Multimorbidity To understand the foundation within which polypharmacy became a notable challenge to be addressed within the healthcare system, there needs to be insight and understanding into the concept of multimorbidity. Multimorbidity occurs when a person is diagnosed with two or more chronic health conditions. While this reality is more common in adults over age 65 (Masnoon et al., 2017), it can occur in patients of all ages and demographics. According to Skou et al. (2022) approximately 30% of adults throughout the world live with multimorbidity. Over 50% of adults living with any chronic condition have more than one chronic condition and thus live with multimorbidity. Living with multiple chronic conditions is correlated to: ● Impaired quality of life ● Identification with low self-related health ● Reduced mobility
and interactions between medications can affect functionality. Lethargy, impaired focus, and frailty can be outcomes of disease that can limit mobility and mental acuity. These impairments can result in muscle loss, which can increase a sense of weakness and fall risk, as well as cognitive abilities. 2. Feelings of worry : Relative to perceived sense of safety and stability, increased feelings of worry can exacerbate vulnerability and stress, which can cause further limitations in daily life. A person may develop a perceived sense of becoming a burden, which can affect interpersonal relationships in the family environment, workplace, and other relationships. Personal relationships can be impaired due to physical dysfunction, which can impact sexual relationships while undermining sense of self and well-being. Personal identity and role, such as husband or wife, partner, parent, and mentor, can be disrupted, causing worry to transition into misperception of self-image and identification. 3. Limited functionality in daily life : Often preceded by worry, some chronic conditions can cause a need to modify lifestyle in a manner that reduces typical involvement and engagement. A person may have to adjust and modify their professional life and actual employment, perhaps finding a job with limited physical demands, or with reduced stress. There can also be a change in a sense of independence and ability to take care of oneself, even if the challenge is temporary. For example, a person living with chronic pain may find that they are no longer able to stand for longer periods of time, which can affect their ability to do such things as cook and clean. The limited capacity to engage in daily activities of daily life and independence may lead to additional problems relative to sustaining nutritional needs and personal hygiene. 4. Social life and connection : All the foregoing challenges directly affect a person who is taking multiple medications to manage concurrent physical and mental health conditions and their ability to maintain a social life with meaningful connections. Root cause symptoms and implications of impaired social life and connections can include feelings of disconnect and malaise, perceived limitations brought on by dietary modifications, and feelings of exhaustion. Ironically, it may be that the need for social connection can be the driver toward adjustment and accommodation of the integration of a wellness plan for life with multimorbidity and polypharmacy. Another common outcome of multimorbidity may be the initial need for numerous doctor visits while developing a disease management plan as the patient integrates their new reality into daily living. During this time, meaningful, supportive relationships may provide the connection needed to adjust in a positive manner that promotes acceptance and normalcy. 5. Self-image : Often multimorbidity and polypharmacy can cause a change in an individual’s ability to accept themselves and the reality of life with multiple chronic conditions. People in this situation may find themselves isolating and hiding their illness, struggling with a sense of shame, guilt, or disappointment that leads to disconnect from others, increased sense of loneliness, and feelings of depression. Disease may cause a change in capacity to assume family responsibilities, as well as employment, both of which can deeply affect self-esteem, confidence, and perceived capabilities. Additionally, should a person simply not feel well, their
● Impaired functional ability ● Increased hospitalizations ● Increased sensation of physical pain ● Psychological distress ● Frailty ● Increased hospitalization ● Increased rates of readmission ● Increased healthcare costs ● Increased morbidity and mortality Multimorbidity can be an Age-Related Health Condition, Affecting Adults By Age Age
Percentage Living with Multimorbidity
45-64
30%
65-84
65%
>85
82%
(Skou et al, 2022) According to Skou et al. (2022) in addition to potential physical limitations of living life with multiple chronic conditions, there are issues that present obstacles and challenges to experiencing positive quality of life. This can directly and negatively impact mental health and psychological well-being. Patients suffering from multimorbidity often have impaired mental health, with an increased potential for two to three times higher rates of depression (Skou et al., 2022) relative to people who do not have multiple chronic conditions. Research conducted by Bissenbakker et al. (2023), involving over 10,000 respondents located throughout the United States that were living with multimorbidity, identified six consistent aspects of daily life that affected their physical and mental health. Self-Assessment Quiz Question #1 Patients suffering from multimorbidity often also experience: 1. Impaired mental health 2. Inability to consume alcohol 3. Increased fertility 4. Improved quality of life Aspects of life impacted by multimorbidity and polypharmacy: 1. Physical ability : Living with multiple chronic conditions can, in and of itself, have limitations, but side effects
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