, the odds of having MM were significantly higher among middle-aged and older adults compared with adolescents and young adults (p < 0.001). Male sex, rural residence, and non-employment were also associated with MM (p < 0.05). Having >1 comorbidity was more likely in older (AOR = 15.72) and middle-aged (AOR = 9.63) adults than in younger groups, and in females versus males (AOR = 1.85; all p < 0.001). Conclusion: Asthma patients in Pakistan face a substantial MM burden influenced by sociodemographic factors, highlighting the need for patient-centered care.

Multimorbidity, the coexistence of two or more chronic conditions, affects about 40% of all adults and over half of adults over 60 years. The complexity of multimorbidity (MM) often renders traditional trial designs inadequate, unable to account for the context of interventions, including the interplay of multiple health conditions in daily life. This gap reduces the generalizability and applicability of their results. This commentary aims to review the current state of trials targeting or involving patients with MM. Highlighting current limitations and drawing on insights from an international dedicated workshop in Bielefeld, Germany, we identify an ongoing and pressing need for innovative, patient-centered approaches to their design and conduct. We propose a shift toward more holistic and integrative experimental approaches, including developing interventions tailored to the characteristics and needs of patients with MM, establishing relevant outcomes, and enhancing data collection and process evaluation. We specifically advocate for adaptive trial designs, prespecified subgroup analyses, and the incorporation of patient-reported outcomes and experience measures such as burden of care to ensure that research is both comprehensive and reflective of the needs of patients living with MM, their caregivers, and of the clinicians participating in their care. Ethical considerations are discussed in our commentary as well, emphasizing the importance of patient safety, data protection, and informed consent. Finally, we call for the development of specific reporting guidance, such as a SPIRIT extension tailored to MM trials, to help researchers adapt standard protocols to the complex and heterogeneous reality of this population. This commentary aims to bridge the gap between research and practice, fostering the development of effective interventions that improve patient outcomes and enhance the quality of care for patients living with MM.

The prevalence of multimorbidity (MM), defined as the co-occurrence of two or more chronic conditions in an individual, presents complex challenges for healthcare providers (HCPs). In Portugal, nearly half of the general population experiences MM, intensifying demands on HCPs. Doctors and nurses often encounter fragmented care pathways, inadequate guidelines, and frequent ethical dilemmas, which can lead to moral distress (MD). MD arises when HCPs are unable to act in accordance with their ethical beliefs due to institutional barriers, and it has consequences for well-being and employee tenure. This study aims to examine whether MM-related clinical work and life satisfaction are associated with MD among HCPs who regularly care for patients with MM. Cross-sectional study surveyed doctors and nurses employed in hospital and non-hospital healthcare facilities in Portugal between August and October 2024. Data were collected using an anonymous electronic questionnaire including validated instruments: the Portuguese version of Measure of Moral Distress for Healthcare Professionals (MMD-HP) and the Satisfaction With Life Scale (SWLS). Additional sociodemographic and work-related information was gathered, including sex, age, marital status, professional role, workplace setting, number of years working with patients with MM (professional experience), and the number of patients with MM seen per week (clinical workload). Associations were examined using linear multiple regression, with the significance level set at 0.05. A total of 340 HCPs participated, mostly women (83.2%), nurses (66.8%), and professionals with more than 10 years of experience caring for patients with MM (75.6%). The median MD (MMD-HP) score was 128 (Q1, Q3: 73, 182); median life satisfaction (SWLS) score was 24 (Q1, Q3: 18, 28). MD was negatively correlated with life satisfaction, indicating that lower life satisfaction was associated with higher MD. Higher MD levels were observed in HCPs under 35 years compared with those over 50 (p=0.010). HCPs with more than 10 years of experience caring for patients with MM reported significantly lower MD (p=0.022). A higher MM-related clinical workload was also associated with greater MD (p=0.003). HCPs currently considering leaving their position due to MD reported significantly higher MD and lower life satisfaction (both p<0.0001). In multivariable analysis, MM-related clinical workload and life satisfaction remained significant predictors of MD. MD was associated with higher MM-related clinical workload and lower life satisfaction. Younger and less experienced HPCs appeared particularly vulnerable. The reliability of these findings should be interpreted with caution due to the use of composite scores and the observational study design . The results reinforce concerns about the impact of MD on intentions to leave healthcare positions and emphasize the need for institutional support/interventions that address workload and promote well-being.

