Whereas comorbidity focuses on one index disease, multimorbidity has several chronic diseases coexisting at the same time, and the difficulty is to figure out which one is the main problem for the patient.
Multimorbidity is clearly correlated with age, but also affects younger people to a lesser extent. In the average population of a family practice, nine out of ten adult patients have more than one chronic disease, and half have five or more [1]. There are very few differences between men and women, and even school education has no influence on the number of chronic diseases, but income does: The more someone earns, the less often they are ill [2].
The primary role of the primary care physician in the care of multimorbid patients is prioritization, that is, figuring out the main problem. “Now, for the patient, the biggest problem is often not the disease that we would call the main problem from our point of view, which is why it is quite important that you keep asking your patients what bothers them the most,” Martin Krause, MD, Münsterlingen, emphasized at this year’s SGIM congress in Basel. Dr. Krause goes on to point out that much of what we now call disease is, in principle, the physiological aging process and therefore does not necessarily require treatment. However, it is important to always keep in mind that this physiological aging process leads to increasing frailty, which significantly worsens the prognosis of new, even minor, diseases and interventions. It is not always easy to make this clear to patients and, above all, to their relatives.
Source: 81st Annual Meeting of the SGIM, May 29-31, 2013, Basel.
Literature:
- Fortin M, et al: Ann Fam Med 2005; 3: 223-228.
- Agborsangaya CB, et al: BMC Public Health 2012; 12: 201.
