Multimorbidity
This distinction is important in how the healthcare system treats people and helps making clear the specific settings in which the use of one or the other term can be preferred.
Multimorbidity offers a more general and person-centered concept that allows focusing on all of the patient's symptoms and providing a more holistic care.
[2][8] The broad definition of multimorbidity, consistent with what is used by most researchers, the WHO and the UK's Academy of Medical Sciences is the "co-existence of two or more chronic conditions".
[9] For example the UK's National Institute for Health and Care Excellence (NICE) includes alcohol and substance misuse in their list of conditions considered to constitute multimorbidity.
[11] The UK's National Institute for Health and Care Research (NIHR) uses the term multiple long-term conditions (MLTC) as it is more accepted and understood by patients and the public.
[13][14] Lifestyle factors that may increase the risk of multiple long-term conditions include obesity, poor diet, poor sleep, smoking, air pollution, alcohol; and lifestyles factors that may reduce the risk of MLTC includes eating a healthy diet, physical activity, and strong social networks.
[1][15] Lower socioeconomic status, measured by a combination of education, occupation and literacy indicators, seems to increase the risk of developing multimorbidity.
[19] The risk of death is positively associated with individuals with greater number of chronic conditions and reversely associated with socioeconomic status.
[20] For example, people with long-term conditions affecting the heart, lung, and urinary systems have strong effects on mortality.
One study from the US found that having more than 3 conditions significantly increased the chance of reduced quality of life and physical functioning.
[26] For people whose long-term conditions include severe mental illness, the lifespan can be 10–20 years less than the general population.
[28] There are many factors which might explain why physical multi-morbidity affects mental health including chronic pain,[29] frailty,[30][31] symptom burden,[32] functional impairment,[33] reduced quality of life,[18] increased levels of inflammation,[34] and polypharmacy.
[36][37] There has been a scarcity of economic evaluations concerning interventions for managing individuals with mental-physical multimorbidity, including depression.
A recent systematic review identified four intervention types (collaborative care, self-management, telephone-based, and antidepressant treatment)) that were assessed for cost-effectiveness in high-income countries.
Further factors that can help clinicians tailor their decisions to the individual are: access to detailed data on the people in their care (including their backgrounds and personal medical goals), discussing plans to stop a medicine already when it is first prescribed, and a good relationship that involves mutual trust and regular discussions on progress.
For example: An increased understanding of which conditions most commonly cluster, along with their underlying risk factors, would help prioritise strategies for early diagnosis, screening and prevention.
[65] Multimorbidity is also associated with factors that are related to socioeconomic disadvantage such as food insecurity,[66] low level of education, living in deprived areas and having unhealthy lifestyles.
[67] There are multiple theories on how socioeconomic inequality leads to multimorbidity but so far there is a lack of scientific evidence about the exact mechanism.
Some of the potential links between the two are health-related behaviours (smoking, drinking, diet), lack of access to financial resources and housing, and the psychological response to living in difficult circumstances.
[71] Research shows that in Scotland residents of deprived areas are affected by multiple long-term conditions 10 to 15 years earlier than people living in affluent neighborhoods.
The framework aims to drive advances in the understanding of multiple long-term conditions and promote a change in research culture to tackle multimorbidity.
