Multimorbidity Redefined: Prospective Health Outcomes and the Cumulative Effect of Co-Occurring Conditions
ORIGINAL RESEARCH — Volume 12 — April 2, 2015
This model shows how enabling factors, predisposing factors, and need factors have an impact on a scale measuring levels of comorbidity, health outcomes and clinical relevance, and use of resources. The scale (Box 1) is balanced when there are no chronic conditions, functional limitations, or geriatric syndromes. The scale tips when chronic conditions, functional limitations, or geriatric syndromes are present. The scale tips even further when there is any combination of a chronic condition, functional limitation, or geriatric syndrome. Health outcomes and clinical relevance (Box 2): health status, 2-year health decline, and 2-year mortality. Use of resources (Box 2): acute care, post-acute care, long-term care, and health care costs.
Figure 1. Model of how the occurrence and co-occurrence of chronic conditions, functional limitations, and geriatric syndromes would be associated with increased patient burden, use of health care services, and costs.
| Category | No CC, FL, or GS | CC | FL | GS | CC + FL | CC + GS | FL + GS | CC + FL + GS |
|---|---|---|---|---|---|---|---|---|
| No CC, FL, or GS (MM0) | 12.59 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
| Has 1 CC or FL or GS (MM1) | 0 | 20.44 | 0.89 | 8.82 | 0 | 0 | 0 | 0 |
| Has 2 of CC, FL, or GS (MM2) | 0 | 0 | 0 | 0 | 4.48 | 23.65 | 3.16 | 0 |
| Has all 3: CC, FL, and GS (MM3) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 25.97 |
Abbreviations: CC, chronic condition; FL, functional limitation; GS, geriatric syndrome; MM, multimorbidity.
Figure 2. Proportion of older adults by categories of multimorbidity, Health and Retirement Study, 2008 and 2010. MM0, MM1, MM2, and MM3 were defined as follows: 1) MM0, no chronic conditions, functional limitations, or geriatric syndromes; 2) MM1, occurrence (but no co-occurrence) of any one of chronic conditions, functional limitations, or geriatric syndromes; 3) MM2, the co-occurrence of any 2 of chronic conditions, functional limitations, or geriatric syndromes; 4) MM3, the co-occurrence of all 3 of chronic conditions, functional limitations, and geriatric syndromes. Abbreviations: CC, chronic condition; FL, functional limitation, GS, geriatric syndrome, MM, multimorbidity.
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