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Monthly Archives: April 2017

Book: Aging, Place, and Health: A Global Perspective

By: William A. Satariano, and Marlon Maus
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.

Multimorbidity as a complex systems phenomenon: a series exploring this perspective from the Journal of Evaluation in Clinical Practice

By René Melis
Multimorbidity is one of public health and healthcare’s top priorities. Yet despite this, healthcare continues to struggle to provide solutions to deal with multimorbidity in healthcare that work. It is recognized that our healthcare systems – due to their focus on the acute phase of single diseases – are not well positioned to deal with multimorbidity. Unfortunately, our dealings with changing the system do not easily translate into successes: there are so many stakeholders involved and multimorbidity is interconnected with a huge number of aspects of life and society. Where to begin? Our multimorbidity challenge has all the characteristics of a “wicked problem”: a societal problem that is so complex that is seems difficult or even impossible to solve. In the most recent Complexity Forum of the Journal of Evaluation in Clinical Practice a series of articles explore multimorbidity and how we should shape our healthcare from the perspective of complex systems thinking (http://onlinelibrary.wiley.com/doi/10.1111/jep.12723/full). Rather than a stable, albeit complicated, arrangement of individual elements with predictable results following from inputs in a linear way, a complex system is a dynamic, ecological system in which outcomes seem to emerge quite unpredictably out of the interaction of the starting conditioning. For the reasons mentioned above, this “complexity” approach might fit very well to the multimorbidity challenge.
The series starts with an introductory paper of Dr Joachim Sturmberg and colleagues. Sturmberg, who is a general practitioner as well as a longstanding expert on complexity in health (care systems), together with his colleagues explore how taking multimorbidity as a complexity phenomenon might shape integrated, personalized care differently. Following, this work is commented on by several authors from different perspectives. Being a “wicked problem” neither of these works provide a miracle potion to solve our multimorbidity issue, however, the richness of the perspectives included does shed new light. The famous Cynefin framework (https://hbr.org/2007/11/a-leaders-framework-for-decision-making) for management problems tells us that managing complex problems – and multimorbidity sure is! – has to begin with uncovering the “unknown unknowns” and we need to “probe first, then sense, and then respond”. The latter is what this series hopefully has to offer to the multimorbidity community.

Brazilian Group of Studies about Multimorbidity

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.

Assessing and measuring chronic multimorbidity in the older population

By Amaia Calderón-Larrañaga and Davide L Vetrano
Multimorbidity is one of the main challenges facing health systems worldwide. While its definition as “the simultaneous presence of two or more chronic diseases” is well established, its operationalization is not yet agreed. This study aimed to provide a clinically-driven comprehensive list of chronic conditions to be included when measuring multimorbidity.
Based on a consensus definition of chronic disease, all codes from the International Classification of Diseases 10th revision (ICD-10) were classified as chronic or not by an international team of physicians and epidemiologists specialized in geriatrics and family medicine, and were subsequently grouped into broader categories. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K).
An initial number of 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had ≥2 of these 60 disease categories, 73.2% had ≥3, and 55.8% had ≥4. Once validated, this operational measure of multimorbidity may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care.
The publication can be found in the following link: