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multiple medical problems; multimorbidity (MMP)

>= 3 chronic disease Epidemiology: - > 50% of elderly - adults < 65 years of age in the poorest socioeconomic decile have rates of multimorbidity equivalent to those of people 10-15 years older in the most affluent decile Complications: - increased risk* of - death - disability - adverse effects - institutionalization - use of healthcare resources - decreased quality of life * elderly with multimorbidity are heterogenous in terms of - illness severity - functional status - prognosis [2] Management: - consider patient preferences - consider the evidence base for treatment - consider the patient's prognosis - assess the clinical feasibility of proposed plan - optimize care plan [2,5] Notes: - most clinical practice guidelines focus on a single disease - elderly with multiple medical problems are excluded from clinical trials

Related

comorbidity

General

morbidity

References

  1. Barnett K et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. Lancet 2012 May 10 PMID: 22579043 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60240-2/fulltext - Salisbury C. Multimorbidity: Redesigning health care for people who use it. Lancet 2012 May 10 PMID: 22579042 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60482-6/fulltext
  2. Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - Geriatric Review Syllabus, 9th edition (GRS9) Medinal-Walpole A, Pacala JT, Porter JF (eds) American Geriatrics Society, 2016
  3. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Guiding principles for the care of older adults with multimorbidity: an approach for clinicians. J Am Geriatr Soc. 2012 Oct;60(10):E1-E25. PMID: 22994865 (corresponding NGC guideline withdrawn Dec 2017) - Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American Geriatrics Society: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc. 2012 Oct;60(10):1957-68. PMID: 22994844
  4. Varadhan R, Weiss CO, Segal JB et al Evaluating health outcomes in the presence of competing risks: a review of statistical methods and clinical applications. Med Care. 2010 Jun;48(6 Suppl):S96-105. Review. PMID: 20473207
  5. Talebraza S et al Geriatrics Evaluation & Management Tools American Geriatrics Society. 2021 https://geriatricscareonline.org/ProductAbstract/geriatrics-evaluation-management-tools/B007/