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An International Perspective on Chronic Multimorbidity: Approaching the Elephant in the Room

November 1, 2017 – 8:05 am

By Davide L Vetrano and Amaia Calderón-Larrañaga
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. Due to the complexity of its assessment and definition, and the lack of clear evidence steering its management, multimorbidity represents one of the main current challenges for clinicians, researchers and policymakers.
Together with an international group of researchers, we reflected on these issues during two twin international symposia at the 2016 European Union Geriatric Medicine Society (EUGMS) meeting in Lisbon, Portugal, and the 2016 Gerontological Society of America (GSA) meeting in New Orleans, USA. The results of this discussion have been reported in an article [1] that we recently published in the Journal of Gerontology: Medical Sciences. In this work we summarize the most relevant aspects related to multimorbidity, with the ultimate goal to identify knowledge gaps and suggest future directions to approach this condition.
This open access article can be found in the following link:
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[1] Vetrano DL, Calderón-Larrañaga A, Marengoni A, Onder G, Bauer JM, Cesari M, Ferrucci L, Fratiglioni L. An international perspective on chronic multimorbidity: approaching the elephant in the room. J Gerontol A Biol Sci Med Sci. 2017 Sep 16. doi: 10.1093/gerona/glx178.
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Publications on multimorbidity May – August 2017

October 20, 2017 – 10:04 am

By Martin Fortin
Our search for papers on multimorbidity that were published during the period May – October 2017 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
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Appreciation of Dr. Martin Fortin’s work on multimorbidity

September 26, 2017 – 12:40 pm

Dr. Martin Fortin is one of the 5 founders the International Research Community on Multimorbidity. He is still a dedicated and active member of the community and its online blog. In the last few weeks, Dr. Fortin’s contribution in advancing knowledge on multimorbidity in primary care deserved the attention from two sources:
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Canadian Academy of Health Sciences
The Canadian Academy of Health Sciences (CAHS) Induction Ceremony was held in Ottawa on September 14, 2017. This year, the Academy welcomed 52 new members. Among this group, Dr. Martin Fortin received this honour for his career as a family physician, teacher and researcher. Induction into CAHS is considered one of the highest and prestigious honours for members of the health sciences community in Canada.
For more information: www.cahs-acss.ca/cahs-news/?lang=en
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Canadian Family Physician
Dr. Martin Fortin’s work was the subject of the cover story of the Canadian Family Physician’s journal. The article, written by Sarah de Leeuw, is titled: Courage, relationships, and applicability – Big research from small places. The article describes Dr. Fortin’s journey and research on the topic of multimorbidity in a regional context. Dr. Fortin is the Research Chair on Chronic Diseases in Primary Care.
To read the article: www.cfp.ca
Congratulations Dr. Fortin!
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Publications on multimorbidity January – April 2017

June 29, 2017 – 10:00 am

By Martin Fortin
Our search for papers on multimorbidity that were published during the period January – April 2017 has been completed. As in previous searches, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
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Comorbidity and progression of late onset Alzheimer’s Disease: A systematic review

May 23, 2017 – 12:55 pm

By Miriam L. Haaksma
and Lara R. Vilela, Alessandra Marengoni, Amaia Calderón-Larrañaga, Jeannie-Marie S. Leoutsakos, Marcel G.M. Olde Rikkert, René J.F. Melis.
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Alzheimer’s disease is a neurodegenerative syndrome characterized by multiple dimensions including cognitive decline, decreased daily functioning and psychiatric symptoms. This systematic review [1] aimed to investigate the relation between somatic comorbidity burden and progression in late-onset Alzheimer’s disease (LOAD). We searched four databases for observational studies that examined cross-sectional or longitudinal associations of cognitive or functional or neuropsychiatric outcomes with comorbidity in individuals with LOAD. From the 7966 articles identified originally, 11 studies were included in this review. Nine studies indicated that comorbidity burden was associated with deterioration in at least one of the three dimensions of LOAD examined. Seven out of ten studies investigating cognition found comorbidities to be related to decreased cognitive performance. Five out of the seven studies investigating daily functioning showed an association between comorbidity burden and decreased daily functioning. Neuropsychiatric symptoms (NPS) increased with increasing comorbidity burden in two out of three studies investigating NPS. Associations were predominantly found in studies analyzing the association cross-sectionally, in a time-varying manner or across short follow-up (≤2 years). Rarely baseline comorbidity burden appeared to be associated with outcomes in studies analyzing progression over longer follow-up periods (>2 years). This review provides evidence of an association between somatic comorbidities and multifaceted LOAD progression. Given that time-varying comorbidity burden, but much less so baseline comorbidity burden, was associated with the three dimensions prospectively, this relationship cannot be reduced to a simple cause-effect relation and is more likely to be dynamic. Therefore, both future studies and clinical practice may benefit from regarding comorbidity as a modifiable factor with a possibly fluctuating influence on LOAD.
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1. Haaksma ML, Vilela LR, Marengoni A, et al. Comorbidity and progression of late onset Alzheimer’s disease: A systematic review. PLoS One. 2017;12:e0177044.
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Book: Aging, Place, and Health: A Global Perspective

