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Defining a care pathway for patients with multimorbidity or frailty

Published:January 19, 2017DOI:https://doi.org/10.1016/j.ejim.2017.01.013
      Multimorbidity and frailty are highly prevalent and emerging conditions [
      • Soong J.
      • Poots A.J.
      • Scott S.
      • Donald K.
      • Woodcock T.
      • Lovett D.
      • et al.
      Quantifying the prevalence of frailty in English hospitals.
      ,
      • Onder G.
      • Marengoni A.
      Frailty: the pleasure and pain of geriatric medicine.
      ,
      • Melis R.
      • Marengoni A.
      • Angleman S.
      • Fratiglioni L.
      Incidence and predictors of multimorbidity in the elderly: a population-based longitudinal study.
      ,
      • Cesari M.
      • Nobili A.
      • Vitale G.
      Frailty and sarcopenia: from theory to clinical implementation and public health relevance.
      ,
      • Marengoni A.
      • Angleman S.
      • Melis R.
      • Mangialasche F.
      • Karp A.
      • Garmen A.
      • et al.
      Aging with multimorbidity: a systematic review of the literature.
      ]. Contrary to patients' and primary care providers' perceptions [
      Frailty: language and perceptions: a report prepared by BritainThinks on behalf of Age UK and the British Geriatrics Society.
      ], multimorbidity does not necessarily imply the onset of frailty. However, both these conditions are determined by a wide and dynamic spectrum of potential causes [
      • Marengoni A.
      • Angleman S.
      • Melis R.
      • Mangialasche F.
      • Karp A.
      • Garmen A.
      • et al.
      Aging with multimorbidity: a systematic review of the literature.
      ,
      • Onder G.
      • Palmer K.
      • Navickas R.
      • Jureviciene E.
      • Mammarella F.
      • Strandzheva M.
      • et al.
      Time to face the challenge of multimorbidity. A European perspective from the joint action on chronic diseases and promoting healthy ageing across the life cycle (JA-CHRODIS).
      ,
      • Palmer K.
      • Marengoni A.
      • Russo P.
      • Mammarella F.
      • Onder G.
      Frailty and drug use.
      ] and they share several common aspects. For example, chronic diseases represent a key component of the frailty vicious cycle [
      • Fried L.P.
      • Tangen C.M.
      • Walston J.
      • Newman A.B.
      • Hirsch C.
      • Gottdiener J.
      • et al.
      Frailty in older adults: evidence for a phenotype.
      ], and both conditions are associated with increased risk of negative outcomes for the individual as well as higher healthcare costs for public health [
      • Cesari M.
      • Nobili A.
      • Vitale G.
      Frailty and sarcopenia: from theory to clinical implementation and public health relevance.
      ,
      • Marengoni A.
      • Angleman S.
      • Melis R.
      • Mangialasche F.
      • Karp A.
      • Garmen A.
      • et al.
      Aging with multimorbidity: a systematic review of the literature.
      ]. Patients presenting with these complex conditions often have special and unmet clinical needs, requiring an adaptation of traditional care organization and services.
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