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Multimorbidity: how to improve quality of life when managing several chronic health conditions

The Bottom Line

If you have 3 or more chronic health conditions: 

  • Ask your family doctor about better ways to communicate and coordinate your care with all the other doctors and health professionals you see.
  • Ask your family doctor about how you might decrease some important health risks or improve some key functional activities.
  • Make sure you are informed about all prescribed medications and keep an accurate list with you.

Why is multimorbidity an important health issue?

At the most recent visit to my doctor, he mentioned the “M” word. I went to see him with a new health problem. This was on top of my other medical problems that included arthritis of my hips, heart problems, and bladder issues. That’s when my doctor talked about “multimorbidity”. I wasn’t quite sure what the “M” word really meant, except that my doctor seemed worried, wanted to talk to my pharmacist and asked me to come back for another visit the next week.


I discovered that the “M” word really means that you are living with three or more chronic diseases. I certainly fit into this category but so do a lot of other seniors and older Canadians. Living with multiple chronic conditions (also means “multimorbidity”) affects a growing number of people. Across the country, approximately 29% of Canadians are living with one chronic condition but 15% have two chronic conditions, and 7% have three or more chronic conditions. However, living with “M” is something that is more likely to affect older people. For example, in Ontario, 43% of adults over the age of 65 had two or more chronic conditions (1).


Living with “M” can create some challenges for yourself, as well as your family and friends. For example, each of the chronic conditions may involve seeing different specialists, all prescribing 2 or more different medications, so the total number soon adds up. Sometimes the help of family and friends is needed to make sure we can get to all the different doctors’ appointments. It also makes it hard for your family doctor to take care of people when they have “M”. Many of the care guidelines for managing chronic diseases don’t consider people who have anything other than the single medical problem.  It is also difficult for your doctor to keep up with some of the changes to your care when so many other specialists and health professionals are involved. 


What does the research (scientific evidence) show us?

A recent evidence brief (2) looked at the “M” problem and described what some older adults already experience. Overall this evidence brief showed that “M” is a complicated issue and a tricky thing to study. Some of the problems not only involve the people who have “M”, but also the family doctor, and the healthcare system. In some people who have “M”, it has a significant impact on their quality of life (2).


The scientific evidence is not clear about the most important risk factors for people who have “M”. As pointed out in a recent evidence brief , the evidence does suggest that people living with “M” are more likely to die early (3), experience poor clinical outcomes (4), have poorer quality of life (5), experience loss of physical functioning (6;7;8), and have difficulty with getting and keeping employment (9).


Two systematic reviews (4;10) compared studies that included combinations of things that might help people still living in the community who have “M”. Although the studies were difficult to compare (so many different problems and interventions) there were a few promising things that might help prevent problems. The studies that focused on making changes to particular risk factors (for example, on things that put you at risk for falls) or making changes to improve your activities of daily living (for example, physiotherapy), tended to be more helpful overall. We don’t have much scientific evidence yet, but building up a stronger social network (friends, family, etc.) can also have a protective effect (11).


What are some important things to know about living with "M"?

In some people who have “M”, it has a significant impact on their quality of life (2), and this means it can be hard to:

  1. Do your own personal care
  2. Do things at home and in the neighbourhood (cleaning, shopping) 
  3. Stick to your budget (many out of pocket expenses for parking and other things)
  4. Visit a lot of doctors and other health professionals
  5. Be independent and not get help from friends and family

The “M” problem also costs our healthcare systems a great deal of money and resources, which has gained the interest of many policymakers. Even though only a small percent of people (7%) have 3 or more health conditions, it seems to have a big financial impact on our health system. One study of high-needs users of the health system in Ontario showed that 1% of the population accounted for 33% of Ontario’s healthcare costs and 5% of the population cost our system about 66% of all expenses (12).


What is the bottom line about multimorbidity?

As we age, the problem of multimorbidity can be a growing concern as more people will have 3 or more different chronic medical conditions. Living with so many health conditions can be complicated for the person with the health issues and for their healthcare providers. It will be important to work on strategies to coordinate your care and get these providers communicating with each other to ensure the best care.


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References

  1. Canadian Institute for Health Information. Seniors and the Health Care System: What is the Impact of Multiple Chronic Conditions. Ottawa, Canada; 2011. https://secure.cihi.ca/free_products/air-chronic_disease_aib_en.pdf
  2. Wilson MG, Gauvin F-P, Lavis JN. Issue Brief: Designing Integrated Approaches to Support People with Multimorbidity in Ontario. Hamilton, Ontario: McMaster Health Forum; 13 A.D. Oct 20. 
  3. Poses RM, McClish DK, Smith WR, Bekes C, Scott WE. Prediction of survival of critically ill patients by admission comorbidity. J Clin Epidemiol. 1996; 49(7):743-7.
  4. Smith SM, Soubhi H, Fortin M, Hudon C, O'Dowd T. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2012; 4:CD006560.
  5. Fortin M, Dubois MF, Hudon C, Soubhi H, Almirall J. Multimorbidity and quality of life: a closer look. Health Qual Life Outcomes. 2007; 5:52.
  6. Fortin M, Bravo G, Hudon C, Lapointe L, Almirall J, Dubois MF, et al. Relationship between multimorbidity and health-related quality of life of patients in primary care. Qual Life Res. 2006; 15(1):83-91.
  7. Fortin M, Lapointe L, Hudon C, Vanasse A, Ntetu AL, Maltais D. Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes. 2004; 2:51.
  8. Bayliss EA, Bayliss MS, Ware JE, Jr., Steiner JF. Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list. Health Qual Life Outcomes. 2004; 2:47.
  9. Boyd CM, Fortin M. Future of multimorbidity research: How should understanding of multimorbidity inform health system design? Public Health Reviews. 2010; 32(2):451-74.
  10. Smith SM, Soubhi H, Fortin M, et al. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2016; 3:CD006560. doi: 10.1002/14651858.CD006560.pub3.
  11. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011; 10(4):430-9.
  12. Wodchis WP, Austin P, Newman A, Corallo A, et al. The Concentration of Healthcare Spending: Little ado (yet) about much (money). 2012 May 30; Montreal, Canada 2012.

DISCLAIMER: The blogs are provided for informational purposes only. They are not a substitute for advice from your own healthcare professionals.

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