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Multimorbidität: Konzept, Epidemiologie, Versorgung

Multimorbidity: concept, epidemiology and treatment

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Zusammenfassung

Multimorbidität wird als das gleichzeitige Vorliegen mehrerer Erkrankungen oder Gesundheitsprobleme (mindestens 2 oder mehr) bei einer Person definiert. Abzugrenzen hiervon ist der Begriff der Komorbidität, der das Auftreten zusätzlicher Erkrankungen zu einer Haupt- oder Indexerkrankung bezeichnet. Die Wahrscheinlichkeit für das Auftreten von Mehrfacherkrankungen steigt mit dem Alter an und stellt ein zunehmendes Problem für die betroffenen Patienten, deren Angehörigen, aber auch für das Gesundheitssystem dar, da multimorbide Patienten eine verringerte Lebensqualität angeben, oftmals einen erhöhten Pflegebedarf benötigen und auf allen Ebenen mehr Gesundheitsleistungen in Anspruch nehmen. Die Prävalenz der Multimorbidität ist aufgrund der unterschiedlichen Konzeptualisierung und der altersabhängigen Häufung schwierig abzuschätzen. Die Zahlen variieren in den unterschiedlichen Studien stark und liegen entsprechend dem untersuchten Kollektiv zwischen 3 und 50 %, z. T. auch höher. Die Behandlung der Patienten ist oftmals schwierig und führt in nicht seltenen Fällen zur Verabreichung einer Vielzahl von Medikamenten und Wirkstoffen, die nicht aufeinander abgestimmt sind und so die Gefahr für unerwünschte Arzneimittelwirkungen bei einer fragilen Population zusätzlich erhöhen können.

Ziel dieses Artikels ist es, einen kurzen Überblich über die Konzeptualisierung des Begriffes der Multi- und Komorbidität zu geben und die Epidemiologie und Versorgung von Patienten mit Mehrfacherkrankungen im nationalen Kontext darzustellen.

Summary

Multimorbidity is defined as the simultaneous presence of several diseases or health conditions (at least two or more) in one person. In contrast, comorbidity indicates the occurrence of additional diseases to a main or index disease. The probability for the occurrence of multimorbidity increases with advancing age and is a growing problem for affected patients, relatives, and also for the healthcare system, as multimorbid patients have a decreased quality of life, often requiring high levels of care and may increase the resource use at all levels of healthcare. The prevalence of multimorbidity is difficult to estimate due to the different conceptualizations and the age-related accumulation. Thus, the numbers vary greatly in the different studies and are estimated to be between 3 % and 50 %, in some studies numbers are even higher. The treatment of patients is often difficult and results in a variety of medications and drugs that are often not coordinated with each other and so may increase the risk for adverse drug effects, especially in a fragile population. The aim of this article is to give a brief overview on the concept of multimorbidity and comorbidity, to present epidemiological data and to describe the care of patients with multiple illnesses in the German context.

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Literatur

  1. U.S. Department of Health & Human Services (2010) Multiple chronic conditions: a strategic framework. Optimum health and quality of life for individuals with multiple chronic conditions, Vol. 2014. U.S. Department of Health & Human Services, Washington, DC

  2. Scheidt-Nave C, Richter S, Fuchs J, Kuhlmey A (2010) Challenges to health research for aging populations using the example of „multimorbidity“. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 53:441–450

    Article  PubMed  CAS  Google Scholar 

  3. Newman AB, Boudreau RM, Naydeck BL et al (2008) A physiologic index of comorbidity: relationship to mortality and disability. J Gerontol A Biol Sci Med Sci 63:603–609

    Article  PubMed Central  PubMed  Google Scholar 

  4. Fortin M, Lapointe L, Hudon C et al (2004) Multimorbidity and quality of life in primary care: a systematic review. Health Qual Life Outcomes 2:51

    Article  PubMed Central  PubMed  Google Scholar 

  5. Hodek JM, Ruhe A, Greiner W (2009) Multimorbidity and health-related quality of life among elderly persons. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 52:1188–1201

