The European General Practice Research Network Presents a Comprehensive Definition of Multimorbidity in Family Medicine and Long Term Care, Following a Systematic Review of Relevant Literature

Reste, Jean Yves Le; Nabbe, Patrice; Manceau, Benedicte; Lygidakis, Charilaos; Doerr, Christa; Lingner, Heidrun; Czachowski, Sławomir; Muñoz, Miguel A.; Argyriadou, Stella; Clavería, Ana Murcia; Floch, Bernard Le; Barais, Marie; Bower, Peter; Marwijk, Harm van; Royen, Paul Van; Liétard, Claire

doi:10.1016/j.jamda.2013.01.001

Cited by 188 publications

(194 citation statements)

References 62 publications

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“…For community-dwelling older people with chronic diseases life is filled with challenges as they try to manage everyday life and cope with symptoms of different origins. Multi-morbidity is a condition that may cause loss of autonomy, disability, social isolation (Falk et al 2013) and frailty (Le Reste et al 2013) if the diseases are not well managed. Even so, research has shown that older people tend to report fewer symptoms compared to younger people (Goldberg et al 2010).…”

Section: Introductionmentioning

confidence: 99%

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Eckerblad

Theander

Ekdahl

et al. 2015

Applied Nursing Research

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Context. Older people with multimorbidity are vulnerable and often suffer from conditions that produce a multiplicity of symptoms and a reduced health-related quality of life.Objectives. The aim of this study is to explore the experience of living with a high symptom burden from the perspective of older community-dwelling people with multi-morbidity.Method. A qualitative descriptive design with semi-structured interviews, including 20 community-dwelling older people with multi-morbidity and a high symptom burden. The participants were 79-89 years old with a mean of 12 symptoms per person. Data were analyzed using content analyses.Results. The experience of living with a high symptom burden revealed the overall theme, "To adjust and endure" and three sub-themes. The first subtheme was "To feel inadequate and limited". Participants reported they no longer had the capacity or the ability to manage and they felt limited and isolated from friends or family. The second sub-theme was "To feel dependent". This was a new and inconvenient experience, the burden they put on others caused a feeling of guilt. The final sub-theme was "To feel dejected". The strength to manage and control their conditions was gone, the only thing left to do was to sit or lie down and wait for it all to pass.Conclusion. This study highlights the importance of a holistic approach when taking care of older people with multi-morbidity. This approach should employ a broad symptom assessment to reveal diseases and conditions that it is possible to treat or improve.

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Section: Introductionmentioning

confidence: 99%

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Eckerblad

Theander

Ekdahl

et al. 2015

Applied Nursing Research

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“…La propuesta teórica detrás del término responde a la necesidad de concebir los perfiles de 'morbilidad' (morbidity) complejos como la relación entre diversos elementos clínicos y no clínicos, y constituye un concepto de múltiples dimensiones que más recientemente ha evolucionado hasta incorporar la funcionalidad y la esfera psicosocial (6). En este contexto, y reconociendo los diversos efectos de la multimorbilidad en la salud (7), y su potencial como elemento modificador de los resultados de los tratamientos en los ensayos clínicos (8), se planteó la urgencia de disponer de una medición apropiada de la condición en los estudios epidemiológicos.…”

Section: Multimorbidity: Conceptual Basis Epidemiological Models Andunclassified

“…Aunque dicho concepto se empleó por primera vez en Alemania (12), y su uso se restringía a la literatura científica publicada en alemán, a partir de la década de los noventa comenzó a extenderse internacionalmente (6). Mientras la comorbilidad implicaba la aparición de otra entidad clínica en el curso de una enfermedad índice (9), la multimorbilidad solo implicaba la coexistencia de enfermedades con distinto grado de relación en un mismo individuo (4,9).…”

Section: Definición Conceptual De Comorbilidad Y Multimorbilidadunclassified

“…Por lo anterior, en un esfuerzo muy reciente por mejorar la definición de multimorbilidad de la OMS y tomar en consideración las propuestas de otros autores, la European General Practice Research Network promovió una reunión de expertos en el 2013 (6). Con base en una revisión sistemática de la literatura científica, los expertos identificaron 132 definiciones en 416 documentos, y acuñaron la siguiente definición integradora: "La multimorbilidad se define como cualquier combinación de una enfermedad crónica con al menos otra enfermedad (aguda o crónica), o con un factor psicosocial (asociado o no), o con un factor somático" (traducción de los autores) (6).…”

Section: Definición Conceptual De Comorbilidad Y Multimorbilidadunclassified

“…Esta definición tan amplia adopta un punto de referencia conceptual muy distinto, de particular importancia en los adultos mayores, y representa un viraje conceptual con respecto a la definición centrada en la enfermedad, útil para el cuidado de las condiciones agudas, hacia una visión centrada en la funcionalidad física y social, la cual resulta importante para el cuidado a largo plazo, por cuanto la expresión "cualquier factor psicosocial o somático" necesariamente alude a múltiples dimensiones y considera el cuidado de los adultos mayores en todas las esferas (6). Así, la condición del adulto mayor no se concibe como una suma de enfermedades crónicas independientes o derivadas de una enfermedad índice (la comorbilidad), sino que se reconoce la existencia de perfiles complejos que incorporan lo psicosocial (14).…”

Section: Definición Conceptual De Comorbilidad Y Multimorbilidadunclassified

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Multimorbilidad: bases conceptuales, modelos epidemiológicos y retos de su medición

