Analysis: Multiple illnesses can cause major challenges for the person who has the conditions, health systems and wider society
By Aidan Keane and Myles Balfe, UCC
Multimorbidity can loosely be described as having two or more illnesses. These can be physical or mental. Depression, for example, is often one of the conditions experienced by patients with multimorbidity.
Multimorbidity can cause major challenges. These challenges are not only for the person who has the conditions, but also for the society in which they live and for the health system which must look after them. Recent studies suggest that multimorbidity is becoming more common. Statistics in some countries have shown that approximately one in four of the adult population is living with two or more long-term conditions.
By 2035, close to one in five people in some Western countries, including Ireland, might have several chronic conditions. There is an interesting, albeit grim, connection between wealth and multimorbidity. The less money you have, the more likely you are to experience multimorbidity during the course of your life.
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Having one chronic illness can have serious consequences for people's lives and health. For instance, think of Type 1 diabetes. You might have to test your blood sugar regularly, watch how much sugar you eat, and inject yourself every day. Now imagine having to manage another condition on top of that, and then another one on top of that. This is what life with multimorbidity can look like. One condition can be really disruptive for people's lives. Three conditions for some people could easily disrupt pretty much everything in their lives, at least at certain times.
As well as health management challenges, multimorbidity can also cause people to experience psychological and identity challenges. In sociological terms, it can cause what is termed a 'loss of self'. This means that the things that you do every day that make you 'you' can become disrupted. For instance, if you love running but find yourself spending increasing amounts of time managing your conditions rather than running, that thing that you love doing and which you build your identity around cannot be done. You therefore experience a 'loss of self'.
Multimorbidity can also cause 'biographical disruption', which means that the multiple conditions can force you into a situation where you might not be able to achieve the imagined future that you always pictured for yourself.
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Ireland is in many ways unprepared for increasing numbers of patients with multimorbidity. The healthcare system is generally set up around the single disease model of care. This means that if patients have multiple conditions they may find their care to be fragmented, for instance having appointments for each condition scheduled at different times and on different days.
Different healthcare workers might only specialize in one condition, and there is a risk that there might not be one healthcare worker like a GP with up-to-date oversight over the person's full health situation. Basically, patients with multimorbidity can experience less continuity of care - when they might need more of it.
Recent research funded by the Health Research Board found several concerning issues around having multimorbidity in Ireland. One was that medication non-adherence was common, linked to the complexity of having to manage different conditions. This research also found that people who have multimorbidity also often experience serious financial strain in Ireland. They spend significantly more on healthcare compared to patients without multimorbidity, and sometimes have to use their savings, reduce their food spending, or borrow money to cope with their healthcare costs.
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Having a health system that is more prepared for managing an individual with multimorbidity is going to be important. The health system needs to begin to develop a proper awareness that increasing numbers of people may have more than one chronic illness, and that these conditions may be mental as well as physical. Services in this health system need to be integrated and coordinated. This is the idea of having different specialists from different disciplines working together in a balanced multidisciplinary team, where patients can access all the focused care that they need in one setting.
The health system needs to recognize that people with multimorbidity are individuals and consequently have specific care demands that stem from the complex interactions of their specific conditions. The system needs to encourage prevention and self-management. And there needs to be good continuity of care for patients with multimorbidity.
Multimorbidity is a complex problem that is growing in importance. It is going to present a major challenge. However there are things that can be done now which may go a long way to help people who live with multimorbidity.
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Aidan Keane is a researcher in the Department of Sociology at UCC. Myles Balfe is a senior lecturer in the Department of Sociology at UCC. He is a former Research Ireland awardee.
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