April 24, 2017 – 9:13 am

By: William A. Satariano, and Marlon Maus
(http://www.jblearning.com/catalog/9781284069389/)
This book represents a collaboration of experts in the field of aging and public health. The present book builds on the first edition of the book (Epidemiology of Aging:  An Ecological Approach. Satariano, 2006).
Various international researchers and practitioners were asked to join the project based on their expertise in particular areas of aging research, practice, and policy. This has resulted in a book that presents each topic, e.g., cognitive function, as an outcome in epidemiological research.  In addition, each chapter considers conceptual and measurement issues, implications for practice and policy, and future directions for research.  The book stresses a global perspective identifying work from countries throughout the world, not just the U.S.
This edition of the book is intended to target a wide audience which includes not only other experts in the field and academics, but also students, practitioners and interested researchers from other disciplines. The book is intended to help inspire further progress in the global effort towards what the World Health Organization has described as a “state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity” of our older population.
Chapter 8, Disease, Comorbidity, and Multimorbidity, by Martin Fortin, Aline Ramond, Cynthia Boyd, and Jose Almirall focuses on multimorbidity (MM). The authors explore how the several coexisting health conditions in a single individual negatively affect an individuals’ health-related outcomes (functional status, social participation, quality of life, life expectancy) and is also responsible for numerous impacts on society (healthcare utilization, direct and indirect costs). The importance of MM is now acknowledged as a research priority in health care, and in-depth understanding of its main determinants is required as a first step in this direction. This chapter helps distinguish MM-related essential definitions and concepts and successively addresses the role of sociodemographics, socioeconomic factors, social networks, social capital, genetics, lifestyle, psychological and psychosocial factors, and polypharmacy as potential risk factors for MM, following an ecological model of health. Finally, the chapter highlights current gaps in the literature as well as specific challenges, and suggests future directions for MM epidemiology research.
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Brazilian Group of Studies about Multimorbidity

April 10, 2017 – 9:59 am

By Bruno P Nunes and Sandro R Rodrigues Batista
We are very satisfied to inform the International Research Community on Multimorbidity (an important encouraging community of our work) about the creation of the Brazilian Group of Studies about Multimorbidity (named in Portuguese: Grupo Brasileiro de Estudos sobre Multimorbidade – GBEM). The group is headed by Bruno P Nunes and Sandro R Rodrigues Batista, two researchers from Brazil. The group is already formalized in the Brazilian national research platform of the Brazilian National Council for Scientific and Technological Development
Furthermore, we are described in ResearchGate too
Currently, we have more than 20 Brazilian researchers and some international collaborators, including researchers from Chile, Colombia, EUA, India, Peru, Portugal and Sri Lanka. One of our research goals as a group is to improve epidemiological information about multimorbidity in Low and Middle Income Countries, mainly in Brazil and South America. We are using a platform for planning our work and intend to publish the first scientific results of the partnership by the end of 2017. The articles already published by group members can be viewed in the ResearchGate website. Furthermore, we are looking for researchers interested in cross-country comparisons about a wide range of issues related to multimorbidity (prevalence, patterns, inequalities, use of health services and others) to be included in the GBEM. Contact e-mail for further information: nunesbp@gmail.com/ sandrorbatista@gmail.com/ gbemulti@gmail.com.
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Publications on multimorbidity October – December 2016

February 27, 2017 – 1:28 pm

By Martin Fortin
Our search for papers on multimorbidity that were published during the period October – December 2016 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.
Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases” in PubMed (https://www.ncbi.nlm.nih.gov/pubmed), but we are sure that most publications on the subject are included in the list.
All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
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Publications on multimorbidity July – September 2016

November 9, 2016 – 10:25 am

By Martin Fortin
Our search for papers on multimorbidity that were published during the period July – September 2016 has been completed. As in previous searches, we found many new papers and the list is too long for this venue. Therefore, we have prepared a PDF file that can be accessed following this link.
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Probably, there are some publications that were not detected by our search strategy using the terms “multimorbidity”, “multi-morbidity” and the expression “multiple chronic diseases”, but we are sure that most publications on the subject are included in the list.
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All references are also included in our library. Feel free to share with anyone interested in multimorbidity.
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Training doctors to manage patients with multimorbidity: a systematic review

October 25, 2016 – 8:35 am
By Cliona Lewis and Susan Smith

We have published a systematic review of the literature addressing training of doctors in the management of patients with multimorbidity [1]. Overall, 75,110 citations were screened, of which 68 full-text articles were then assessed for eligibility, and just two studies met the inclusion criteria for the review.
While much has been published about the challenges presented by patients with multimorbidity, the issue of educating doctors to manage these patients has been poorly addressed. The two studies presented in this review implemented and evaluated multimorbidity workshops, and provide a basis for further research. It remains to be determined whether there is a specific need for training of doctors to manage patients with multimorbidity, and if so, how that need can best be met. It also remains to be proven that improving knowledge, skills and confidence of doctors results in improved care of this patient group. We have identified existing literature that provides a platform for management of these patients, and for curriculum development in training doctors in the management of multimorbidity. Incorporation of emerging guidelines and research findings into multimorbidity training curricula for doctors is needed in order to optimise practice and enhance the competence and confidence of doctors in managing this challenging population of patients, with the ultimate aim of improving clinical outcomes.
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1) Lewis C, Wallace E, Kyne L, Cullen W, Smith SM. Training doctors to manage patients with multimorbidity: a systematic review. Journal of Comorbidity 2016;6(2):85–94. DOI: 10.15256/joc.2016.6.87
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