Multiple Chronic Conditions and Multimorbidity Among Older Adults in Southern Albania: Distribution and Impact on Care Needs, Medication Adherence, and Quality of Life

Introduction: Multimorbidity, defined as the coexistence of two or more chronic conditions, is a major global public health challenge. It exists on a continuum from non-complex to highly complex forms, with increasing complexity associated with greater instrumental activities of daily living (IADL) disability, frailty, and mortality. Objectives: This study aims (1) to assess chronic condition complexity (CCC) by distinguishing multiple chronic conditions (MCCs) from multimorbidity (MM); (2) evaluate their distribution and impact on care needs, medication adherence, and quality of life; and (3) examine associations between MM and sociodemographic factors among older adults in Albania. Methods: A descriptive, cross-sectional, multicenter observational study was conducted among older adults aged 65 years and older with ≥2 chronic conditions. Data were collected from participants attending six primary health care centers in southern Albania between March and December 2024. Medication adherence and quality of life were assessed using the Simplified Medication Adherence Questionnaire (SMAQ) and the Older People’s Quality of Life Questionnaire (OPQOL-35), both validated for the Albanian population. Results: In a sample of 727 older adults with ≥2 chronic conditions, MM was significantly associated with advanced age, polypharmacy, medication non-adherence, and lower educational level (p < 0.05). Additional factors, such as reliance on family care and reduced quality of life, were also linked to higher odds of MM, while gender and secondary education showed non-significant associations. Conclusions: Although multimorbidity represents a smaller subgroup within MCCs, it is associated with greater clinical and functional complexity, particularly among older adults of advanced age and lower educational level, indicating that disease burden alone does not fully capture clinical complexity.