Multiple long-term conditions (or multimorbidity) – what is it and why is it an issue?
Miles Witham is Professor of Trials for Older People at Newcastle University, and the Ageing Syndromes Deputy Theme Lead with the Newcastle Biomedical Research Centre.
Multimorbidity is a hot topic in medicine at the moment, with the National Institute for Health Research (NIHR) and a range of other medical research funding bodies making it a high priority. Professor Chris Whitty, former head of the NIHR and now England’s Chief Medical Officer (CMO) has described the future of medicine as being “increasingly one of multimorbidity in older people”.
But what is multimorbidity and why is it important?
Multimorbidity is not a word that makes much sense to the majority of patients or the public more widely, even though it is relatively simple to explain:
Multimorbidity is the experience of having two or more diseases or medical conditions, at the same time.
A recent consultation exercise undertaken with patients and the public gave a clear steer that the phrase “multiple long-term conditions” was a more descriptive (and less worrying!) phrase, and so we use this term for the remainder of this blog.
Multiple long-term conditions are very common – especially as we age – and two-thirds of people will be affected by the age of 70. Definitions vary, but the term is usually applied only to chronic conditions (such as liver disease, or diabetes) rather than short term illnesses such as pneumonia. Some researchers describe combinations of different types of condition – for example infections and non-infectious disease, or physical and mental health conditions.
What is becoming clear is that diseases do not coexist randomly, but form clusters. For instance, we have known for years that people with diabetes also tend to have high blood pressure and are more likely to have heart attacks or a stroke. Recent research has shown that much broader clusters of diseases exist. The hope is that if we can understand the causes of these clusters of conditions, we can more effectively treat multiple conditions at once rather than looking at each condition separately.
So why are multiple long-term conditions important for us to study and better understand?
There are two main reasons. The first reason is that they are important to patients. People with multiple long-term conditions do not live as long, and suffer from poorer health, which often impairs their ability to stay independent as they get older. Having multiple long-term conditions usually means having to take multiple treatments. At the moment we treat each condition separately, often using several treatments for each condition. This means that the number of tablets to be taken, appointments to see specialists, and exercise programmes and diets that a person needs to for their conditions increases dramatically depending on the number of multiple long-term conditions they have.
Recent research suggests that a patient with six long term conditions would need to take an average of 18 tablets a day and spend 20 hours a week carrying out instructions on self-care and attending appointments! As well as the burden this puts on patients and carers, taking this many medications increases the chances of medication side effects – often because a medication benefiting one condition might worsen another.
The second reason that multiple long-term conditions are an increasing area of priority is that they are important to health services. People with multiple long-term conditions are frequent users of healthcare, whether through GP surgeries or through hospital admissions. Health services around the world have evolved to look after people with a single condition or people with a short-term illness; they have not been designed to give effective care to people with multiple long-term conditions. There is an urgent need to redesign our health services so that they are fit for purpose, given that most of our healthcare spending now goes on looking after people with long term conditions.
The NIHR Newcastle Biomedical Research Centre (BRC) has multiple long-term conditions at the heart of our work. Understanding patterns of multiple long-term conditions and their underlying causes is important, so that we can find solutions that can improve the symptoms of multiple diseases with a single treatment, rather than responding to each disease individually. Our work aims to understand these patterns and mechanisms, and also understand the consequences of multiple long-term conditions – for instance how they affect physical function for older people. These insights will then allow us to design and test new medicines, lifestyle approaches and therapies that are effective at either preventing or treating multiple long-term conditions at any age.
Overcoming these challenges is a large and complex task, but the work of the Newcastle BRC is at the forefront of improving the health of people living with multiple long-term conditions.