Abstract
Due to demographic aging of the population, chronic diseases are growing. If two or more chronic diseases exist at the same time, the state of health of the patient can be referred to as multimorbid. In contrast to comorbidity, there is no primary underlying disease in multimorbidity. In particular, for specific populations such as the elderly, these definitions are however insufficient because the disease pattern, the temporal development of disease, social factors but also geriatrics typical syndromes (such as incontinence, confusion, risk of falls and complex pain conditions), relevant to everyday life functional limitations and disabilities are of great importance. Frailty is a consequence of multimorbidity in these elderly patients. The challenges of managing patients with multimorbidity are multiple, including the lack of guidelines that are applicable to these complex patients and the conflicting recommendations that arise in trying to apply guidelines developed for single disease conditions; competing and shifting patient priorities of conditions to be addressed; the risks associated with polypharmacy; and the lack of evidence on how best to treat patients with specific comorbid illnesses. They are at heightened risk of adverse health outcomes, often beyond the effects of the individual conditions.
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References
Nowossadeck E (2012) Demografische Alterung und Folgen für das Gesundheitswesen. In: Berlin RK-I, editor. Zahlen und Trends aus der Gesundheitsberichterstattung des Bundes: GBE kompakt. p. 1–8.
Hansen W. Altern und Krankheit. In: Hansen W, editor. Medizin des Alterns und des alten Menschen. Stuttgart: Schattauer Verlag; 2007. p. 10–1.
Aerzteblatt.de (2013) Internisten fordern mehr Forschung zu Multimorbidität. Available from: http://www.aezteblatt.de/nachrichten/49798.
Boyd CM, Fortin M. Future of multimorbidity research: How should understanding of multimorbidity inform health system design? Public Health Reviews 2010; 32:451.
von den Akker M, Buntinx F, Metsemakers JF, et al. Multimorbidity in general practice: prevalencem incidence, and determinants of co-occuring chronic and recurrent diseases. J Clin Epidemiol 1998; 51: 367.
Gijsen R, Hoeymans N, Schellevis F, Ruwaard D, Satariano W, van den Bos G. Causes and consequences of comorbidity: a review. J Clin Epidemiol. 2001;54(7):661–74.
Beyer M, Otterbach I, Erler A, Muth C, Gensichen J, Gerlach FM. Multimorbidität in der Allgemeinpraxis Teil I: Pragmatische Definition, Epidemi- ologie und Versorgungsprämissen. Z Allgemeinmed. 2007;83(9):310–5.
Hodek J-M, Ruhe A-K, Greiner W. Assoziation zwischen Multimorbidität und Krankheitskosten – Eine systematische Übersichtsarbeit. PharmacoEconomics German Research Articles. 2010;8(1):31–46.
Nagl A, Witte J, Hodeck JM, Greiner W. Relationship between multimorbidity and direct healthcare costs in an advanced elderly population. Results of the PRISCUS trial. Z Gerontol Geriatr. 2012;45(2):146–54.
Burkhardt H. Heterogenität und Vulnerabilität älterer Patienten. In: Wehling M, Burkhardt H, editors. Arzneimitteltherapie für Ältere. Heidelberg: Springer; 2010. p. 2–8.
Bahrmann P, Haack A, Sieber CC. Iatrogenität. Unerwünschte Ereignisse im Zusammenhang mit medizinischen Maßnahmen. Dtsch Med Wochenschr. 2012;136(22):1169–71.
Kaplan MH, Feinstein AR. The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis. 1974;27(7–8):387–404.
de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol. 2003;56(3):221–9.
Sauerbrei W, Blettner M. Interpretation der Ergebnisse von 2x2 Tafeln. Teil 9 der Serie zur Bewertung wissenschaftlicher Publikationen. Dtsch Ärztebl Int. 2009;106(48):795–800.
Ressing M, Blettner M, Klug SJ. Auswertung epidemiologischer Studien. Teil 11 der Serie zur Bewertung wissen- schaftlicher Publikationen. Dtsch Ärztebl Int. 2010;107(11):187–92.
Hall SF. A user’s guide to selecting a comorbidity index for clinical research. J Clin Epidemiol. 2006;59(8):849–55.
Diedrichs C, Bartels DB, Berger K. Methodische Herausforderungen bei der Auswahl von Erkrankungen für einen standardisierten Multimorbiditätsindex. Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz. 2011;54(8):972–8.
van den Akker M, Buntinx F, Knottnerus JA. Comorbidity or multimorbidity: what’s in a name? A review of literature. Eur J Gen Pract. 1996;2(2):65–70.
Fortin M, Lapointe L, Hudon C, Vanasse A. Multimorbidity is common to family practice. Is it commonly researched? Can Fam Physician. 2005;51(2):244–5.
Le Reste JY, Nabbe P, Manceau B, Lygidakis C, Doerr C, Lingner H, et al. 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. J Am Med Dir Assoc. 2013;14(5):319–25.
