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Multimorbidity: Through a Glass Darkly

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The Value of Systems and Complexity Sciences for Healthcare

Abstract

This chapter firstly provides an overview of multimorbidity as a complicated clinico-epidemiological, yet reductionist construct of multiple discreet disease(s) occurring in one individual. Current multimorbidity studies highlight taxonomic challenges about the actual nature of disease or chronic disease singly or in clusters and their underlying processes, and clinical practices. Multimorbidity is then viewed through the lens of systems medicine in the future, as multi-layered complex adaptive systems health care. Systems medicine is an interdisciplinary field of science which studies the nature and processes of complex systems of the biological sciences, as well as in information technology applied to medicine. Networks and psychoneuroimmunology and social phenomena form another “branch” of systems medicine. Nevertheless, clinico-epidemiological multi-morbidity, systems medicine and psychoneuroimmunology are very far apart in the literature with few intersecting research publications, despite commonality in the use of biomarkers and biometrics. As multimorbidity care will inevitably embrace new knowledge and technologies, it is important to improve personal- and population-centred care, rather than biomarker and biometrics reductionism. Opportunities must be embraced to transcend fragmented silos of knowledge and reductionistic care into integrated systems from biomarkers to clinical and population networks that help improve individual care.

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Notes

  1. 1.

    Relative to co-morbidity and multimorbidity indicators, three measurement issues were cited: (1) Limitations in functional status. The degree of independence or difficulty in basic and instrumental activities of daily living should be considered for inclusion in all co-morbidity evaluations. (2) Severity levels of co-morbidity and multimorbidity should address additive and multiplicative relationships. (3) Although biologic and physical responses within individuals are major foci of treatment and care, they are not disconnected from social and psychological events and changes occurring in older patients’ lives.

References

  1. International Research Community on Multimorbidity. The definition of multimorbidity: looking for a consensus. http://crmcspl-blog.recherche.usherbrooke.ca/2014. Cited Accessed 3 Oct 2014.

  2. Feinstein A. The pre-therapeutic classification of co-morbidity in chronic disease. J Chronic Dis. 1970;23(7):455–68.

    Article  CAS  PubMed  Google Scholar 

  3. Valderas JM, Starfield B, Sibbald B, Salisbury C, Roland M. Defining comorbidity: implications for understanding health and health services. Ann Fam Med. 2009;7(4):357–63.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Prados-Torres A, Calderón-Larrañaga A, Hancco-Saavedra J, Poblador-Plou B, van den Akker M. Multimorbidity patterns: a systematic review. J Clin Epidemiol. 2014;67(3):254–66.

    Article  PubMed  Google Scholar 

  5. France E, Wyke S, Gunn J, Mair F, McLean G, Mercer S. Multimorbidity in primary care: a systematic review of prospective cohort studies. Br J Gen Pract. 2012;62(597):e297–307.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Britt H, Harrison C, Miller G, Knox S. Prevalence and patterns of multimorbidity in Australia. Med J Aust. 2008;189:72–77.

    PubMed  Google Scholar 

  7. McDaid O, Hanly MJ, Richardson K, Kee F, Kenny RA, Savva GM. The effect of multiple chronic conditions on self-rated health, disability and quality of life among the older populations of Northern Ireland and the Republic of Ireland: a comparison of two nationally representative cross-sectional surveys. BMJ Open. 2013;3(6):e002571.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Harrison C, Britt H, Miller G, Henderson J. Examining different measures of multimorbidity, using a large prospective cross-sectional study in Australian general practice. BMJ Open. 2014;4(7):e004694.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Violán C, Foguet-Boreu Q, Roso-Llorach A, Rodriguez-Blanco T, Pons-Vigués M, Pujol-Ribera E, Muñoz-Pérez M and Valderas J. Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study. BMC Public Health. 2014;14:530.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Marengoni A, von Strauss E, Rizzuto D, Winblad B, Fratiglioni L. The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med. 2009;265(2):288–95.

    Article  CAS  PubMed  Google Scholar 

  11. Lappenschaar M, Hommersom A, Lucas PJ. Probabilistic causal models of multimorbidity concepts. AMIA Annu Symp Proc. 2012;2012:475–84.

    PubMed  PubMed Central  Google Scholar 

  12. Smith SM, Soubhi H, Fortin M, Hudon C, O’Dowd T. Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. Br Med J. 2012;345:e5205.