Multimorbidity (MM), defined as the co-occurrence of multiple chronic conditions in a single individual, poses a major challenge to health systems. Its consequences include higher morbidity and mortality rates, reduced quality of life, and increased healthcare costs. Despite its substantial public health burden, no systematic reviews have comprehensively assessed the pooled prevalence of MM in Brazil. This manuscript outlines a protocol for a systematic review and meta-analysis aimed at estimating the prevalence of MM among community-dwelling adults in Brazil. We will conduct a systematic review and meta-analysis of population-based studies reporting MM prevalence in community settings. A comprehensive search will be performed in PubMed, Scopus, Web of Science, Embase, LILACS, and SciELO databases. Two independent reviewers will screen articles, assess study quality using the Joanna Briggs Institute (JBI) Checklist for prevalence studies, and extract data. For the meta-analysis, pooled estimates will be calculated using random-effects models with Restricted Maximum Likelihood (REML) estimators to account for between-study variability. Heterogeneity will be assessed using the I² statistic and Cochran's Q test. Subgroups analyses (e.g., age group, sex, region, and study type) will be conducted where feasible. Findings will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The protocol is registered with the International Prospective Register of Systematic Reviews (CRD42024389106). This review will provide comprehensive evidence on MM prevalence in Brazil, identifying the burden of this problem for future research and informing public health strategies.

BackgroundThe role of age at first marriage in chronic disease risk remains understudied, and evidence on its association with chronic health outcomes in men and women is limited. We therefore examined the relationship between age at first marriage and the risk of chronic diseases among adult men and women in the Azar cohort.MethodsThis cross-sectional study used data from 13,326 participants in the Azar Cohort, which evaluates risk factors for chronic non-communicable diseases (NCDs) in northwest Iran. A structured questionnaire captured demographic variables, age at first marriage, medical history, and personal habits. Based on age at first marriage, participants were classified into two groups: under 18 years (child marriage) and 18 years or older (adult marriage).ResultsAmong 13,326 participants, the prevalence of child marriage was 26.36%. Women constituted a larger share of the child marriage group than men (46.6% vs. 3.6%; P < 0.001). In men, child marriage showed no association with NCDs except for obesity (Odds ratio [OR]: 1.43) and multimorbidity (MM) (OR: 1.41). In women, marriage before 18 years was associated with higher odds of diabetes (OR: 1.25), hypertension (OR: 1.37), cardiovascular disease (OR: 1.67), stroke (OR: 1.84), depression (OR: 1.35), obesity (OR: 1.50), and MM (OR: 1.53). Notably, the highest odds occurred for stroke.ConclusionChild marriage was associated with obesity and MM in men, and with diabetes, hypertension, cardiovascular disease, stroke, depression, obesity, and depression in women. These results indicate a need for tailored health interventions for people affected by child marriage, particularly women. Longitudinal follow-up is recommended to assess causality.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12889-025-25391-4.

Introduction A negative association between the number of chronic conditions and quality of life (QoL) is well known, but the complexity of this association is not fully understood. This study aimed to 1) examine the association between the number of diagnosis groups, as a measure of multimorbidity, and needs-based QoL, and 2) explore how this association varies across sociodemographic subgroups. Methods This cross-sectional study included adults with chronic conditions managed at a general practitioner (GP) who participated in a cluster-randomized trial. The exposure was the number of self-reported diagnosis groups, using an organ-specific definition, and the outcome was needs-based QoL measured using the Multi Morbidity Questionnaire 1 (MMQ1). Multivariable linear regression models were used, and a Minimal Important Difference (MID) for each domain were calculated to assess the clinical relevance. Results The study included 31,753 patients. Significant, linear, associations were found between the number of diagnosis groups and needs-based QoL. Age, education, occupation, and living alone were identified as effect modifiers. The strongest associations were observed among participants aged 40–59 years, those with lower educational levels, the unemployed, and those living alone. Conclusion A cumulative burden of multimorbidity was identified as increasing number of diagnoses was associated with lower needs-based QoL. Socioeconomically and socially vulnerable groups may experience greater impacts on their QoL and may benefit from additional support or more personalized care approaches. These findings highlight the importance of a bio-psycho-social approach when caring for patients with chronic disease and multimorbidity in general practice.

