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Review
. 2025 Mar 18:15:26335565251326309.
doi: 10.1177/26335565251326309. eCollection 2025 Jan-Dec.

Descriptions of advanced multimorbidity: A scoping review with content analysis

Sarah P Bowers  1 , Polly Black  1 , Lewis McCheyne  2 , Darcy Wilson  3 , Rose S Penfold  4   5 , Liam Stapleton  6 , Pam Channer  7 , Sarah E E Mills  1   2 , Linda Williams  8 , Frances Quirk  1   2 , Jo Bowden  1   2
Affiliations
Review

Descriptions of advanced multimorbidity: A scoping review with content analysis

Sarah P Bowers et al. J Multimorb Comorb. .

Abstract

Introduction: Multimorbidity is associated with adverse clinical outcomes, including increased symptom burden and healthcare utilisation, particularly towards the end of life. Despite this, there is no accepted method to identify the point at which individuals with deteriorating health due to long-term conditions are nearing the end of life or might benefit from a palliative care approach - conceptualised as 'Advanced Multimorbidity'. This scoping review explored how Advanced Multimorbidity is described and operationalised within the literature.

Methods: Multiple electronic databases and Grey Literature sources were searched following scoping review frameworks. Two reviewers independently performed screening and data extraction. Content analysis was used to examine the different descriptions of Advanced Multimorbidity. Stakeholder consultations were undertaken with clinicians, academics and public participants. Patient and public involvement was separately integrated throughout this review from conceptualisation, design and reporting.

Results: Forty-four different descriptions of Advanced Multimorbidity were identified from 38 publications. These varied in terms of the clinical conditions and descriptors used. Eighteen descriptions relied on a single indicator to identify Advanced Multimorbidity; 24 used a multidimensional approach. Stakeholder consultations highlighted the need for descriptions that are user-friendly and actionable.

Conclusion: The lack of a standardised definition of Advanced Multimorbidity risks variance in clinical and research practice, potentially affecting patient care. A consensus on defining Advanced Multimorbidity would enable better identification of patients who could benefit from a palliative care approach, ensuring more consistent and person-centred care, as well as supporting research and policy development.

Keywords: Multimorbidity; ageing; end of life; palliative care; scoping review.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: SPB is a current Editorial Fellow with the Journal of Multimorbidity & Comorbidity. SPB, PB and RSP are all fellows on the Multimorbidity Doctoral Training Programme for Health Professionals, which is supported by the Wellcome Trust (223499/Z/21/Z).

Figures

Figure 1.
Figure 1.
PRISMA flowchart for Scoping Reviews.
Figure 2.
Figure 2.
This figure details the various indicators included in the descriptions, with the number of definitions which involved each indicator and the frequency of particular combinations of indicators within the definitions.
See this image and copyright information in PMC

References

    1. The PLoS Medicine Editors . Multimorbidity: Addressing the next global pandemic. PLoS Med 2023; 20(4): e1004229. DOI: 10.1371/journal.pmed.1004229. - DOI - PMC - PubMed
    1. Cassell A, Edwards D, Harshfield A, et al. The epidemiology of multimorbidity in primary care: a retrospective cohort study. Br J Gen Pract 2018; 68(669): e245–e251. DOI: 10.3399/bjgp18X695465. - DOI - PMC - PubMed
    1. Johnston MC, Black C, Mercer SW, et al. Prevalence of secondary care multimorbidity in mid-life and its association with premature mortality in a large longitudinal cohort study. BMJ Open 2020; 10(5): e033622. DOI: 10.1136/bmjopen-2019-033622. - DOI - PMC - PubMed
    1. Hanlon P, Jani BD, Nicholl B, et al. Associations between multimorbidity and adverse health outcomes in UK Biobank and the SAIL Databank: A comparison of longitudinal cohort studies. PLoS Med 2022; 19(3): e1003931. DOI: 10.1371/journal.pmed.1003931. - DOI - PMC - PubMed
    1. Fortin M, Lapointe L, Hudon C, et al. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes 2004; 2: 51. DOI: 10.1186/1477-7525-2-51. - DOI - PMC - PubMed

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