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Joanna C Ford, John A Ford
The concept of multimorbidity has risen in popularity over the past few years. It is use has led to, or coincided with, an increased recognition that patients often have more than one health problem which should not be treated in isolation. The motivation for more holistic, person-centred care that lies behind multimorbidity is to be welcomed. The 2016 National Institute for Health and Care Excellence multimorbidity management guideline helpfully makes recommendations in key areas that are important in the care of patients with complicated medical problems...
September 26, 2017: Age and Ageing
Ish P Bhalla, Robert A Rosenheck
OBJECTIVE: There has been increasing interest within psychiatry in the concept of multimorbidity because psychiatric patients typically present with multiple concurrent disorders, these disorders mutually exacerbate one another, and their interaction shapes treatment options. Metrics have not been developed to document multimorbidity in psychiatric clinical practice. METHODS: Four classes of indicators relevant to multimorbidity were defined and evaluated among veterans treated in mental health specialty clinics nationally in the Veterans Health Administration (VHA) in fiscal year 2012...
October 16, 2017: Psychiatric Services: a Journal of the American Psychiatric Association
Jan-F Schlender, Valvanera Vozmediano, Adam G Golden, Monica Rodriguez, Tanay S Samant, Chakradhar V Lagishetty, Thomas Eissing, Stephan Schmidt
Although the term "personalized medicine" has been associated in many cases with pharmacogenomics, its definition embraces the use of specific biomarkers and covariates to help in the selection of medical treatments and procedures which are best for each patient. While several efforts have been performed for the tailored selection of therapies and dosing regimens in the general population, developing personalized medicine initiatives for elderly patients remains understudied. The personalized drug therapy for older patients requires the consideration of anatomical, physiological and functional alterations in a multimorbid setting requiring multiple medications...
October 12, 2017: European Journal of Pharmaceutical Sciences
Werner Hofmann
The incidence of spondylodiscitis is increasing and attributable to an aging population with multimorbidities. Spondylodiscitis represents a life-threatening disease. Typical clinical manifestations often involve nonspecific symptoms with back pain; however, due to the frequent absence of fever the disease is often overlooked. Pathogen detection and spinal imaging with magnetic resonance imaging (MRI) are essential for the diagnosis. Identification of the causative pathogen is particularly important for initiating targeted antibiotic treatment...
October 10, 2017: Zeitschrift Für Gerontologie und Geriatrie
Nashwa Masnoon, Sepehr Shakib, Lisa Kalisch-Ellett, Gillian E Caughey
BACKGROUND: Multimorbidity and the associated use of multiple medicines (polypharmacy), is common in the older population. Despite this, there is no consensus definition for polypharmacy. A systematic review was conducted to identify and summarise polypharmacy definitions in existing literature. METHODS: The reporting of this systematic review conforms to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. MEDLINE (Ovid), EMBASE and Cochrane were systematically searched, as well as grey literature, to identify articles which defined the term polypharmacy (without any limits on the types of definitions) and were in English, published between 1st January 2000 and 30th May 2016...
October 10, 2017: BMC Geriatrics
Jacky Jones, Gareth D Jones, Michael Thacker, Sara Faithfull
BACKGROUND: Older adults live with multimorbidity including frailty and cognitive impairment often requiring hospitalization. While physical activity interventions (PAIs) are a normal rehabilitative treatment, their clinical effect in hospitalized older adults is uncertain. OBJECTIVE: To observe PAI dosing characteristics and determine their impact on clinical performance parameters. DESIGN: A single-site prospective observational cohort study in an older persons' unit...
October 8, 2017: Journal of Evaluation in Clinical Practice
Kednapa Thavorn, Colleen J Maxwell, Andrea Gruneir, Susan E Bronskill, YuQing Bai, Anna J Koné Pefoyo, Yelena Petrosyan, Walter P Wodchis
OBJECTIVES: To estimate the attributable costs of multimorbidity and assess whether the association between the level of multimorbidity and health system costs varies by socio-demographic factors in young (<65 years) and older (≥65 years) adults living in Ontario, Canada. DESIGN: A population-based, retrospective cohort study SETTING: The province of Ontario, Canada PARTICIPANTS: 6 639 089 Ontarians who were diagnosed with at least one of 16 selected medical conditions on 1 April 2009...