Fernández-Niño

Bustos-Vázquez

2016

biomedica

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Contribución de los autores:Ambos autores contribuyeron a la concepción y el diseño del ensayo, el análisis y la interpretación de las fuentes originales, así como a la redacción y la aprobación de la versión final. Multimorbilidad: bases conceptuales, modelos epidemiológicos y retos de su mediciónJulián A. Fernández-Niño 1 , Eduardo Bustos-Vázquez 2 1 Centro de Información para Decisiones en Salud Pública, Instituto Nacional de Salud Pública, Cuernavaca, México 2 Escuela de Salud Pública de México, Instituto Nacional de Salud Pública, Cuernavaca, México El incremento continuo de pacientes con perfiles clínicos complejos debidos a enfermedades crónicas ha favorecido el uso cada vez más extendido del término multimorbilidad. Es indispensable disponer de una medición apropiada de esta condición, dado que representa un reto para el manejo clínico de los pacientes, los sistemas de salud y la investigación epidemiológica. En este ensayo se revisan las propuestas conceptuales subyacentes a la medición de la multimorbilidad y se discuten los retos metodológicos involucrados, tomando como referencia las definiciones clásicas de comorbilidad, sus diferencias con el concepto de multimorbilidad y su papel en los estudios epidemiológicos, así como los distintos modelos conceptuales de los que se derivan las definiciones operativas y las estrategias de medición de dicha variable. Se pudo determinar que hay una brecha importante entre el desarrollo del concepto de multimorbilidad y las definiciones operativas, a pesar del significativo avance teórico que ha permitido trascender la concepción clásica de comorbilidad para llegar al concepto actual de multimorbilidad. Sin embargo, las estrategias de medición no se han desarrollado al mismo ritmo del concepto, por lo que se requieren nuevas propuestas metodológicas que permitan obtener información sobre su verdadero impacto en la salud de las personas y sus implicaciones para la salud pública.Palabras clave: comorbilidad, enfermedad crónica, modelos teóricos, estudios epidemiológicos, sesgo (epidemiología), envejecimiento. doi: http://dx.doi.org/10.7705/biomedica.v36i2.2710 Multimorbidity: conceptual basis, epidemiological models and measurement challengesThe growing number of patients with complex clinical profiles related to chronic diseases has contributed to the increasingly widespread use of the term 'multimorbidity'. A suitable measurement of this condition is essential to epidemiological studies considering that it represents a challenge for the clinical management of patients as well as for health systems and epidemiological investigations. In this context, the present essay reviews the conceptual proposals behind the measurement of multimorbidity including the epidemiological and methodological challenges it involves. We discuss classical definitions of comorbidity, how they differ from the concept of multimorbidity, and their roles in epidemiological studies. The various conceptual models that contribute to the operational definitions and strategies to measure this vari...

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Analysis of Epigenetic Age Acceleration and Healthy Longevity Among Older US Women

et al. 2022

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IMPORTANCEAccelerated biological aging is associated with decreased physical capability and cognitive functioning, which are associated with increased risk of morbidity and mortality. OBJECTIVE We investigated associations between epigenetic age acceleration (EAA), a biomarker associated with aging, and healthy longevity among older women. DESIGN, SETTING, AND PARTICIPANTS This cohort study was a secondary analysis of participants in the Women's Health Initiative (WHI) who were eligible to survive to age 90 years by September 30, 2020. Participants were located in multiple centers. This study was restricted to women with genome-wide DNA methylation data, generated from baseline blood samples within 3 WHI ancillary studies. Median (IQR) follow-up times from baseline were 21.6 (19.6-22.9) years and 21.4 (19.8-22.7) years for women who survived to age 90 years with and without intact mobility, respectively, and 13.2 (8.8-16.7) for women who did not survive to age 90 years. Data were analyzed from December 2020 to July 2021. EXPOSURES EAA was estimated using 4 established "clocks": Horvath pantissue, Hannum, Pheno, and Grim. MAIN OUTCOMES AND MEASURES Using multinomial logistic regression, odds ratios (ORs) and 95% CIs were estimated for 3 healthy longevity outcomes for each clock: survival to age 90 years with intact mobility, survival to age 90 years without intact mobility, and no survival to age 90 years. RESULTS Among 1813 women, there were 464 women (mean [SD] age at baseline, 71.6 [3.5] years) who survived to age 90 years with intact mobility and cognitive functioning, 420 women (mean [SD] age at baseline, 71.3 [3.2] years) who survived to age 90 years without intact mobility and cognitive functioning, and 929 women (mean [SD] age at baseline, 70.2 [3.4] years) who did not survive to age 90 years. Women who survived to age 90 years with intact mobility and cognitive function were healthier at baseline compared with women who survived without those outcomes or who did not survive to age 90 years (eg, 143 women [30.8%] vs 101 women [24.0%] and 202 women [21.7%]with 0 chronic conditions). The odds of surviving to age 90 years with intact mobility were lower for every 1 SD increase in EAA compared with those who did not survive to age 90 years as measured

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The European General Practice Research Network Presents a Comprehensive Definition of Multimorbidity in Family Medicine and Long Term Care, Following a Systematic Review of Relevant Literature

Cited by 188 publications

References 62 publications

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

To adjust and endure: a qualitative study of symptom burden in older people with multimorbidity

Multimorbilidad: bases conceptuales, modelos epidemiológicos y retos de su medición

Analysis of Epigenetic Age Acceleration and Healthy Longevity Among Older US Women

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