    Article  PubMed  CAS  Google Scholar 

  6. Marengoni A, Strauss E von, Rizzuto D et al (2009) The impact of chronic multimorbidity and disability on functional decline and survival in elderly persons. A community-based, longitudinal study. J Intern Med 265:288–295

    Article  PubMed  CAS  Google Scholar 

  7. Bayliss EA, Bayliss MS, Ware JE Jr, Steiner JF (2004) Predicting declines in physical function in persons with multiple chronic medical conditions: what we can learn from the medical problem list. Health Qual Life Outcomes 2:47

    Article  PubMed Central  PubMed  Google Scholar 

  8. Hessel A, Gunzelmann T, Geyer M, Brahler E (2000) Utilization of medical services and medication intake of patients over 60 in Germany – health related, social structure related, socio-demographic and subjective factors. Z Gerontol Geriatr 33:289–299

    Article  PubMed  CAS  Google Scholar 

  9. Librero J, Peiro S, Ordinana R (1999) Chronic comorbidity and outcomes of hospital care: length of stay, mortality, and readmission at 30 and 365 days. J Clin Epidemiol 52:171–179

    Article  PubMed  CAS  Google Scholar 

  10. Lehnert T, Heider D, Leicht H et al (2011) Review: health care utilization and costs of elderly persons with multiple chronic conditions. Med Care Res Rev 68:387–420

    Article  PubMed  Google Scholar 

  11. Schneider KM, O’Donnell BE, Dean D (2009) Prevalence of multiple chronic conditions in the United States‘ Medicare population. Health Qual Life Outcomes 7:82

    Article  PubMed Central  PubMed  Google Scholar 

  12. Wolff JL, Starfield B, Anderson G (2002) Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med 162:2269–2276

    Article  PubMed  Google Scholar 

  13. Bussche H van den, Schafer I, Wiese B et al (2013) A comparative study demonstrated that prevalence figures on multimorbidity require cautious interpretation when drawn from a single database. J Clin Epidemiol 66:209–217

    Article  PubMed  Google Scholar 

  14. Akker M van den, Buntinx F, Roos S, Knottnerus J (1996) Comorbidity or multimorbidity: what’s in a name? A review of the literature. Eur J Gen Pract 2:65–70

    Article  Google Scholar 

  15. Akker M van den, Buntinx F, Metsemakers JF et al (1998) Multimorbidity in general practice: prevalence, incidence, and determinants of co-occurring chronic and recurrent diseases. J Clin Epidemiol 51:367–375

    Article  PubMed  Google Scholar 

  16. Fortin M, Smith SM (2913) Improving the external validity of clinical trials: the case of multiple chronic conditions. J Comorbidity 3:30–25

    Google Scholar 

  17. Schaink A, Kuluski K, Lyons R et al (2012) A scoping review and thematic classifi cation of patient complexity: offering a unifying framework. J Comorbidity 2:1–9

    Google Scholar 

  18. Institute of Medicine of the National Academies (2010) Roundtable on value & science-driven health care: medically complex patients. In: Yong P, Saunders R, Olsen L (Hrsg) The healthcare imperative: lowering costs and improving outcomes: workshop series summary. The National Academies Press, Washington, S 493–516

  19. Feinstein A (1970) The pre-therapeutic classification of comorbidity in chronic disease. J Chronic Dis 23:455–468

    Article  Google Scholar 

  20. Valderas JM, Starfield B, Sibbald B et al (2009) Defining comorbidity: implications for understanding health and health services. Ann Fam Med 7:357–363

    Article  PubMed Central  PubMed  Google Scholar 

  21. Salive ME (2013) Multimorbidity in older adults. Epidemiol Rev 35:75–83

    Article  Google Scholar 

  22. Jakovljević M, Ostojić L (2013) Comorbidity and multimorbidity in medicine today: challenges and opportunities for bringing separated branches of medicine closer to each other. Psychiatr Danub 1:18–28