October 6, 2017: BMJ Open
Melanie R Keats, Yunsong Cui, Vanessa DeClercq, Trevor J B Dummer, Cynthia Forbes, Scott A Grandy, Jason Hicks, Ellen Sweeney, Zhijie Michael Yu, Louise Parker
Owing to an aging population and medical advances, the anticipated growth and prevalence of multimorbidity has been recognized as a significant challenge and priority in health care settings. Although physical activity has been shown to play a vital role in the primary and secondary prevention of chronic disease, much less is known about the relationship between physical activity and multimorbidity. The objective of the present study was to examine the relationship between physical activity levels and multimorbidity in male and female adults after adjusting for key demographic, geographical, and lifestyle factors...
October 5, 2017: Preventive Medicine
Alison J Yarnall, Avan A Sayer, Andrew Clegg, Kenneth Rockwood, Stuart Parker, John V Hindle
The concept of multimorbidity has attracted growing interest over recent years, and more latterly with the publication of specific guidelines on multimorbidity by the National Institute for Health and Care Excellence (NICE). Increasingly it is recognised that this is of particular relevance to practitioners caring for older adults, where multimorbidity may be more complex due to the overlap of physical and mental health disorders, frailty and polypharmacy. The overlap of frailty and multimorbidity in particular is likely to be due to the widespread health deficit accumulation, leading in some cases to functional impairment...
September 4, 2017: Age and Ageing
P Bialas, W Hubner, T Vogt, T Volk, C S L Müller
In order to avoid chronification of pain, appropriate treatment has to be started as early as possible. Inpatient dermatology patients not only suffer from old age and associated multimorbidities but also from characteristic pain due to distinct dermatological diseases. In many cases clinicians have little experience with specific pain treatment but instead have many concerns about how to deal with analgesics. So far chronic pain has been treated according to the pain ladder of the World Health Organization (WHO), which prioritizes the intensity of pain...
October 5, 2017: Der Hautarzt; Zeitschrift Für Dermatologie, Venerologie, und Verwandte Gebiete
Beatriz Olaya, Joan Domènech-Abella, Maria Victoria Moneta, Elvira Lara, Francisco Félix Caballero, Laura Alejandra Rico-Uribe, Josep Maria Haro
OBJECTIVES: To determine whether the effect of multimorbidity on time to mortality is modified by level of social support and loneliness in a representative sample of 2113 participants aged 60+. METHODS: Vital status was ascertained through national registers or by asking participants' relatives. Baseline variables included number of illnesses, self-perceived social support (Oslo social support scale) and loneliness (UCLA loneliness scale). Kaplan-Meier survival curves were used to estimate the time to death by multimorbidity, social support and loneliness...
October 2, 2017: Experimental Gerontology
Ting-Ching Tang, An-Chun Hwang, Li-Kuo Liu, Wei-Ju Lee, Liang-Yu Chen, Yi-Hui Wu, Chung-Yu Huang, Cheng-Hao Hung, Chih-Jen Wang, Ming-Hsien Lin, Li-Ning Peng, Liang-Kung Chen
Background: To evaluate the predictive validity of sarcopenia defined by the Foundation for the National Institutes of Health (FNIH) Sarcopenia Project among Asian older adults. Methods: Data of the I-Lan Longitudinal Aging Study were obtained for analysis. Overall, 1,839 community-dwelling people aged 50 years and older, capable of completing a 6-m walk, with life expectancy of more than 6 months, and not institutionalized at time of data collection were enrolled for study...
July 25, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
N Bleijenberg, N P A Zuithoff, A K Smith, N J de Wit, M J Schuurmans
OBJECTIVES: To examine the risk of disability in 15 individual ADL, IADL, and mobility in older adults by age; and to assess the association of multimorbidity, gender, and education with disability. DESIGN AND SETTING: A prospective cohort study. The sample included 805 community-dwelling older people aged 60+ living in the Netherlands. MEASUREMENTS: Disability was assessed using the Katz-15 Index of Independence in Basic Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL) and one mobility item...
2017: Journal of Nutrition, Health & Aging
Kerry Kuluski, Julia W Ho, Parminder Kaur Hans, Michelle LA Nelson
INTRODUCTION: A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care components to support complex patients and their families in the community. METHODS: Expert panel focus groups with 24 care providers, working in health and social care sectors across Toronto, Ontario, Canada were conducted...
