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General Principles of Management of Patients with Multimorbidity and Frailty

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Optimizing Pharmacotherapy in Older Patients

Part of the book series: Practical Issues in Geriatrics ((PIG))

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Abstract

The progressive ageing of the population has led to a new health scenario, where frailty and multimorbidity are extremely common. Multimorbidity, usually described as the coexistence of two or more chronic diseases in the same individual, is a heterogeneous and complex entity characterized by the intricate relationship between chronic conditions and clinical, social, behavioural and functional factors and is associated with worse health outcomes and a challenging clinical management. Frailty, an increased vulnerability to physiological stressors, also confers increased risk of adverse health outcomes including mortality, hospitalization and disability. The presence of chronic diseases and multimorbidity has a central role in initiating or worsening frailty, and most frail individuals are also multimorbid. However, there is a lack of guidance to optimize the management of complexity, and guidelines for chronic diseases are usually single-disease oriented. A new clinical approach to deal with complexity has been underlined by the National Institute for Health and Care Excellence on multimorbidity guidelines and the recently published Italian Guidelines on Multimorbidity and Polypharmacy that strongly suggest a multidisciplinary approach to patients with multimorbidity to avoid fragmentation of care between different specialists, stratification strategies to detect individuals with more demanding needs and complex-to-treat groups, standard assessment of frailty to identify a target multimorbid population that is more susceptible to negative outcome and that can benefit from an integrated, patient-centred and holistic management. This approach outlines the importance to incorporate patients’ preferences and expectations, to empower self-management of one’s health, to discuss and accommodate individualized care plans with patients and caregivers, and to support a more flexible use of existing guidelines on single diseases to optimize benefits of treatment (such as symptomatic treatment of pain), minimize potential harms and reduce polytherapy. In this context, precision medicine could be a key to integrate the care of multimorbidity and frailty and to create effective interventions to comprehensively target multimorbidity.

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References

  1. Vetrano DL, Palmer K, Marengoni A, Marzetti E, Lattanzio F, Roller-Wirnsberger R, et al. Frailty and multimorbidity: a systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci [Internet]. 2019 [cited 2022 Mar 15];74(5):659–666. https://pubmed.ncbi.nlm.nih.gov/29726918/.

  2. Cesari M, Pérez-Zepeda MU, Marzetti E. Frailty and multimorbidity: different ways of thinking about geriatrics. J Am Med Dir Assoc [Internet]. 2017 [cited 2022 Mar 16];18(4):361–4. http://www.jamda.com/article/S1525861017300348/fulltext.

  3. Onder G, Vetrano DL, Palmer K, Trevisan C, Amato L, Berti F, Campomori A, Catalano L, Corsonello A, Kruger P, Medea G, Nobili A, Trifirò G, Vecchi S, Veronese N, Marengoni A. Italian guidelines on management of persons with multimorbidity and polypharmacy. [Internet]. Aging Clin Exp Res. 2022. [cited 2022 Mar 15]. https://www.sigg.it/news/linea-guida-inter-societaria-per-la-gestione-della-multimorbilita-e-polifarmacoterapia-2021/.

  4. Buta BJ, Walston JD, Godino JG, Park M, Kalyani RR, Xue QL, et al. Frailty assessment instruments: systematic characterization of the uses and contexts of highly-cited instruments. Ageing Res Rev [Internet]. 2016 [cited 2022 Mar 16];26:53. /pmc/articles/PMC4806795/.

    Google Scholar 

  5. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet [Internet]. 2013 [cited 2022 Mar 16];381(9868):752–62. http://www.thelancet.com/article/S0140673612621679/fulltext.

  6. Muth C, Blom JW, Smith SM, Johnell K, Gonzalez-Gonzalez AI, Nguyen TS, et al. Evidence supporting the best clinical management of patients with multimorbidity and polypharmacy: a systematic guideline review and expert consensus. J Intern Med [Internet]. 2019 [cited 2022 Mar 15];285(3):272–88. https://onlinelibrary.wiley.com/doi/full/10.1111/joim.12842.

  7. Villacampa-Fernández P, Navarro-Pardo E, Tarín JJ, Cano A. Frailty and multimorbidity: two related yet different concepts. Maturitas [Internet]. 2017 [cited 2022 Mar 15];95:31–5. https://pubmed.ncbi.nlm.nih.gov/27889050/.

  8. Zucchelli A, Vetrano DL, Marengoni A, Grande G, Romanelli G, Calderón-Larrañaga A, et al. Frailty predicts short-term survival even in older adults without multimorbidity. Eur J Intern Med [Internet]. 2018 [cited 2022 Mar 15];56:53–6. http://www.ejinme.com/article/S0953620518302620/fulltext.

  9. Yarnall AJ, Sayer AA, Clegg A, Rockwood K, Parker S, Hindle JV. New horizons in multimorbidity in older adults. Age Ageing [Internet]. 2017 [cited 2022 Mar 15];46(6):882–8. https://academic.oup.com/ageing/article/46/6/882/4103436.

  10. Overview | Multimorbidity: clinical assessment and management | Guidance | NICE [Internet]. [cited 2022 Mar 19]. https://www.nice.org.uk/guidance/ng56.

  11. Muth C, van den Akker M, Blom JW, Mallen CD, Rochon J, Schellevis FG, et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med [Internet]. 2014 [cited 2022 Mar 19];12(1):1–11. https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-014-0223-1

  12. Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, et al. Decision making for older adults with multiple chronic conditions: executive summary for the American Geriatrics Society guiding principles on the care of older adults with multimorbidity. J Am Geriatr Soc [Internet]. 2019 [cited 2022 Mar 19];67(4):665–73. https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.15809.

  13. Mazya AL, Garvin P, Ekdahl AW. Outpatient comprehensive geriatric assessment: effects on frailty and mortality in old people with multimorbidity and high health care utilization. Aging Clin Exp Res [Internet]. 2019 [cited 2022 Mar 15];31(4):519–25. https://pubmed.ncbi.nlm.nih.gov/30039453/.

  14. Onder G, Vetrano DL, Marengoni A, Bell JS, Johnell K, Palmer K. Accounting for frailty when treating chronic diseases. Eur J Intern Med [Internet]. 2018 [cited 2022 Mar 15];56:49–52. http://www.ejinme.com/article/S0953620518300815/fulltext.

  15. Onder G, Bernabei R, Vetrano DL, Palmer K, Marengoni A. Facing multimorbidity in the precision medicine era. Mech Ageing Dev. 2020;190:111287.

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Correspondence to Camilla Cocchi .

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Cocchi, C., Onder, G., Zazzara, M.B. (2023). General Principles of Management of Patients with Multimorbidity and Frailty. In: Cherubini, A., Mangoni, A.A., O’Mahony, D., Petrovic, M. (eds) Optimizing Pharmacotherapy in Older Patients. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-031-28061-0_11

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  • DOI: https://doi.org/10.1007/978-3-031-28061-0_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-28060-3

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