The Cohort of Health-Related Outcomes in Chronic Illness Care in General Practice was established using data collected as part of a cluster-randomised trial. This aims to support the trial's follow-up and enable further examination of the interplay between chronic disease, multimorbidity (MM), polypharmacy (PP) and quality of life (QoL) in a Danish general practice setting. The cohort comprises 35 977 adult patients from 250 general practices participating in a cluster-randomised trial and had a response rate of 22.4%. Participants were either registered as chronic care patients or had attended an annual chronic disease consultation. They completed a comprehensive questionnaire on self-reported chronic conditions, medication use, QoL, treatment burden and patient-centred care. Additionally, 431 general practitioners (GPs) from the participating practices completed a questionnaire about managing patients with complex MM. Among participants, 51.9% were female, the mean age was 65.6 (SD 12.9) years, 93.1% had education beyond basic schooling, and half were retired. Conditions from more than one organ system-based disease group were reported by 82.2%, and 94.6% used one or more prescription medications. The main challenges reported by the participating GPs in managing patients with complex MM were keeping time and obtaining an overview of the patient's health status. Cohort data will be linked with Danish registries to improve the detection and treatment of chronic conditions and PP in general practice. The cluster randomised trial (MM600) is registered with ClinicalTrials.gov ID: NCT05676541.

Abstract Background Childhood socioeconomic disadvantage (SED) is a public health concern in Europe, where &amp;gt;20% of children face poverty/social exclusion. It is a foundational health determinant prioritised through initiatives eg. European Child Guarantee. Multimorbidity (MM),co-occurrence of ≥ 2 chronic conditions,is also rising, especially among disadvantaged groups. Yet long-term impact of early-life SED on adult MM remains underexplored. Methods We conducted PROSPERO-registered systematic review (CRD42024588657) searching four databases for observational studies quantifying associations between childhood SED and adult MM. Random-effects metaanalyses were performed where feasible; heterogeneity was assessed with I². Where metaanalysis was infeasible, effect direction synthesis was used. Risk of bias (RoB) was assessed via ROBINS-E; certainty graded using GRADE. Results From 5,617 records, 10 studies met inclusion criteria. Most were cross-sectional and used self-reported outcomes. Exposures included perceived childhood economic adversity(n = 6), parental education(n = 4), parental occupation(n = 1), and composite measures(n = 3). Findings were mixed. Several studies reported harmful associations, but directions and magnitudes varied. Metaanalysis of perceived adversity showed no clear association (OR 1.03; 95% CI: 0.84-1.27; I²=94.4%). Pooled ORs for father's and mother's education were 0.95 (95% CI: 0.66-1.37; I²=66.8%) and 1.07 (95% CI: 0.70-1.61; I²=36.9%), respectively. RII estimates ranged from 0.46-2.06, with inconsistent patterns across exposures/settings. All studies were high/very high RoB; evidence certainty was very low. Conclusions Evidence linking childhood SED to adult MM is inconclusive and heterogeneous. Studies suggest potential harmful associations but very low certainty and methodological limitations preclude firm conclusions. Reducing childhood poverty remains a public health priority, but further high-quality research is needed to clarify long-term impacts on MM. Key messages • Despite limited evidence childhood socioeconomic disadvantage appears to be consistently linked to higher adult multimorbidity, with strongest associations for parental education and occupation. • To inform action on child poverty and chronic disease, including in the European union, causal research is needed on how early-life policies can reduce long-term multimorbidity and health inequality.

