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Multimorbidity

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The Very Old Critically Ill Patients

Part of the book series: Lessons from the ICU ((LEICU))

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Abstract

Multimorbidity, defined by the co-occurrence of multiple chronic diseases, increases with age and represents several challenges for care, in health systems designed with a ‘single-disease approach’. Especially, multimorbidity is one of the geriatric conditions which needs to be assessed and managed in intensive care units (ICU). The assessment of chronic medical conditions is a one of the steps helping to decide an ICU admission and the intensity of ICU treatments and will also be helpful to manage the patient once admitted in the ICU. Apart from the treatment of the acute event resulting in ICU admission, management of chronic underlying diseases is crucial to avoid a cascade of exacerbations. Old patients with multimorbidity admitted to the ICU are more prone, in addition to the acute illness, to develop other subsequent organ failures and finally have an increased related mortality. In the first part of the present chapter, we summarize current knowledge on multimorbidity in older persons: definitions, epidemiology, consequences and models of care. The second part of this chapter is dedicated to provide tools to assess multimorbidity at the bedside of the patient at triage and to anticipate and prevent future failures of chronic health conditions during the ICU stay.

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References

  1. Brandlmeier P. Multimorbidity among elderly patients in an urban general practice. ZFA (Stuttgart). 1976;52(25):1269–75.

    Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

  3. Marengoni A, Angleman S, Melis R, Mangialasche F, Karp A, Garmen A, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011;10(4):430–9.

    Article  PubMed  Google Scholar 

  4. Heuft G. Future research perspectives of a psychoanalytical gerontopsychophysiology--personality and the aging process. Z Gerontol. 1990;23(5):262–6.

    CAS  PubMed  Google Scholar 

  5. Le Reste JY, Nabbe P, Lygidakis C, Doerr C, Lingner H, Czachowski S, et al. A research group from the European general practice research network (EGPRN) explores the concept of multimorbidity for further research into long term care. J Am Med Dir Assoc. 2013;14(2):132–3.

    Article  PubMed  Google Scholar 

  6. Batstra L, Bos EH, Neeleman J. Quantifying psychiatric comorbidity--lessions from chronic disease epidemiology. Soc Psychiatry Psychiatr Epidemiol. 2002;37(3):105–11.

    Article  CAS  PubMed  Google Scholar 

  7. Nicholson K, Almirall J, Fortin M. The measurement of multimorbidity. Health Psychol. 2019;38(9):783–90.

    Article  PubMed  Google Scholar 

  8. Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.

    Article  PubMed  Google Scholar 

  9. Fabbri E, Zoli M, Gonzalez-Freire M, Salive ME, Studenski SA, Ferrucci L. Aging and multimorbidity: new tasks, priorities, and Frontiers for integrated Gerontological and clinical research. J Am Med Dir Assoc. 2015;16(8):640–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Nguyen QD, Wu C, Odden MC, Kim DH. Multimorbidity patterns, frailty, and survival in community-dwelling older adults. J Gerontol A Biol Sci Med Sci. 2019;74(8):1265–70.

    Article  PubMed  Google Scholar 

  11. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  PubMed  Google Scholar 

  12. Miller MD, Paradis CF, Houck PR, Mazumdar S, Stack JA, Rifai AH, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale. Psychiatry Res. 1992;41(3):237–48.

    Article  CAS  PubMed  Google Scholar 

  13. van den Akker M, Buntinx F, Metsemakers JF, Roos S, Knottnerus JA. Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol. 1998;51(5):367–75.

    Article  PubMed  Google Scholar 

  14. Vetrano DL, Roso-Llorach A, Fernandez S, Guisado-Clavero M, Violan C, Onder G, et al. Twelve-year clinical trajectories of multimorbidity in a population of older adults. Nat Commun. 2020;11(1):3223.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Kennedy BK, Berger SL, Brunet A, Campisi J, Cuervo AM, Epel ES, et al. Geroscience: linking aging to chronic disease. Cell. 2014;159(4):709–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lopez-Otin C, Blasco MA, Partridge L, Serrano M, Kroemer G. The hallmarks of aging. Cell. 2013;153(6):1194–217.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Fraccaro P, Kontopantelis E, Sperrin M, Peek N, Mallen C, Urban P, et al. Predicting mortality from change-over-time in the Charlson comorbidity index: a retrospective cohort study in a data-intensive UK health system. Medicine (Baltimore). 2016;95(43):e4973.

    Article  Google Scholar 

  18. St John PD, Tyas SL, Menec V, Tate R. Multimorbidity, disability, and mortality in community-dwelling older adults. Can Fam Physician. 2014;60(5):e272–80.

    PubMed  PubMed Central  Google Scholar 

  19. Mason B, Nanton V, Epiphaniou E, Murray SA, Donaldson A, Shipman C, et al. ‘My body's falling apart’. Understanding the experiences of patients with advanced multimorbidity to improve care: serial interviews with patients and carers. BMJ Support Palliat Care. 2016;6(1):60–5.

    Article  PubMed  Google Scholar 

  20. Banerjee S. Multimorbidity--older adults need health care that can count past one. Lancet. 2015;385(9968):587–9.

    Article  PubMed  Google Scholar 

  21. 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. 2019;67(4):665–73.

