The chronic crisis of multimorbidity

By Esca van Blarikom, Nina Fudge and Deborah Swinglehurst

Multimorbidity, or the co-existence of two or more long-term health conditions, is considered one of the greatest challenges to care services worldwide. But not much is known about the everyday experience of living with multiple long-term conditions. We published a paper shedding light on three stories of East London residents navigating complex care services with mental and physical long-term illness.

Health services are often tailored to address single diseases. Our paper explores the challenges faced by those individuals managing multiple long-term health conditions. The study leading to the paper is set in a socially disadvantaged East London borough, where we unravelled the complex web of issues surrounding multimorbidity.

We argue that life for people with multiple long-term conditions often constitutes a form of ‘chronic crisis.’ This crisis extends beyond ill-health to encompass overmedicalization, polypharmacy (taking many medicines), and social exclusion. In the three participants’ stories, it becomes clear that multimorbidity does not come about suddenly as a biographic disruption. Rather it forms part of people’s everyday lives in the face of widespread social challenges.
The expectation to self-manage chronic illness through overly simplistic approaches doesn’t match the real lack of control people feel in the midst of ongoing crises. This mismatch creates a sense of failure and a feeling of being stuck in life. Living with long-term health conditions often means facing a continuous cycle of social difficulties and declining health, making it even more challenging to overcome these chronic crises.

Rather than focusing solely on diagnoses and treatments that address individual diseases, we advocate for a more nuanced understanding of patients’ unique illness stories. The paper suggests prioritizing the notion of ‘flourishing’ over ‘cure,’ acknowledging that the absence of disease is not always a realistic goal. To foster this emphasis on flourishing, we call for a focus on open conversation rather than individual diseases and treatments for patients with multimorbidity. This approach aims to better support patients’ existential needs in the context of long-term illness.

Our findings underscore the importance of moving beyond a disease-centric model to one that considers the whole person. Healthcare should not only aim for the absence of disease but also prioritize the overall well-being and flourishing of individuals living with multimorbidity.

Many people live with multiple conditions. We hope that the stories in our paper create an understanding of their experiences with illness and care, so that they can be better supported by clinicians and others in their lives. If you have any thoughts about the stories or how to use them to deliver better services, feel free to write them down in the comments and I’ll take them on board.

If you are interested to know more about the paper, you can read it here in full:

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