Abstract Background Chronic health issues are becoming the primary healthcare burden, leading to a rise in elderly individuals living with multimorbidity (MM). MM nearly always leads to polypharmacy (PPha), with an overall prevalence of 26.3-39.9% in elderly Europeans in 2018. PPha increases healthcare costs and can lead to adverse consequences like falls, readmissions and death. To face this, physical activity (PA) is crucial as a preventive and therapeutic tool. PA has been found to be as effective as medications in preventing diabetes, certain types of cancers, anxiety, depression and coronary heart disease. PA also positively affects adherence to medication regimens and enhances the elderly's quality of life (QoL) and mental well-being. Methods This study follows the methodological steps of Joanna Briggs Institute for scoping reviews. We searched Medline via PubMed, Web of Science and Scopus. The PRISMA Extension for Scoping Reviews was used for reporting. Results Six cross-sectional studies were included; five measured PA by questionnaires and one through accelerometers. MM affected from 33% to 100% of participants; all results were adjusted for confounders. Prevalence of PPha ranged from 25.9% to 57.7%. All of them showed an inverse association between PA and PPha, irrespective of the definition of PPha and the PA assessment method employed. Conclusions Findings revealed a promising inverse association between PA and PPha in multimorbid elders. Here arises a significant opportunity to design and implement specialized PA multicomponent and multilevel programs for multimorbid elders with PPha. Such programs could provide essential education on the benefits of PA, personalized exercise routines, guidance on proper medication management, and regular health monitoring. Such a holistic approach not only addresses the physical aspect of health but also promotes mental well-being, social interaction, and overall QoL for older adults facing the challenges of MM and PPha. Key messages • This study highlights how physical activity can significantly reduce polypharmacy in multimorbid older adults, promoting better health outcomes and QoL while minimizing medication-related risks. • The lack of studies, RCT in particular, shows the necessity of implementing community programs of physical activity to reduce the polypharmacy burden and healthcare costs among multimorbid elders.

People with severe mental illness (SMI), such as schizophrenia and bipolar disorder have a reduced life expectancy. This is largely due to physical multimorbidity (MM), defined as the coexistence of two or more physical health conditions. This systematic review identifies which psychosocial and demographic factors are associated with MM in SMI. Embase, PubMed, and PsychINFO were searched with no limits on publication date or study design. Studies were eligible for inclusion if they assessed the impact of psychosocial and/or demographic factors on MM outcomes among people with SMI. Thirty studies met the inclusion criteria for this review. The strongest predictors of MM were childhood maltreatment (odds ratios [OR] up to 8.70 [95% CI 2.49-30.33]), female gender (OR up to 2.47 [95% CI 1.35-4.50]), older age (OR up to 1.60 [95% CI 1.31-1.96]), and ethnicity (e.g. OR up to 2.09 [95% CI 1.81-2.42] for Black Caribbean groups relative to White British groups). Predictors with mixed evidence included educational attainment, employment status, socioeconomic status, marital status, urbanicity, deprivation, country of origin, healthcare access, and global functioning. The findings highlight psychosocial factors (e.g. childhood maltreatment) and demographic factors (e.g. older age) that may contribute to MM, which has strong clinical implications. Some factors are modifiable (e.g. education) and can inform risk prevention strategies for MM in SMI, mitigating risks of premature mortality. Future research should use consistent definitions of MM for cross-study comparisons and assess additional risk factors, their interactions, and underlying mechanisms.

Objectives Wales participation to OECD PaRIS offered a unique opportunity to gather over 25,000 health outcomes and experiences of adults over 45 living in Wales. These structured questionnaires are now being linked to other nationally held datasets to understand the impact on daily lives and activities for those with chronic conditions. Methods In 2023, Wales PaRIS data collection saw 75 GP practices completing the Provider Survey and over 25,000 adults over 45 complete the Patient Survey. These questionnaires were developed by a scientific committee on behalf of OECD Member States to undertake the first outcome based international benchmarking study of adults managed in primary care (PaRIS). Wales implementation allowed for patient identifiable data to be collected that could be linked to nationally held data sets (hospital activity data, mortality, emergency care etc.), providing a unique opportunity to understand outcomes and experiences of the Welsh adult population through a Value Based Healthcare lens. ResultsThe large data set is generating valuable insights into variation of outcomes between regions (rural vs city), people’s characteristics (sex, age, income etc) and diseases. Initial analysis shows that patients with multi morbidity have lower PROMIS scores across four domains – physical health, mental health, general health, and social functioning. The Population Health Survey data alongside activity and testing data is revealing new understanding into the communication and self-management needs of individuals with various risk factors and clinical outcomes. This will guide us in supporting people with different needs to better manage their care. Additionally, we are using this information to understand the impact of pain on people’s daily activities and outcomes, to drive improvement in the way we coordinate and manage people’s pain and conditions. ConclusionWales participation in PaRIS has provided the perfect opportunity to undertake an adult population needs assessment for Wales. The data insights being generated are of an unprecedented scale and quality, thanks to its implementation model, that allows its wider use within our NHS Wales data ecosystem.

