New horizons in multimorbidity in older adults

Abstract

The concept of multimorbidity has attracted growing interest over recent years, and more latterly with the publication of specific guidelines on multimorbidity by the National Institute for Health and Care Excellence (NICE). Increasingly it is recognised that this is of particular relevance to practitioners caring for older adults, where multimorbidity may be more complex due to the overlap of physical and mental health disorders, frailty and polypharmacy. The overlap of frailty and multimorbidity in particular is likely to be due to the widespread health deficit accumulation, leading in some cases to functional impairment. The NICE guidelines identify 'target groups' who may benefit from a tailored approach to care that takes their multimorbidity into account, and make a number of research recommendations. Management includes a proactive individualised assessment and care plan, which improves quality of life by reducing treatment burden, adverse events, and unplanned or uncoordinated care.

Keywords: frailty; long-term conditions; multimorbidity; older people.

Figure 1.

Diagram to indicate the need for an approach to care that takes account of multimorbidity [10]. Reproduced with permission National Guideline Centre (2016) Multimorbidity: clinical assessment and management (NG56). Published by the National Guidelines Centre at The Royal College of Physicians, 11 St Andrews Place, Regent's Park, London NW1 4LE. Copyright © NGC. Reproduced by permission.

Figure 2.

Flowchart of the evolution of a single disease process to multimorbidity, functional impairment and finally frailty.