    Article  PubMed  Google Scholar 

  22. Fried TR, Tinetti ME, Iannone L. Primary care clinicians' experiences with treatment decision making for older persons with multiple conditions. Arch Intern Med. 2011;171(1):75–80.

    PubMed  Google Scholar 

  23. Boyd CM, Darer J, Boult C, Fried LP, Boult L, Wu AW. Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA. 2005;294(6):716–24.

    Article  CAS  PubMed  Google Scholar 

  24. Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition--multimorbidity. JAMA. 2012;307(23):2493–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Naik AD, Dyer CB, Kunik ME, McCullough LB. Patient autonomy for the management of chronic conditions: a two-component re-conceptualization. Am J Bioeth. 2009;9(2):23–30.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Wolff JL, Boyd CM. A look at person- and family-centered care among older adults: results from a National Survey [corrected]. J Gen Intern Med. 2015;30(10):1497–504.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hall M, Dondo TB, Yan AT, Mamas MA, Timmis AD, Deanfield JE, et al. Multimorbidity and survival for patients with acute myocardial infarction in England and Wales: latent class analysis of a nationwide population-based cohort. PLoS Med. 2018;15(3):e1002501.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zador Z, Landry A, Cusimano MD, Geifman N. Multimorbidity states associated with higher mortality rates in organ dysfunction and sepsis: a data-driven analysis in critical care. Crit Care. 2019;23(1):247.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ho VP, Schiltz NK, Reimer AP, Madigan EA, Koroukian SM. High-risk comorbidity combinations in older patients undergoing emergency general surgery. J Am Geriatr Soc. 2019;67(3):503–10.

    Article  PubMed  Google Scholar 

  30. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/north American multicenter study. JAMA. 1993;270(24):2957–63.

    Article  PubMed  Google Scholar 

  31. Zimmerman JE, Kramer AA, McNair DS, Malila FM. Acute physiology and chronic health evaluation (APACHE) IV: hospital mortality assessment for today's critically ill patients. Crit Care Med. 2006;34(5):1297–310.

    Article  PubMed  Google Scholar 

  32. Flaatten H, de Lange DW, Artigas A, Bin D, Moreno R, Christensen S, et al. The status of intensive care medicine research and a future agenda for very old patients in the ICU. Intensive Care Med. 2017;43(9):1319–28.

    Article  CAS  PubMed  Google Scholar 

  33. Vallet H, Schwarz GL, Flaatten H, de Lange DW, Guidet B, Dechartres A. Mortality of older patients admitted to an ICU: a systematic review. Crit Care Med. 2021;49(2):324–34.

    Article  PubMed  Google Scholar 

  34. 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. 2019;74(5):659–66.

    Article  PubMed  Google Scholar 

  35. Hewitt J, Carter B, Vilches-Moraga A, Quinn TJ, Braude P, Verduri A, et al. The effect of frailty on survival in patients with COVID-19 (COPE): a multicentre, European, observational cohort study. Lancet Public Health. 2020;5(8):e444–e51.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Bouchon J. 1 + 3 ou comment tenter d’être efficace en gériatrie. Rev Prat Méd Gén. 1984;34:888.

    Google Scholar 

  37. Shehab N, Lovegrove MC, Geller AI, Rose KO, Weidle NJ, Budnitz DS. US emergency department visits for outpatient adverse drug events, 2013-2014. JAMA. 2016;316(20):2115–25.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dautzenberg L. Bretagne L. Tsokani S, Zevgiti S, Rodondi N, et al. Medication review interventions to reduce hospital readmissions in older people. J Am Geriatr Soc: Koek HL; 2021.

    Google Scholar 

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Author information

Authors and Affiliations

  1. CHU de Bordeaux, Pôle de Gérontologie Clinique, Bordeaux, France

    Claire Roubaud-Baudron & Florent Guerville

Authors
  1. Claire Roubaud-Baudron
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  2. Florent Guerville
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Corresponding author

Correspondence to Claire Roubaud-Baudron .

Editor information

Editors and Affiliations

  1. Faculty of Medicine, Department of Clinical Medicine and Department of Anaesthesia and Intensive Care, University of Bergen and Haukeland University Hospital, Bergen, Norway

    Hans Flaatten

  2. Sorbonne Université, INSERM Institut Pierre Louis d’Epidémiologie et de, Santé Publique, AP-HP, Hôpital Saint Antoine, Paris, France

    Bertrand Guidet

  3. Sorbonne Université, Hôpital Saint Antoine Unité de Gériatrie Aiguë, Assistance Publique, Hôpitaux de Paris, Paris, France

    Hélène Vallet

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Roubaud-Baudron, C., Guerville, F. (2022). Multimorbidity. In: Flaatten, H., Guidet, B., Vallet, H. (eds) The Very Old Critically Ill Patients. Lessons from the ICU. Springer, Cham. https://doi.org/10.1007/978-3-030-94133-8_8

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  • DOI: https://doi.org/10.1007/978-3-030-94133-8_8

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-94132-1

  • Online ISBN: 978-3-030-94133-8

  • eBook Packages: MedicineMedicine (R0)

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