    Google Scholar 

  23. Krueger RF, Markon KE (2006) Reinterpreting comorbidity: a model-based approach to understanding and classifying psychopathology. Annu Rev Clin Psychol 2:111–133

    Article  PubMed Central  PubMed  Google Scholar 

  24. Brandlmeier P (1976) Multimorbidity among elderly patients in an urban general practice. ZFA (Stuttgart) 52:1269–1275

    Google Scholar 

  25. Le Reste JY Nabbe P, Manceau B et al (2013) The European General Practice Research Network presents a comprehensive definition of multimorbidity in family medicine and long term care, following a systematic review of relevant literature. J Am Med Dir Assoc 14:319–325

    Article  Google Scholar 

  26. Groot V de, Beckerman H, Lankhorst GJ, Bouter LM (2003) How to measure comorbidity. a critical review of available methods. J Clin Epidemiol 56:221–229

    Article  PubMed  Google Scholar 

  27. Diederichs C, Berger K, Bartels DB (2011) The measurement of multiple chronic diseases – a systematic review on existing multimorbidity indices. J Gerontol A Biol Sci Med Sci 66:301–311

    Article  PubMed  Google Scholar 

  28. Fortin M, Stewart M, Poitras ME et al (2012) A systematic review of prevalence studies on multimorbidity: toward a more uniform methodology. Ann Fam Med 10:142–151

    Article  PubMed Central  PubMed  Google Scholar 

  29. Kohler M, Ziese T (2004) Telefonischer Gesundheitssurvey des Robert Koch-Instituts zu chronischen Krankheiten und ihren Bedingungen. RKI, Berlin

  30. Steinhagen-Thiessen E, BM. (2010) Die Berliner Altersstudie. In: Smith J, Lindenberger U, Mayer KU, Baltes PB (Hrsg) Morbidität, Medikation und Funktionalität im Alter. Akademie Verlag, Berlin, S 175–208

  31. Fuchs J, Busch M, Lange C, Scheidt-Nave C (2012) Prevalence and patterns of morbidity among adults in Germany. Results of the German telephone health interview survey German Health Update (GEDA) 2009. Bundesgesundheitsbl Gesundheitsforsch Gesundheitssch 55:576–586

    Article  CAS  Google Scholar 

  32. Robert Koch Institut (2003) Multimorbidität in Deutschland. Stand -Entwicklung – Folgen, Berlin

  33. Bussche H van den, Koller D, Kolonko T et al (2011) Which chronic diseases and disease combinations are specific to multimorbidity in the elderly? Results of a claims data based cross-sectional study in Germany. BMC Public Health 11:101

    Article  PubMed Central  PubMed  Google Scholar 

  34. Prados-Torres A, Calderon-Larranaga A, Hancco-Saavedra J et al (2014) Multimorbidity patterns: a systematic review. J Clin Epidemiol 67:254–266

    Article  PubMed  Google Scholar 

  35. Marengoni A, Rizzuto D, Wang HX et al (2009) Patterns of chronic multimorbidity in the elderly population. J Am Geriatr Soc 57:225–230

    Article  PubMed  Google Scholar 

  36. Barnett K, Mercer SW, Norbury M et al (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380:37–43

    Article  PubMed  Google Scholar 

  37. Hodek JM, Ruhe AK, Greiner W (2010) Relationship between health-related quality of life and multimorbidity. Gesundheitswesen 72:455–465

    Article  PubMed  Google Scholar 

  38. Glaeske G, Janhsen K (2006) GEK-Arzneimittelreport. Asgard-Verlag, St. Augustin

  39. Pirmohamed M, James S, Meakin S et al (2004) Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 329:15–19

    Article  PubMed Central  PubMed  Google Scholar 

  40. Mulrow CD, Gerety MB, Cornell JE et al (1994) The relationship between disease and function and perceived health in very frail elders. J Am Geriatr Soc 42:374–380

    PubMed  CAS  Google Scholar 

  41. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  42. Linn BS, Linn MW, Gurel L (1968) Cumulative illness rating scale. J Am Geriatr Soc 16:622–626

