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Monthly Archives: October 2015

Multimorbidity and functional decline: a systematic review

By Áine Ryan, Emma Wallace, Paul O’Hara, Susan M. Smith

Multimorbidity is recognised internationally as having a negative impact on patient outcomes. Functional decline is defined as developing difficulties with activities of daily living and is also independently associated with poorer health outcomes. We recently published a systematic review examining the association between multimorbidity and functional decline. We also examined the extent to which multimorbidity predicts future functional decline [1].
The review retrieved 37 relevant studies (nine cohort and 28 cross-sectional).The majority of studies (n= 31) demonstrated a consistent association between multimorbidity and poorer functional status. Future functional decline was more likely with increasing numbers of conditions and was also linked to condition severity.
We can be reasonably confident of the findings of this systematic review; as overall, there was minimal risk of bias in the included studies. However, variation in study participants, multimorbidity definitions, follow-up duration and outcome measures resulted in meta-analysis not being possible.
The findings of this systematic review are consistent with existing evidence linking multimorbidity and poorer health related quality of life. It also highlights a potential cumulative effect, in that both multimorbidity and functional decline independently predict poorer patient outcomes. This review examines one direction of effect, i.e. that baseline multimorbidity predicts future functional decline. Conversely, it is also possible that poor physical functioning will lead to worsening of multimorbidity, a relationship that our study group plans to examine in an ongoing prospective cohort study in Ireland [2].
This review suggests that functional decline needs to be carefully considered in patients with multimorbidity. Future research should focus on the development and testing of interventions which prioritise physical function in this patient group, particularly for patients with higher numbers of conditions and greater disease severity.

The complete article can be accessed at:

[1] Ryan A, Wallace E, O’Hara P, Smith SM. Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health and Quality of Life Outcomes. DOI: 10.1186/s12955-015-0355-9.
[2] The Irish Longitudinal Study on Ageing (TILDA), Trinity College Dublin, Ireland. www.tilda.ie

Invitation to participate in a study related to the multimorbidity issue

By Walter Wodchis and Yelena Petrosyan

We would like to invite Canadian primary care physicians/geriatricians to participate in the Delphi study that aims to  define the most appropriate set of quality indicators for assessing quality of overall care of older diabetes patients with comorbid concordant and discordant chronic conditions. Various quality measures have been developed for assessing care for single diseases. However, adherence to disease-specific measures for patients with multiple chronic conditions may lead to the unintended consequence of delivering inappropriate care. Therefore, it is crucial to identify measures that would address the heterogeneity and scope of care for a particular individual with particular types of co-existing conditions to improve the quality of care of people with multimorbidity.

Your participation will be anonymous, and will consist of responding to 2-3 electronic questionnaires, and each round will take approximately 20 minutes to complete. After completion of all three rounds, expected by December 20th 2015, you will be given a cheque for $200 to compensate you for any disruption to your practice.
If you might be interested in participating in our study please contact Walter Wodchis at walter.wodchis@utoronto.ca or Yelena Petrosyan at yelena.petrosyan@mail.utoronto.ca for further information.

Publications on multimorbidity April-August 2015

By Martin Fortin

Our search for papers on multimorbidity that were published during the period April-August 2015 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”, 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.