Comorbidity and Multimorbidity

Comorbidity and Multimorbidity

What we know

Prevalence of many diseases increases with age so many older people have more than one illness. The terms multimorbidity and comorbidity both describe a state of multiple chronic conditions. In comorbidity, an index condition (e.g. diabetes, stroke, cancer) takes priority. In contrast, multimorbidity is not dominated by an index condition so that all co-existing conditions are regarded equally with none taking priority. Comorbidity and particularly multimorbidity are associated with poorer quality of life, increased use of health services and hospitalisation, and polypharmacy (> 5 medications). Frailty with ageing and multimorbidity can make prognostication difficult. Care planning discussions may be beneficial in recognising the need for palliative care and reducing burdensome medication and treatments. Prioritising treatments requires an assessment across all health issues with respect for a person’s wishes.

What can I do?

Use the Supportive and Palliative Care Indicators Tool (SPICT-4ALL (317kb pdf)) to identify people with deteriorating health due to one or more advanced conditions or a new serious illness so they benefit from holistic assessment and future care planning.

Use the Instrument for Patient Capacity Assessment (ICAN) (344kb pdf) to better understand a person’s interests, and their sense of satisfaction and burden.

Liaise with the family and the person to find out their priorities for health care and suggest a family meeting to formalise these preferences.

Flag older adults with multimorbidity and multiple medications for a government-funded Residential Medication Management Review and Quality Use of Medicines or Home Medicines Review.

Direct families to palliAGED website - For the Community for further information on care planning.

Check the RACGP Silver Book section on Multimorbidity for practical guidance on care issues.

What can I learn?

Read this article from the Australian Prescriber (2017): Prescribing for frail older people

Read STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation. Lavan AH, Gallagher P, Parsons C, O’Mahony D. Age and Ageing. 2017 Jan 23.

Read Australian Guidelines: Managing comorbidities and deprescribing in palliative care - Therapeutic Guidelines - Palliative care. (subscription required).

Read RACGP Silver Book section on Multimorbidity.

Read National Institute for Health and Care Excellence (UK) guidance.

Read Framework for Decision-making for Older Adults with Multiple Chronic Conditions: Action Steps for the AGS Guiding Principles on the Care of Older Adults with Multimorbidity.

Read Muth C, van den Akker M, Blom JW, Mallen CD, Rochon J, Schellevis FG, et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med. 2014 Dec 8;12:223.

Read American Guidelines: American Geriatrics Society. Guiding principles for the care of older adults with multimorbidity: An approach for clinicians. J Am Geriatr Soc. 2012 Oct; 60(10): E1–E25.

What can my organisation do?

Implement screening of polypharmacy for older adults in Residential Aged Care (RAC) with multimorbidity using:

  • a recently validated screening tool (medications) – STOPP/START = Screening Tool of Older Persons Prescriptions/Screening Tool to Alert doctors to Right Treatment
  • Beers Criteria Medication List includes considerations for older people. Payment required to access this resource.

Consider incorporating into standard practice a medicine review for residents on admission to an aged care facility and when they return after recent hospitalisation. Read about the role of pharmacists in residential aged care.

This Aged Care Quality and Safety Commission/Pharmaceutical Society of Australia webinar also explains the role of the pharmacist in residential aged care.

Page updated 11 April 2023