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Help for Patients With Multiple Chronic Conditions

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, while 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 greater than 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.1,2 Comorbidities are likely to show up in patients with type 2 diabetes,3 chronic obstructive pulmonary disease (COPD),4 childhood asthma,5 and migraines,6 to name a few. Furthermore, the presence of comorbidities can be a driver of poor outcomes in cancer,7 chronic kidney disease,8 ischemic stroke,9 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.10 Some clinicians believe this asks for a paradigm shift—one that moves away from single disease–oriented patient management and toward patient-tailored multimorbidity medicine.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, to determine the root cause.

Dr. Thomas A. Sult is a graduate of the UCLA School of Medicine, a Fellow of the American Academy of Family Physicians, and a Diplomate of the American Board of Family Medicine as well as the American Board of Physician Specialties in Integrative Medicine, and board-certified by the American Board of Integrative Holistic Medicine.

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

When practitioners use Functional Medicine to look upstream and identify the key physiological factors that underlie disease, they find that multiple downstream diagnoses tend to improve or may even be reversed. 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.

Learn More About AFMCP

References

  1. Gerteis J, Izrael D, Deitz D, et al. Multiple Chronic Conditions Chartbook. Rockville, MD: Agency for Healthcare Research and Quality; 2014. https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf. Accessed March 7, 2017.
  2. Multiple chronic conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/multiple-chronic.htm. Updated January 20, 2016. Accessed March 7, 2017.
  3. 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.
  4. 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.
  5. Mirabelli M, Hsu J, Gower WA. Comorbidities of asthma in U.S. children. Respir Med. 2016;116:34-40. doi:1016/j.rmed.2016.05.008.
  6. 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.
  7. 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.
  8. 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.
  9. 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.
  10. 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.
  11. Divo MJ, Martinez CH, Mannino DM. Ageing and the epidemiology of multimorbidity. Eur Respir J. 2014;44(4):1055-1068. doi:1183/09031936.00059814.

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