Multimorbidity (MM), defined as two or more chronic diseases in an individual, is linked to adverse outcomes. MM is increasing in sub-Saharan Africa due to rapidly advancing epidemiological and social transitions. The Multimorbidity in Africa: Digital Innovation, Visualisation and Application Research Hub (MADIVA) aims to address MM by developing data science solutions informed by stakeholder engagement. MADIVA uses complex, individual-level datasets from research centres in rural Bushbuckridge, South Africa and urban Nairobi, Kenya. These datasets will be harmonised, linked and curated, and then used to develop MM risk prediction models, novel data science methods and interactive dashboards for research and clinical use. Pilot projects and mentorship programmes will support data science capacity development. Ethics approval has been granted. Dissemination will occur through scientific meetings and publications. MADIVA is committed to making data FAIR: findable, accessible, interoperable and reusable.

In economically less-developed areas, the public is likely to neglect the physical and psychological health of middle-aged and elderly Chinese women by the public. Comorbidities such as multi morbidity and depression are becoming a severe global challenge. This paper aims to explain the impact of depression on multimorbidity in middle-aged and elderly Chinese women with urban-rural differences. In the China Health and Retirement Longitudinal Study 2020, a total of 6317 participants older than 45-year-old were included in this study. First, the Kruskal-Wallis H test and χ² test were used to determine the frequency and correlation between variables, depression, and multimorbidity. Second, logistic regression was used to measure the impact of depression on multimorbidity and identify the confounding factors. Finally, subgroup analysis explained the urban-rural differences. Of the 6317 individuals included, 65.5% of the multimorbidity participants had suffered from minor depression and 82.6% had major depression. Four binary logistic regression models with a good degree of fit were established to indicate that the prevalence of multimorbidity was increased after excluding the confounding factors of residence. In the subgroup analysis, marital status, depression, and self-rated health make sense in urban-rural differences. This study found that depression was more strongly associated with multimorbidity in urban women than in rural ones. In summary, urban women with depression experience multimorbidity with ease. The elderly population (≥60-year-old), unmarried rural women, and urban women with middle school education are more susceptible; in other words, these people might face more serious challenges in China.

Longitudinal Analysis of the Transition Between Multimorbidity and Mortality Patterns from a Syndemic Perspective.

Abstract The present study has made an attempt to explore the relationship between multi-morbidity and sleep quality among the elderly. The interrelation between poor sleep quality and negative emotions has also been examined in this study which further hampers the subjective well-being of the elderly. Multivariate Logistic regression model has been used to explore the association between multi morbidity, sleep pattern and subjective well being among the elderly. Result of the study shows that sleep quality and multi- morbidity have a significant direct effect on subjective well being of the elderly. The study concluded that negative emotional state like depression is negatively associated with sleeping pattern of the elderly. Although sleep disorder is not life threatening for the elderly, in the long run it can impair the immune system which lead to multiple diseases and reduce subjective well being among the elderly. Key words: Multi-morbidity, sleep quality, subjective well-being, negative emotions.

Multimorbidity (MM), defined as the presence of two or more chronic health conditions in an individual, can be more burdensome than single chronic disease. To estimate the prevalence of MM and determine its drivers among middle-aged and older adults in a city of North India. A community-based, cross-sectional study was conducted in semiurban and rural areas of Aligarh in Uttar Pradesh, India, among 420 adults aged ≥45 years using simple random sampling. Sociodemographic, dietary, anthropometry, clinical information, and diagnosed diseases were collected. Descriptive statistics, Chi-square test, and logistic regression analysis were done using IBM SPSS V.20.0. We found the prevalence of MM was 40.2% (P = 0.40, 95% CI: 35.5%-45.1%), females > males (42.1% vs 37.5%). The odds of MM was almost 5 times higher in adults aged >75 years compared to 45-55 years old (AOR: 4.73; 95% CI: 1.40-16.05) and 2 times higher in urban areas (AOR: 2.10; 95% CI: 1.25-3.51). Physically inactive adults [AOR: 4.75 (95% CI: 2.19-10.28)], those who ever consumed tobacco or alcohol (AOR: 3.20; 95% CI: 1.85-5.54), those with lack of dietary diversity (AOR: 1.94; 95% CI: 1.04-3.63), and those morbidly obese (AOR: 10.17; 95% CI: 2.55-40.59) were at risk. With four out of ten adults having MM, its burden is high, especially in semiurban areas. Targeted interventions to reduce physical inactivity, obesity, and tobacco consumption and to increase dietary diversity are recommended.