    Article  Google Scholar 

  13. Barnett K, Mercer S, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multi-morbidity and implications for health care, research and medical education: a cross-sectional study. Lancet. 2012;380(9836):37–43.

    Article  PubMed  Google Scholar 

  14. Mercer S. Multimorbidity and the inverse care law in primary care. Br Med J. 2012;344:e4152.

    Article  Google Scholar 

  15. Galenkamp H, Braam AW, Huisman M, Deeg DJ. Somatic multimorbidity and self-rated health in the older population. J Gerontol B Psychol Sci Soc Sci. 2011;66(3):380–86.

    Article  PubMed  Google Scholar 

  16. Nobrega TC, Jaluul O, Machado AN, Paschoal SM, Jacob Filho W. Quality of life and multimorbidity of elderly outpatients. Clinics (Sao Paulo). 2009;64(1):45–50.

    Article  Google Scholar 

  17. Martin CM, Peterson C. The social construction of chronicity–a key to understanding chronic care transformations. J Eval Clin Pract. 2009;15(3):578–85.

    Article  PubMed  Google Scholar 

  18. Bayliss EA, Ellis JL, Steiner JF. Seniors’ self-reported multimorbidity captured biopsychosocial factors not incorporated into two other data-based morbidity measures. J Clin Epidemiol. 2009;62(5):550–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Martin CM. The care of chronic illness in general practice. Ph.D. Thesis. Canberra: Australian National University; 1998.

    Google Scholar 

  20. Kline TJ, Willness C, Ghali WA. Predicting patient complaints in hospital settings. Qual Saf Health Care. 2008;17(5):346–50.

    Article  CAS  PubMed  Google Scholar 

  21. Voorham J, Denig P. Groningen initiative to analyse type 2 diabetes treatment. Computerized extraction of information on the quality of diabetes care from free text in electronic patient records of general practitioners. J Am Med Inform Assoc. 2007;14(3):349–54.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kontopantelis E, Springate DA, Ashworth M, Webb RT, Buchan IE, Doran T. Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study. Br Med J. 2015;350:h904.

    Article  Google Scholar 

  23. McLean G, Sutton M, Guthrie B. Deprivation and quality of primary care services: evidence for persistence of the inverse care law from the UK Quality and Outcomes Framework. J Epidemiol Community Health. 2006;60(11):917–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Federoff HJ, Gostin LO. Evolving from reductionism to holism: is there a future for systems medicine? JAMA. 2009;302(9):994–6.

    Article  CAS  PubMed  Google Scholar 

  25. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev. 2010;35(1):2–16.

    Article  PubMed  Google Scholar 

  26. Westerhoff HV, Palsson BO. The evolution of molecular biology into systems biology. Nat Biotechnol. 2004;22(10):1249–52.

    Article  CAS  PubMed  Google Scholar 

  27. Martin CM, Peterson C. The social construction of chronicity - a key to understanding chronic care transformations. J Eval Clin Pract. 2009;15(3):578–85.

    Article  PubMed  Google Scholar 

  28. Armstrong D. The emancipation of biographical medicine. Soc Sci Med. 1979;13:1–8.

    Google Scholar 

  29. Engel GL. The biopsychosocial model and the education of health professionals. Gen Hosp Psychiatry. 1979;1(2):156–65.

    Article  CAS  PubMed  Google Scholar 

  30. Yancik R, Ershler W, Satariano W, Hazzard W, Cohen HJ, Ferrucci L. Report of the National Institute on aging task force on comorbidity. J Gerontol A Biol Sci Med Sci. 2007;62(3): 275–80.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Sturmberg JP, Martin CM. Diagnosis - the limiting focus of taxonomy. J Eval Clin Pract. 2015. http://dx.doi.org/10.1111/jep.12113. Accessed 21 Dec 2015 [online version 2014].

  32. van der Heijden MJ, Schroen Y. Global advances in health and medicine through systems biology: an example from the Netherlands. Global Adv Health Med. 2012;1(4):92–3.

    Article  Google Scholar 

  33. Strauss VY, Jones PW, Kadam UT, Jordan KP. Distinct trajectories of multimorbidity in primary care were identified using latent class growth analysis. J Clin Epidemiol. 2014;67(10):1163–71.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Baylis D, Bartlett DB, Syddall HE, Ntani G, Gale CR, Cooper C, et al. Immune-endocrine biomarkers as predictors of frailty and mortality: a 10-year longitudinal study in community-dwelling older people. Age (Dordr.) 2013;35(3):963–71.