    PubMed  CAS  Google Scholar 

  43. Cornoni-Huntley JC, Foley DJ, Guralnik JM (1991) Co-morbidity analysis: a strategy for understanding mortality, disability and use of health care facilities of older people. Int J Epidemiol 20(Suppl 1):S8–S17

    PubMed  Google Scholar 

  44. Rochon PA, Katz JN, Morrow LA et al (1996) Comorbid illness is associated with survival and length of hospital stay in patients with chronic disability. A prospective comparison of three comorbidity indices. Med Care 34:1093–1101

    Article  PubMed  CAS  Google Scholar 

  45. Elixhauser A, Steiner C, Harris DR, Coffey RM (1998) Comorbidity measures for use with administrative data. Med Care 36:8–27

    Article  PubMed  CAS  Google Scholar 

  46. Parkerson GR Jr, Broadhead WE, Tse CK (1995) Health status and severity of illness as predictors of outcomes in primary care. Med Care 33:53–66

    Article  PubMed  Google Scholar 

  47. Hallstrom AP, Cobb LA, Yu BH (1996) Influence of comorbidity on the outcome of patients treated for out-of-hospital ventricular fibrillation. Circulation 93:2019–2022

    Article  PubMed  CAS  Google Scholar 

  48. Hurwitz EL, Morgenstern H (1997) The effects of comorbidity and other factors on medical versus chiropractic care for back problems. Spine 22:2254–2263

    Article  PubMed  CAS  Google Scholar 

  49. Greenfield S, Apolone G, McNeil BJ, Cleary PD (1993) The importance of co-existent disease in the occurrence of postoperative complications and one-year recovery in patients undergoing total hip replacement. Comorbidity and outcomes after hip replacement. Med Care 31:141–154

    Article  PubMed  CAS  Google Scholar 

  50. Incalzi RA, Capparella O, Gemma A et al (1997) The interaction between age and comorbidity contributes to predicting the mortality of geriatric patients in the acute-care hospital. J Intern Med 242:291–298

    Article  PubMed  CAS  Google Scholar 

  51. Kaplan MH, Feinstein AR (1974) The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus. J Chronic Dis 27:387–404

    Article  PubMed  CAS  Google Scholar 

  52. Liu M, Tsuji T, Tsujiuchi K, Chino N (1999) Comorbidities in stroke patients as assessed with a newly developed comorbidity scale. Am J Phys Med Rehabil 78:416–424

    Article  PubMed  CAS  Google Scholar 

  53. Shwartz M, Iezzoni LI, Moskowitz MA et al (1996) The importance of comorbidities in explaining differences in patient costs. Med Care 34:767–782

    Article  PubMed  CAS  Google Scholar 

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Einhaltung ethischer Richtlinien

Interessenkonflikt. R. Dodel: Vorstandsmitglied: Solvay, Affiris, GE Healthcare, Lilly, Baxter; Beratertätigkeit: Octapharma, Lilly, Pfizer, Baxter, Adept Field Sulutions, AstraZeneca, Contigo Consulting, TEVA Pharma GmbH, Med Panel, Merz Pharmaceuticals GmbH, Semantics, Solvay; Förderung: UGKM, ZLB Behring, CSL Behring, Behring-Röntgen Stiftung, M.J. Fox Foundation, Rentschler, Deutsche Parkinson Vereinigung, International Parkinson Fond, Faber Stiftung, Movement Disorder Society, Novartis, Hector-Stiftung, Alzheimer Forschung Initiative, DGSM, Lundbeck, Abbott, Baxter, BMBF, Deutsche Gesellschaft für Neurologie, Bayer Schering, Medtronic. Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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  1. Klinik und Poliklinik für Neurologie, Philipps-Universität Marburg, Universitätsklinikum Gießen und Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland

    R. Dodel MPH

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Dodel, R. Multimorbidität: Konzept, Epidemiologie, Versorgung. Nervenarzt 85, 401–408 (2014). https://doi.org/10.1007/s00115-013-3937-y

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