ObjectivesThis study examined whether incorporating free-text entries into structured general practice records improves the detection of long-term conditions (LTCs) and multimorbidity (MM) in New Zealand (NZ) general practices.MethodsData from 374 071 deidentified individuals in general practices were analysed to identify 61 LTCs. Structured data were extracted using Read codes from a national master list, and clinical raters independently identified condition-related free-text, including synonyms, negation terms and common misspellings in randomised samples. Keywords were categorised and refined through ten iterative tests. Programmatic text classification was developed and assessed against gold-standard clinician ratings, using sensitivity, specificity, positive predictive value (PPV) and F1-score.ResultsA quarter of general practitioner classifications contained either unrecognised Read codes or consisted of free-text only. Clinician inter-rater reliability was high (kappa ≥0.9). Compared with clinical gold standard, text classification yielded an average sensitivity of 88%, specificity of 99% and PPV of 95%, with an F1-score range of 82%–95%. Incorporating free text increased LTC prevalence from 42.1% to 46.3%, reducing misclassification of MM diagnoses by identifying 12 626 additional patients with MM and 15 972 additional patients with at least one LTC.DiscussionIn the course of workflow, general practitioners face barriers to accurate LTC coding or may simply annotate with text-based descriptions. Programmatic text classification has demonstrated high performance and identified many more patients receiving LTC care.ConclusionsCombining structured and unstructured data optimises MM detection in NZ general practices and has the potential to improve case management, follow-up care and allocation of healthcare resources.

Introduction: As life expectancy increases, the proportion of older adults in Ireland is steadily increasing. There are currently 742,300 older adults in Ireland and that number is expected to increase to 1.56 million by 2051. However, these projected increases in life expectancy do not equate to increases in “healthy life expectancy”, with latter years often characterised by age-related multi-morbidity due to one or more chronic diseases. This may result in a reduction in quality of life and increasing cost to health care utilisation and budgets. This increased incidence in multi morbidity, along with older adult populations demonstrating lower thresholds for accessing acute care, has resulted in increasing numbers of older adults accessing acute and emergency care. The National Integrated Care for Older Persons (NICPOP) is leading out on the development of end to end pathways across primary, secondary and acute services for older people with a specific focus on those with complex health needs. The Carlow Kilkenny Integrated Care Programme for Older Persons (ICPOP) was established in 2021 and aims to facilitate integration and collaborative delivery of services for older persons, acting as a co-ordinator of integrated care in tandem with public and private health and social care providers. Aim &amp; Objectives: To engage multiple stakeholders in a rapid improvement event (RIE) promoting collaborative evaluation, planning and service development that in turn facilitates the delivery of an improved model of integrated care for older persons in Carlow-Kilkenny. Methods: •All public and private social and healthcare providers working with older persons in Carlow/Kilkenny were invited to participate or provide representation. Elements of the Lean methodology were adopted to facilitate multi stakeholder workshop style discussions over five days in summer 2023. A current and future state was mapped and a gap analysis was completed. Solutions were identified, prioritised and implemented over a ninety day period.' Progress updates were reported to all participants and stakeholders at RIE thirty, sixty and ninety days. The process was facilitated by the Ireland East Hospital Group Improvement Team. Results: The following were identified as priority areas for development and change in practice; 1.Development and adoption of defined inclusion criteria, triaging and prioritisation systems and dissemination of same to all referrers. This facilitated more timely access for patients most in need. (ICPOP team were are able to see patients identified at high risk of hospital admission in a more timely fashion, without any change in resources). 2.Development, evaluation and re-evaluation of defined metrics to measure impact of service interaction on older persons’ quality of life and function. 3.Development of a service directory for older persons and establish clear integration pathways across acute and community services. 4.The development and provision of education modules on older person services and frailty identification for health and social care providers. Conclusions: This process proved pivotal in the development of services provided for older persons in Carlow and Kilkenny. Referral rates and efficiency of access to the ICPOP service have increased significantly since the RIE.