Multimorbidity

Multimorbidity means living with two or more chronic illnesses.[1] For example, a person could have diabetes, heart disease and depression. Multimorbidity is common in older adults, estimated to affect over half of those aged 65 and over.[2] This increased prevalence has been explained by older adults' "longer exposure and increased vulnerability to risk factors for chronic health problems".[3] The prevalence of multimorbidity has been increasing in recent decades.[4][5][6] The high prevalence of multimorbidity has led to some describing it as "The most common chronic condition".[7] Multimorbidity is also more common among people from lower Socioeconomic statuses.[8][9][10] Multimorbidity is a significant issue in low‐ and middle‐income countries, though prevalence is not as high as in high income countries.[11]

Multimorbidity is associated with reduced quality of life[12] and increased risk of death.[13]

Due to the higher prevalence of multimorbidity (55 - 98%),[14] a new concept of "complex multimorbidity (CMM)" has been proposed.[15] CMM differs from the definition of conventional multimorbidity in that CMM is defined by the number of body systems affected by the diseases rather than the number of diseases. CMM is associated is mortality and long-term care needs in older adults.[16][17][18]

People with multimorbidity face many challenges because of the way health systems are organised. Most health systems are designed to cater for people with a single chronic condition.[19] Some of the difficulties experienced by people with multimorbidity include: poor coordination of medical care, managing multiple medications, high costs associated with treatment,[20] increases in their time spent managing illness,[21] difficulty managing multiple illness management regimes,[22] and aggravation of one condition by symptoms or treatment of another.[23]

See also

References

  1. ↑ Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009 Jul-Aug;7(4):357-63.
  2. ↑ Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L. Aging with multimorbidity: a systematic review of the literature. Ageing research reviews. 2011 Sep 1;10(4):430-9.
  3. ↑ Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, T Fratiglioni L. Aging with multimorbidity: a systematic review of the literature. Ageing research reviews. 2011 Sep 1;10(4):430-9.
  4. ↑ King DE, Xiang J, Pilkerton CS. Multimorbidity trends in United States adults, 1988–2014. J Am Board Fam Med. 2018; 31(4): 503‐ 513.
  5. ↑ Pefoyo AJK, Bronskill SE, Gruneir A, et al. The increasing burden and complexity of multimorbidity. BMC Public Health. 2015;15(1):415.
  6. ↑ Uijen AA, van de Lisdonk EH. Multimorbidity in primary care: prevalence and trend over the last 20 years. Eur J Gen Pract. 2008;14(sup1):28‐32.
  7. ↑ Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition—multimorbidity. Jama. 2012 Jun 20;307(23):2493-4.
  8. ↑ Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, Meinow B, Fratiglioni L. Aging with multimorbidity: a systematic review of the literature. Ageing research reviews. 2011 Sep 1;10(4):430-9.
  9. ↑ Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet. 2012 Jul 7;380(9836):37-43.
  10. ↑ Pathirana TI, Jackson CA. Socioeconomic status and multimorbidity: a systematic review and meta‐analysis. Australian and New Zealand journal of public health. 2018 Apr;42(2):186-94.
  11. ↑ Afshar S, Roderick PJ, Kowal P, Dimitrov BD, Hill AG. Multimorbidity and the inequalities of global ageing: a cross‐sectional study of 28 countries using the World Health Surveys. BMC Public Health. 2015;15(1):776.
  12. ↑ Makovski TT, Schmitz S, Zeegers MP, Stranges S, van den Akker M. Multimorbidity and quality of life: systematic literature review and meta-analysis. Ageing research reviews. 2019 Aug 1;53:100903.
  13. ↑ Nunes BP, Flores TR, Mielke GI, Thumé E, Facchini LA. Multimorbidity and mortality in older adults: a systematic review and meta-analysis. Archives of gerontology and geriatrics. 2016 Nov 1;67:130-8.
  14. ↑ Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: A systematic review of the literature. Vol. 10, Ageing Research Reviews. Elsevier; 2011. p. 430–9.
  15. ↑ Harrison C, Britt H, Miller G, Henderson J. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open. 2014;4(7):4694.
  16. ↑ Storeng, Siri H., et al. "Associations between complex multimorbidity, activities of daily living and mortality among older Norwegians. A prospective cohort study: The HUNT Study, Norway." BMC geriatrics 20.1 (2020): 1-8.
  17. ↑ Kato D, Kawachi I, Saito J, et alComplex multimorbidity and mortality in Japan: a prospective propensity-matched cohort study, BMJ Open 2021;11:e046749. doi: 10.1136/bmjopen-2020-046749.
  18. ↑ Kato, D., Kawachi, I., Saito, J., & Kondo, N. (2021). Complex multimorbidity and incidence of long-term care needs in Japan: a prospective cohort study, 18(19), 10523; https://doi.org/10.3390/ijerph181910523
  19. ↑ Salisbury C. Multimorbidity: redesigning health care for people who use it. Lancet. 2012;380(9836):7‐9.
  20. ↑ Wang L, Si L, Cocker F, Palmer AJ, Sanderson K. A systematic review of cost‐of‐illness studies of multimorbidity. Appl Health Econ Health Policy. 2018;16(1):15‐29.
  21. ↑ Jowsey T, McRae IS, Valderas JM, Dugdale P, Phillips R, Bunton R, Gillespie J, Banfield M, Jones L, Kljakovic M, Yen L (2013). "Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey". PLOS ONE. 8 (4): e59379. Bibcode:2013PLoSO...859379J. doi:10.1371/journal.pone.0059379. PMC 3613388. PMID 23560046.
  22. ↑ Jowsey T, Dennis S, Yen L, Mofizul Islam M, Parkinson A, Dawda P (July 2016). "Time to manage: patient strategies for coping with an absence of care coordination and continuity". Sociology of Health & Illness. 38 (6): 854–73. doi:10.1111/1467-9566.12404. PMID 26871716.
  23. ↑ Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS (2003). "Descriptions of barriers to self-care by persons with comorbid chronic diseases". Annals of Family Medicine. 1 (1): 15–21. doi:10.1370/afm.4. PMC 1466563. PMID 15043175.
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