July 21, 2017: International Journal of Integrated Care
Salvador Tortajada, María Soledad Giménez-Campos, Julia Villar-López, Raquel Faubel-Cava, Lucas Donat-Castelló, Bernardo Valdivieso-Martínez, Elisa Soriano-Melchor, Amparo Bahamontes-Mulió, Juan M García-Gómez
In the past few years, healthcare systems have been facing a growing demand related to the high prevalence of chronic diseases. Case management programs have emerged as an integrated care approach for the management of chronic disease. Nevertheless, there is little scientific evidence on the impact of using a case management program for patients with complex multimorbidity regarding hospital resource utilisation. We evaluated an integrated case management intervention set up by community-based care at outpatient clinics with nurse case managers from a telemedicine unit...
June 20, 2017: International Journal of Integrated Care
Katie Palmer, Alessandra Marengoni, Maria João Forjaz, Elena Jureviciene, Tiina Laatikainen, Federica Mammarella, Christiane Muth, Rokas Navickas, Alexandra Prados-Torres, Mieke Rijken, Ulrike Rothe, Laurène Souchet, Jose Valderas, Theodore Vontetsianos, Jelka Zaletel, Graziano Onder
Patients with multimorbidity have complex health needs but, due to the current traditional disease-oriented approach, they face a highly fragmented form of care that leads to inefficient, ineffective, and possibly harmful clinical interventions. There is limited evidence on available integrated and multidimensional care pathways for multimorbid patients. An expert consensus meeting was held to develop a framework for care of multimorbid patients that can be applied across Europe, within a project funded by the European Union; the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS)...
September 14, 2017: Health Policy
Theresa Keller, C Hohmann, M Standl, A H Wijga, U Gehring, E Melén, C Almqvist, S Lau, E Eller, U Wahn, E Soegaard Christiansen, A V Berg, J Heinrich, I Lehmann, D Maier, D S Postma, J M Antó, J Bousquet, T Keil, S Roll
BACKGROUND: Cross-sectional studies suggested that allergy prevalence in childhood is higher in boys compared to girls, but it remains unclear if this inequality changes after puberty. We examined the sex-specific prevalence of asthma and rhinitis as single and as multimorbid diseases before and after puberty-onset in longitudinal cohort data. METHODS: In six European population-based birth cohort studies we assessed the outcomes current rhinitis, current asthma, current allergic multimorbidity (i...
September 27, 2017: Allergy
Davide L Vetrano, Amaia Calderón-Larrañaga, Alessandra Marengoni, Graziano Onder, Jürgen M Bauer, Matteo Cesari, Luigi Ferrucci, Laura Fratiglioni
Multimorbidity is a common and burdensome condition that may affect quality of life, increase medical needs and make people live more years of life with disability. Negative outcomes related to multimorbidity occur beyond what we would expect from the summed effect of single conditions, as chronic diseases interact with each other, mutually enhancing their negative effects, and eventually leading to new clinical phenotypes. Moreover, multimorbidity mirrors an accelerated global susceptibility and a loss of resilience, which are both hallmarks of aging...
September 16, 2017: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
A Stickley, A Koyanagi, H Takahashi, V Ruchkin, Y Inoue, Y Kamio
BACKGROUND: There has been little research on the association of attention-deficit/hyperactivity disorder (ADHD) with co-occurring physical diseases. The aim of this study was to examine the association between possible ADHD and physical multimorbidity (i.e.≥2 physical diseases) among adults in the English general population. METHODS: Data were analyzed from 7274 individuals aged≥18 years that came from the Adult Psychiatric Morbidity Survey 2007. ADHD symptoms were assessed with the Adult Self-Report Scale (ASRS) Screener...
August 4, 2017: European Psychiatry: the Journal of the Association of European Psychiatrists
Damaris Marzahn, Wolfgang Pfister, Anja Kwetkat
BACKGROUND: Nursing home residents and older hospitalized patients have a significantly higher risk to suffer from nosocomial infections (NI). It is still an unanswered question whether patients suffering from NI are at greater risk for deterioration of activities of daily living. MATERIAL AND METHODS: In a retrospective observational study, we evaluated the prevalence of NI during hospitalization of acute geriatric inpatients of the geriatric department at Jena University Hospital by patient records...
September 27, 2017: Zeitschrift Für Gerontologie und Geriatrie
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