New Horizons in multimorbidity

Dr John V. Hindle was appointed Senior Clinical Lecturer in Care of the Elderly, to the School of Medical Sciences, in 2009. He has also held an honorary appointment as Senior Lecturer in Bangor University’s School of Psychology, since 1998. Here he discusses his Age and Ageing paper New horizons in multimorbidity in older adults.

There is increasing political and clinical interests in the concepts of multimorbidity and frailty. For those of us working with older people in primary and secondary care we feel that intuitively we understand these concepts. After all, we have been working towards improvement in care people with multimorbidity and frailty for many decades, and in some ways this was the origin of the specialty of Geriatric Medicine. However, although I have been working as a geriatrician for over 30 years, armed with my intuition, it is only in recent times that I have begun to truly understand the complexities of these issues. In recent years the concept of multimorbidity and particularly frailty have been injected with scientific understanding and explanation. We have come to understand the great impact that these issues have on health and social care, and the pressures that they bring to bear. The complexity of multimorbidity in the context of frailty, dementia and polypharmacy particularly bears a substantial healthcare burden. If like me you struggle to understand the full picture of the relationship between frailty and multi-morbidity, it is worth reading the article on New Horizons on Multimorbidity in Older Adults [1]. This overview helps explain the link between the concepts of multi-mobility and frailty and their relevance to the healthcare of older people. Although many people live with multimorbidity in midlife, particularly contributed to by social deprivation, it is important to understand that complex multimorbidity increases with increasing age.  The majority of older people have two or more long term conditions with care home residents having significant levels of multimorbidity.   

New Collaboration Looks for Trans-Atlantic Common Ground in Geriatrics

Top research journals launch international editorial series tackling the latest in geriatrics clinical practice & public policy. Up first: commonalities “across the pond” for older adults with multimorbidity.

Healthcare professionals across the Atlantic and around the world need to think beyond single-disease guidelines as they look to provide high-quality, person-centered care for more and more older adults living with multiple chronic conditions, so say editors from the Journal of the American Geriatrics Society and the British Geriatrics Society’s (BGS’s) Age and Ageing in the first from a series of joint editorials launched today. The series will look for common ground in geriatrics “across the pond,” beginning here with the U.K.’s National Institute for Health and Care Excellence (NICE) guideline on multimorbidity, the medical term for those living with several chronic health concerns.

NICE guidance and the importance of considering multimorbidity

Amit Arora is a consultant physician in care of older people and Chair of the England Council of the BGS. 

Finally, multi-morbidity may be recognized- is this wishful thinking or a BGS victory for our patients?

Whatever it is, it is time for action!

NICE is committed to developing more relevant guidance for GPs that takes into account the complexity of patients they see in daily practice with multiple long-term conditions, the chief executive of NICE told delegates at Pulse Live.

Opening the first day of the conference in London on 29^th April 2014, Professor David Haslam said NICE recognized current single-condition guidance was impractical for GPs dealing with patients with multimorbidity. ‘Single long-term conditions – which is the way NHS is organized generally apart from primary care – is the rarity.’ This of course is a cause close to the hearts and minds of many geriatricians. I have myself written about this on this blog and in some submissions to the health agencies in past.