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Multimorbidity: a guide to care

Around two thirds of people over 65 who live in the UK are living with multimorbidity. 

What is multimorbidity?

The word “multimorbidity” is used by doctors and nurses to describe people who are living with more than one ongoing health problem or long term condition. These conditions include disabilities, mental health problems, sight or hearing loss or long term conditions such as high blood pressure, diabetes, arthritis etc.

Multimorbidity and quality of life

Living and coping with the symptoms of more than one long term health problem can be challenging and often, quality of life can be undermined by all the care on offer.

Unfortunately, people living with multimorbidity, can sometimes find that they are given so much care that it becomes more of a hindrance than a help.

Often care is so specialised that people with multiple problems find themselves being cared for by multiple specialists and/or therapists with a busy schedule of different appointments. For those able to attend, there is a significant burden in terms of time, travel and transport. Similarly, those housebound can find their home becomes a busy thoroughfare for a seemingly endless stream of health and care practitioners.

The multitude of practitioners can lead to fragmented care which can seem to be unnecessarily time consuming or disruptive for those affected as well as their partners, carents and carers.

It can also be frustrating because symptoms and concerns have to be repeated to everyone involved with the added risk of confusing or even losing the key messages and advice.

Effective treatment for people living with multimorbidity can be challenging and can seem elusive. Each condition usually requires its own medication and therapy regime and as the number of health problems increases, so does the number of medicines and treatments. The different medicines are not always compatible which can sometimes offset their benefits or cause unwanted interactions with unpleasant or risky side effects.

The administrative challenge of multimorbidity can also be onerous, even overwhelming – a constant stream of letters, forms, care plans, prescriptions, and appointments to (re)schedule. With limited time, poor health and competing demands, even the paperwork can seem unnecessary complex.

What can you do?

To try and overcome these challenges, national guidelines and standards have been developed to improve care for people living with multimorbidity. (The specific details are provided in the “want to know more” section below). This guidance emphasises that people living with multimorbidity should be given personalised advice and care which is tailored to their preferences.

To get things sorted, you should ask the GP for a special appointment to talk about your (parent’s) care and use that time to agree a way forward which is the most practical and effective.

Everyone has their own perspective on life and what they want from it and their care. This is often shaped by personal values, priorities or goals. Personalising care involves understanding these perspectives and tailoring care accordingly.

Care can be tailored towards personal priorities such as:
• maintaining independence
• preventing something awful happening eg a stroke
• reducing the number of tablets you take or the range of appointments you attend
• living longer
• being able to participate in hobbies, social activities, work, family life
• reducing medicine related side effects or risks
• lengthening life.

Before the special appointment, it will be useful if you can help your parent consider their own priorities – what matters most to them? and what they want the GP to take into account? These questions might be helpful for them to consider:
• How do your health problems affect you? How do you feel about that?
• Are your treatments helping, or do you have any side effects that cause you problems?
• Is it difficult to get to your healthcare appointments? Are they a long way from your home?
• What matters most to you about your health and everyday life?
• Is there one problem that bothers you more than others?
• Are you most concerned about symptoms you have now, or worried about future problems?
• Are you worried about losing your independence?
• What sort of activities do you want to be able to do?

The special appointment is also an opportunity for you and your parent to ask the GP questions about care. These questions can cover lifestyle and support, medicines, decisions about treatments, healthcare appointments. This link will give you some ideas about the sorts of things other people ask and which you might want to explore.

Medication reviews are an important and essential part of care for anyone. Reviewing medicines is an opportunity to stop some medicines and start others. This might be done as part of the special appointment or it could be done at (yet) another appointment.

In reviewing your parent’s prescriptions, a GP or pharmacist should discuss:
• how helpful each medicine is in terms of treating current problems and preventing other
• any side effects from the medicine eg constipation, drowsiness, feeling unsteady
• what could happen by stopping a medicine
• alternative medicines which might have different risks or benefits.

Together, you (if that’s what your parent wants), your parent and their GP, should agree a plan which will improve their care and quality of life. It should say who will coordinate all the care across different health and care services and what will happen in an emergency or urgent situation. It should also say what has been agreed about any changes to medicines, treatments or appointments, and when things will be reviewed again.

The plan should be given to your parent in a way that is easy for them to use and to understand. With their agreement, family members, carents or carers can also have a copy of the plan .

Ongoing challenges

It is well recognised that health and social care services in the UK are poorly equipped to support people living with multimorbidity. The NHS, has a strong focus on “specialisms” which creates barriers to integrated care. Such barriers are most evident for patients who are living with physical and mental health conditions.

The NHS is investing a considerable effort into improving the way services are delivered so that they can better support those with multimorbidity.

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Did you find this information helpful?  Let us know what you  think or pass on some advice to other carents by emailing us at [email protected]

Created November 2020

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