    Article  CAS  Google Scholar 

  35. Förhécz Z, Gombos T, Borgulya G, Pozsonyi Z, Prohászka Z, Jánoskuti L. Red cell distribution width in heart failure: prediction of clinical events and relationship with markers of ineffective erythropoiesis, inflammation, renal function, and nutritional state. Am. Heart J 2009;158(4):659–66.

    Article  PubMed  Google Scholar 

  36. Peters S, Janssen H-G, Vivő-Truyols G. Trend analysis of time-series data: a novel method for untargeted metabolite discovery. Anal Chim Acta. 2010;663(1):98–104.

    Article  CAS  PubMed  Google Scholar 

  37. Cole SW. Social regulation of human gene expression: mechanisms and implications for public health. Am J Public Health. 2013;103 Suppl 1:S84–92.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Christian LM, Glaser R, Porter K, Malarkey WB, Beversdorf D, Kiecolt-Glaser JK. Poorer self-rated health is associated with elevated inflammatory markers among older adults. Psychoneuroendocrinology. 2011;36(10):1495–1504.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Jylhä M, Volpato S, Guralnik J. Self-rated health showed a graded association with frequently used biomarkers in a large population sample. J Clin Epidemiol. 2006;59:465–71.

    Article  PubMed  Google Scholar 

  40. Juster RP, Marin MF, Sindi S, Nair NP, Ng YK, Pruessner JC, Lupien SJ. Allostatic load associations to acute, 3-year and 6-year prospective depressive symptoms in healthy older adults. Physiol Cehavior. 2011;104(2):360–64.

    Article  CAS  Google Scholar 

  41. Picard M, Juster R, Sabiston C. Is the whole greater than the sum of the parts? Self-rated health and transdisciplinarity. Health. 2013;5:24–30.

    Article  Google Scholar 

  42. Salanitro AH, Ritchie CS, Hovater M, Roth DL, Sawyer P, Locher JL, et al. Inflammatory biomarkers as predictors of hospitalization and death in community-dwelling older adults. Arch Gerontol Geriatr. 2012;54(3):e387–91.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Vanfleteren LE, Spruit MA, Groenen M, Gaffron S, van Empel VP, Bruijnzeel PL, Rutten EP, Op’t Roodt J, Wouters EF, Franssen FM. Clusters of comorbidities based on validated objective measurements and systemic inflammation in patients with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2013;187(7):728–35.

    Article  PubMed  Google Scholar 

  44. Melis R, Marengoni A, Angleman S, Fratiglioni L. Incidence and predictors of multimorbidity in the elderly: a population-based longitudinal study. PloS One. 2014;9(7):e103120.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kurtz C, Snowden D. The new dynamics of strategy: Sense-making in a complex and complicated world. IBM Syst J. 2003;42(3):462–83.

    Article  Google Scholar 

  46. Morgan WK. Letter: Medical-industrial complex. Lancet. 1974;1(7847):96.

    Article  CAS  PubMed  Google Scholar 

  47. Relman AS. The new medical-industrial complex. N Engl J Med. 1980;303(17):963–70.

    Article  CAS  PubMed  Google Scholar 

  48. Halfon N, Larson K, Lu M, Tullis E, Russ S. Lifecourse health development: past, present and future. Matern Child Health J. 2014;18(2):344–65.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Martin CM, Vogel C, Grady D, Zarabzadeh A, Hederman L, Kellett J, et al. Implementation of complex adaptive chronic care: the Patient Journey Record system (PaJR). J Eval Clin Pract. 2012;18(6):1226–34.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Public Health and Primary Care, Trinity College, College Green, 34/72 Lorimer Terrace, Kelvin Grove, Brisbane, Qld 4059, Dublin 2, Ireland

    Carmel M. Martin

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Correspondence to Carmel M. Martin .

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Editors and Affiliations

  1. Department of General Practice, Newcastle University, Newcastle, New South Wales, Australia

    Joachim P. Sturmberg

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Martin, C.M. (2016). Multimorbidity: Through a Glass Darkly. In: Sturmberg, J. (eds) The Value of Systems and Complexity Sciences for Healthcare. Springer, Cham. https://doi.org/10.1007/978-3-319-26221-5_10

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  • DOI: https://doi.org/10.1007/978-3-319-26221-5_10

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