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

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