Nikolaus T. Gesundes Altwerden. In: Zeyfang A, Hagg-Grün U, Nikolaus T, editors. Basiswissen Medizin des Alterns und des alten Menschen. Heidelberg: Springer; 2008. p. 59–76.
Borchelt M, Kolb G, Lübke N, Lüttje D, Meyer A-K, Nikolaus T, et al. (2014) Abgrenzungskriterien der Geriatrie. Erarbeitet von einer gemeinsamen Arbeitsgruppe der Bundesarbeitsgemeinschaft der Klinisch-Geriatrischen Einrichtungen e.V., der Deutschen Gesellschaft für Geriatrie e.V. und der Deutschen Gesellschaft für Gerontologie und Geriatrie e.V. Available from: http://www.geriatrie-drg.de/public/docs/Abgrenzungskriterien_Geriatrie_V13_16-03-04.pdf.
Feinstein AR. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970;23(7):455–68.
Charlson M, Pompei P, Ales K, MacKenzie C. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.
Glattacker M, Meixner K, Farin E, Jäckel WH. Entwicklung eines rehablitationsspezifischen Komorbiditätsscores und erste Prü- fung methodischer Gütekriterien. Physikalische Medizin Rehabilitationsmedizin Kurortmedizin. 2007;5(17):260–70.
Bauer JM, Sieber CC. Geriatrie 2007. Dtsch Med Wochenschr. 2007;132(25/26):1414–6.
Woodhouse KW, O’Mahony MS. Frailty and ageing. Age Ageing. 1997;26(4):245–6.
Schuler M, Oster P. Gebrechlichkeit. In: Schuler M, Oster P, editors. Geriatrie von A bis Z. Stuttgart: Schattauer Verlag; 2008. p. 102–3.
Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A. 2001;56(3):M146–56.
Fretwell MD. Acute hospital care for frail older patients. In: Hazzard WR, Andres R, Bierman EL, Blass JP, editors. Principles of geriatric medicine and gerontology. New York: McGraw-Hill; 1990. p. 247–53.
Drey M, Pfeifer K, Sieber CC, Bauer JM. The fried frailty criteria as inclusion criteria for a randomized controlled trial: personal experience and literature review. Gerontology. 2011;57(1):11–8.
Fried LP, Ferrucci L, Darer J, Williamson JD, Anderson G. Untangling the concepts of disability, frailty, and comorbidity: implications for improved targeting and care. J Gerontol A. 2004;59(3):255–63.
Schellevis FG, van der Velden J, van de Lisdonk E, van Eijk JTM, van Weel C. Comorbidity of chronic diseases in general practice. J Clin Epidemiol. 1993;46(5):469–73.
van den Bussche H, Scherer M. Das Verbundvorhaben “Komorbidität und Multimorbidität in der hausärztlichen Versorgung” (MultiCare). Zeitschrift für Geriatrie und Gerontologie. 2011;44(Supplement 2):73.
Extermann M. Measuring comorbidity in older cancer patients. Eur J Cancer. 2000;36(4):453–71.
Deyo R, Cherkin D, Ciol M. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613–9.
Romano P, Roos L, Jollis J. Adapting a clinical comorbidity index for use with ICD-9-CM administrative Da ta: Differing perspectives. J Clin Epidemiol. 1993;46(10):1075–9.
Linn BS, Linn MW, Gurel L. Cumulative illness rating scale. J Am Geriatr Soc. 1968;16(5):622–6.
Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Res. 1992;41(3):237–48.
Hudon C, Fortin M, Soubhi H. Abbreviated guidelines for scoring the Cumulative Illness Rating Scale (CIRS) in family practice. J Clin Epidemiol. 2007;60(2):212.
Parmalee PA, Thuras PD, Katz IR, Lawton MP. Validation of the Cumulative Illness Rating Scale in a geriatric residential popul- tion. J Am Geriatr Soc. 1995;43(2):130–7.
Waldman E, Potter JF. A prospective evaluation of the cumulative illness rating scale. Aging Clin Exp Res. 1992;4(2):171–8.
Linn MW, Linn BS, Gurel L. Physical resistance in the aged. Geriatrics. 1967;22(10):134–8.
Conwell Y, Forbes NT, Cox C, Caine ED. Validation of a measure of physical illness burden at autopsy: the Cumulative Illness Rating Scale. J Am Geriatr Soc. 1993;41(1):38–41.
Hudon C, Fortin M, Vanasse A. Cumulative Illness Rating Scale was a reliable and valid index in a family practice context. J Clin Epidemiol. 2005;58(6):603–8.
Miskulin DC, Athienites NV, Yan G, Martin AA, Ornt DB, Kusek JW, et al. Comorbidity assessment using the Index of Coexistent Diseases in a multicenter clinical trial. Kidney Int. 2001;60(4):1498–510.
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Bahrmann, P. (2015). Comorbid Burden and Its Impact on Outcome. In: Rittger, H. (eds) Interventional Cardiology in the Elderly. Springer, Cham. https://doi.org/10.1007/978-3-319-21142-8_4
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DOI: https://doi.org/10.1007/978-3-319-21142-8_4
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