The emergence of multimorbidity as a matter of concern: a critical review
By Esca van Blarikom, Nina Fudge and Deborah Swinglehurst
Multimorbidity, when one person has two or more long-term health conditions, is one of the greatest challenges to health services today. Some researchers even speak of a “multimorbidity epidemic”. In the UK, for example, evidence shows that people with more than one health condition account for half of general practice appointments.
Despite these claims, there is no agreement on how to measure multimorbidity. This lack of agreement leads to different estimates of how prevalent multimorbidity really is. For example, studies in the UK show huge differences in the numbers affected by multimorbidity – ranging from 16% of the adult population in some studies to 58% in other studies. Interpretations of the rising prevalence of multimorbidity often fail to consider how disease categories change over time. The markers for many chronic diseases have become broader, which means more people are diagnosed with these conditions than before. Also, new diagnoses have come to replace health problems that were previously seen as “natural” consequences of ageing.
In our recently-published critical review, we argue that it is not so much the rising prevalence of co-occurring long-term conditions that poses such a challenge, but rather the increased inability of contemporary health services to care for patients with many long-term health conditions. This is mainly due to the fact that health services are organised to manage single diseases. If doctors apply “best practice” treatment guidelines, developed for single diseases, to people with many conditions, high treatment burdens and overtreatment are often the result.