As the population ages with a longer life expectancy, more and more people are living with not just one, but two or more chronic conditions.1 Nearly a third of all Americans suffer from multiple chronic conditions, and the likelihood of comorbidities increases with age.1 In fact, almost half of people aged 45-64 suffer from multiple chronic conditions, and that number skyrockets to 80% for people aged 65 and over.1 Co-occurring chronic diseases are also associated with functional limitations, particularly for the aging population ?50?years old.1
The implications for multiple comorbidities are many: premature death, hospitalizations, poor daily functioning, substantial healthcare costs, and decreased clarity of an effective treatment plan.1 Comorbidities are likely to show up in patients with type 2 diabetes,2 chronic obstructive pulmonary disease (COPD),3 childhood asthma,4 and migraines,5 to name a few. Furthermore, the presence of comorbidities can be a driver of poor outcomes in cancer,6 chronic kidney disease,7 ischemic stroke,8 and other conditions.
Although mortality rates are decreasing for many diseases, the years gained are often spent with multiple chronic and slowly progressive conditions. Such is the case for patients with COPD; affected individuals often have multiple diagnoses related to the cardiopulmonary-metabolic axis such as atrial fibrillation, renal failure, or diabetes.9 A complicating factor in the care of patients like these is the fragmentation of medical care, with different clinician specialists treating each disease in a piecemeal fashion.10 Some clinicians believe this calls for a paradigm shift—one that moves away from single disease–oriented patient management and toward patient-tailored multimorbidity medicine.9, 10
In this video, IFM educator Dr. Thomas Sult talks about how Functional Medicine gives clinicians the tools necessary to assess underlying commonalities in multiple diagnoses and determine the root cause that may be common to all of them.
Chronic diseases may cluster together because of shared underlying risk factors like inflammation.11 Traditionally, researchers have focused on a single disease or disease pairs, but departing from this reductionist approach toward a more integrative assessment of multiple comorbidities may be beneficial.11
The Functional Medicine approach is to look upstream to identify the key physiological dysfunction that underlies co-occurring diseases and then apply treatments that address those factors. This may lead to improvement in multiple downstream diagnoses and in some cases even reversal of disease states. IFM’s Applying Functional Medicine in Clinical Practice (AFMCP) teaches practitioners how to identify and treat the underlying causes affecting patients with multiple comorbidities.
Learn more about the upstream factors that sustain disease, as well as how to choose personalized treatments to create optimal health in your patients.
- Gerteis J, Izrael D, Deitz D, et al. Multiple Chronic Conditions Chartbook. Agency for Healthcare Research and Quality; 2014. Accessed Sept 17, 2019. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf
- Iglay K, Hannachi H, Joseph Howie P, et al. Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Curr Med Res Opin. 2016;32(7):1243-1252. doi:1185/03007995.2016.1168291
- Laforest L, Roche N, Devouassoux G, et al. Frequency of comorbidities in chronic obstructive pulmonary disease, and impact on all-cause mortality: a population-based cohort study. Respir Med. 2016;117:33-39. doi:1016/j.rmed.2016.05.019
- Mirabelli MC, Hsu J, Gower WA. Comorbidities of asthma in U.S. children. Respir Med. 2016;116:34-40. doi:1016/j.rmed.2016.05.008
- Minen MT, Begasse De Dhaem O, Kroon Van Diest A, et al. Migraine and its psychiatric comorbidities. J Neurol Neurosurg Psychiatry. 2016;87(7):741-749. doi:1136/jnnp-2015-312233
- Søgaard M, Thomsen RW, Bossen KS, Sørensen HT, Nørgaard M. The impact of comorbidity on cancer survival: a review. Clin Epidemiol. 2013;5(Suppl 1):3-29. doi:2147/CLEP.S47150
- Tonelli M, Wiebe N, Guthrie B, et al. Comorbidity as a driver of adverse outcomes in people with chronic kidney disease. Kidney Int. 2015;88(4):859-866. doi:1038/ki.2015.228
- Bushnell CD, Lee J, Duncan PW, Newby LK, Goldstein LB. Impact of comorbidities on ischemic stroke outcomes in women. Stroke. 2008;39(7):2138-2140. doi:1161/STROKEAHA.107.509281
- Geersing GJ, de Groot JA, Reitsma JB, Hoes AW, Rutten FH. The impending epidemic of chronic cardiopulmonary disease and multimorbidity: the need for new research approaches to guide daily practice. Chest. 2015;148(4):865-869. doi:1378/chest.14-3172
- Bierman AS. Preventing and managing multimorbidity by integrating behavioral health and primary care. Health Psychol. 2019;38(9):851-854. doi:1037/hea0000787
- Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. Eur Respir J. 2014;44(4):1055-1068. doi:1183/09031936.00059814