Advertisement

Comorbidity, Multi-Morbidity, Stepped Care and Skill Mix in the Care of the Older Population

  • Gabriel Ivbijaro
  • David Goldberg
  • Yaccub Enum
  • Lucja Kolkiewicz
Chapter

Abstract

One of the consequences of an ageing population is the increasing prevalence of people living with more than one long-term condition (multi-morbidity). The coexistence of more than one long-term condition often has poorer outcomes for older adults and makes them more likely to access care from different health and social care providers concurrently. As a result, the overall cost of managing these individuals increases. Collaborative care is a useful way of providing care for such patients, utilising the skills and expertise of different disciplines in primary, secondary care and other settings in a coordinated way. Stepped care ensures that interventions match the severity and complexity of presentation so that effort is not wasted.

Keywords

Comorbidity Multi-morbidity Collaborative care Stepped care 

References

  1. 1.
    Fortin M, Bravo G, Hudon C, Vanasse A, Lapointe L. Prevalence of multimorbidity among adults seen in family practice. Ann Fam Med. 2005;3(3):223–8.CrossRefGoogle Scholar
  2. 2.
    Smith SM, Wallace E, O’Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database of Syst Rev. 2016;3:CD006560.  https://doi.org/10.1002/14651858.CD006560.pub3.
  3. 3.
    Valderas JM, Mercer S, Fortin M. Research on patients with multiple health conditions: different constructs, different views, one voice. J Comorb. 2011;1(1):1–3.CrossRefGoogle Scholar
  4. 4.
    Rushton CA, Satchithananda DK, Kadam UT. Comorbidity in modern nursing: a closer look at heart failure. Br J Nurs. 2011;20(5):280–5.CrossRefGoogle Scholar
  5. 5.
    Hindmarsh D, Loh M, Finch CF, Hayen A, Close JC. Effect of comorbidity on relative survival following hospitalisation for fall-related hip fracture in older people. Australas J Ageing. 2014;33(3):E1.CrossRefGoogle Scholar
  6. 6.
    Payne RA, Abel GA, Guthrie B, Mercer SW. The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study. Can Med Assoc J. 2013;185(5):E221–8.CrossRefGoogle Scholar
  7. 7.
    Brettschneider C, Leicht H, Bickel H, Dahlhaus A, Fuchs A, MultiCare Study Group. Relative impact of multimorbid chronic conditions on health-related quality of life – results from the MultiCare Study Group. PLoS One. 2013;8(6):e66742.CrossRefGoogle Scholar
  8. 8.
    Martín-García S, Rodríguez-Blázquez C, Martínez-López I, Martínez-Martín P, Forjaz MJ. Comorbidity health status, and quality of life in institutionalized older people with and without dementia. Int Psychogeriatr. 2013;25(7):1077–84.CrossRefGoogle Scholar
  9. 9.
    Verbrugge LM, Lepkowski JM, Imanaka Y. Comorbidity and its impact on disability. Milbank Q. 1989;67(3–4):450–84.CrossRefGoogle Scholar
  10. 10.
    McClure RJ, Turner C, Peel N, Spinks A, Eakin E, Hughes K. Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database of Syst Rev. 2005;1:CD004441.  https://doi.org/10.1002/14651858.CD004441.pub2.CrossRefGoogle Scholar
  11. 11.
    Vu T, Finch CF, Day L. Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: a cluster analysis. BMC Geriatr. 2011;11:45.CrossRefGoogle Scholar
  12. 12.
    Duerden M, Avery T, Payne R. Polypharmacy and medicines optimisation. https://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf. Accessed Dec 2016.
  13. 13.
    Ivbijaro GO, Enum Y, Khan AA, Lam SS-K, Gabzdyl A. Collaborative care: models for treatment of patients with complex medical-psychiatric conditions. Curr Psychiatry Rep. 2014;16:506.CrossRefGoogle Scholar
  14. 14.
    Ivbijaro G. Mental health: a resilience factor against both NCDs and CDs. In: Commonwealth health partnerships 2012. Cambridge: Nexus Strategic Partnerships; 2012. p. 17–20.Google Scholar
  15. 15.
    World Health Organization. The global burden of disease: 2004 update. Geneva: The World Health Organization; 2008.Google Scholar
  16. 16.
    Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ. 2015;350:176.CrossRefGoogle Scholar
  17. 17.
    Katon W, Russo J, Lin EHB, Schmittdiel J, Ciechanowski P, Ludman E, et al. Cost-effectiveness of a multicondition collaborative care intervention. Arch Gen Psychiatry. 2012;69(5):506–14.CrossRefGoogle Scholar
  18. 18.
    Huang Y, Wei X, Wu T, Chen R, Guo A. Collaborative care for patients with depression and diabetes mellitus: a systematic review and meta-analysis. BMC Psychiatry. 2013;13:260–71.CrossRefGoogle Scholar
  19. 19.
    Unützer J, Harbin H, Schoenbaum M, Druss B. The collaborative care model: an approach for integrating physical and mental health car in Medicaid Health Homes. Center for Health Strategies and Mathematica Policy Research; 2013.Google Scholar
  20. 20.
    Watson LC, Amick HR, Gaynes BN, Brownley KA, Thaker S, Viswanaathan M, et al. Practice-based interventions addressing concomitant depression and chronic medical conditions in the primary care setting: a systematic review and meta-analysis. J Prim Care Community Health. 2013;4(4):294–306.CrossRefGoogle Scholar
  21. 21.
    National Institute for Health and Care Excellence. Common mental health problems: identification and pathways to care. NICE clinical guideline 123. NICE 2011. https://www.nice.org.uk/guidance/cg123.
  22. 22.
    Oosterbaan DB, Verbraak MJPM, Terluin B, et al. Collaborative stepped care v. care as usual for common mental disorders: 8-month, cluster randomised controlled trial. Br J Psychiatry. 2013;203:132–9.CrossRefGoogle Scholar
  23. 23.
    Franx G, Oud M, de Lange J, et al. Implementing a stepped-care approach in primary care: results of a qualitative study. Implement Sci. 2012;7:8.CrossRefGoogle Scholar
  24. 24.
    National Institute for Health and Care Excellence. Depression in adults: recognition and management (Updated 2016) NICE clinical guideline 90. NICE 2009. https://www.nice.org.uk/guidance/cg90.
  25. 25.
    Richards DA. Stepped care: a method to deliver increased access to psychological therapies. Can J Psychiatr. 2012;57(4):210–5.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Gabriel Ivbijaro
    • 1
    • 2
  • David Goldberg
    • 3
  • Yaccub Enum
    • 4
    • 5
  • Lucja Kolkiewicz
    • 1
    • 6
  1. 1.NOVA UniversityLisbonPortugal
  2. 2.Waltham Forest Community and Family Health ServicesLondonUK
  3. 3.King’s CollegeLondonUK
  4. 4.Public Health DepartmentLondon Borough of Waltham ForestLondonUK
  5. 5.East London NHS Foundation TrustLondonUK
  6. 6.East London NHS Foundation TrustLondonUK

Personalised recommendations