Multimorbidity and functional impairment–bidirectional interplay, synergistic effects and common pathways

Abstract

Calderón-Larrañaga A, Vetrano DL, Ferrucci L, Mercer SW, Marengoni A, Onder G, Eriksdotter M, Fratiglioni L. (Karolinska Institutet-Stockholm University, Stockholm, Sweden; Catholic University of the Sacred Heart, Rome, Italy; National Institutes of Health, Baltimore, MD, USA; University of Glasgow, Glasgow, UK; University of Brescia, Brescia, Italy; Karolinska Institutet, Stockholm, Sweden; Stockholm Gerontology Research Center, Stockholm, Sweden; Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Rome, Italy). Multimorbidity and functional impairment– bidirectional interplay, synergistic effects and common pathways. This review discusses the interplay between multimorbidity (i.e. co-occurrence of more than one chronic health condition in an individual) and functional impairment (i.e. limitations in mobility, strength or cognition that may eventually hamper a person’s ability to perform everyday tasks). On the one hand, diseases belonging to common patterns of multimorbidity may interact, curtailing compensatory mechanisms and resulting in physical and cognitive decline. On the other hand, physical and cognitive impairment impact the severity and burden of multimorbidity, contributing to the establishment of a vicious circle. The circle may be further exacerbated by people’s reduced ability to cope with treatment and care burden and physicians’ fragmented view of health problems, which cause suboptimal use of health services and reduced quality of life and survival. Thus, the synergistic effects of medical diagnoses and functional status in adults, particularly older adults, emerge as central to assessing their health and care needs. Furthermore, common pathways seem to underlie multimorbidity, functional impairment and their interplay. For example, older age, obesity, involuntary weight loss and sedentarism can accelerate damage accumulation in organs and physiological systems by fostering inflammatory status. Inappropriate use or overuse of specific medications and drug–drug and drug–disease interactions also contribute to the bidirectional association between multimorbidity and functional impairment. Additionally, psychosocial factors such as low socioeconomic status and the direct or indirect effects of negative life events, weak social networks and an external locus of control may underlie the complex interactions between multimorbidity, functional decline and negative outcomes. Identifying modifiable risk factors and pathways common to multimorbidity and functional impairment could aid in the design of interventions to delay, prevent or alleviate age-related health deterioration; this review provides an overview of knowledge gaps and future directions.

Sarcopenia, long‐term conditions, and multimorbidity: findings from UK Biobank participants

“…Probable sarcopenia is an example of impaired physical function that is thought to have complex relationships with individual long-term conditions and multimorbidity, including bidirectional effects. 34 The associations we have demonstrated may be due to confounding, for example, by lifestyle risk factors such as lower physical activity. However, there are also several possibilities by which the associations may be causal.…”

Patients' experiences of coping with multiple chronic conditions: A qualitative descriptive study

“…Furthermore, this study found that people predominantly constituted priorities by targeting individual conditions that impact a lot, but the potential effects of the prioritisation were not identified. (Kim, Bennett, Wallace, Fahey, & Cahir, 2018), medication beliefs (Schüz et al, 2011), fragmented care (Green, Hawley, & Rask, 2007) and synergistic effects between chronic conditions (Calderón-Larrañaga et al, 2019). Participants in this study did not report issues of managing multiple prescriptions nor adverse effects.…”

“…These explanations might indicate that people misunderstood their health regarding MCCs and an inability to participate in disease self‐management (Pages‐Puigdemont et al, ). Key reasons for nonadherence to treatments among MCCs population are varied, including differences in clinical variables (Kim, Bennett, Wallace, Fahey, & Cahir, ), medication beliefs (Schüz et al, ), fragmented care (Green, Hawley, & Rask, ) and synergistic effects between chronic conditions (Calderón‐Larrañaga et al, ). Participants in this study did not report issues of managing multiple prescriptions nor adverse effects.…”

“…Multiple chronic conditions have a significant impact on people's lives. MCCs are highly associated with physical limitations (Calderon‐Larranaga et al, ), negative moods (Read, Sharpe, Modini, & Dear, ) and poor quality of life (QoL) (Shad et al, ). MCCs also pose massive burdens to people's families.…”

Quality of care assessment for people with multimorbidity

“…Chronic conditions contribute to a large proportion of the morbidity burden and pose a major challenge to health systems worldwide [1]. Response to chronic conditions is frequently complicated by multimorbidity, the simultaneous presence of multiple health conditions in an individual [2][3][4][5]. Multimorbidity challenges usual care delivery, which is frequently structured around pathways of care for single diseases [6][7][8][9][10].…”