Abstract
Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients; High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.
Highlights
Multi-morbidity is common in primary care and in a system with strong gate-keeping is associated with high healthcare utilization and cost
The six themes pertaining to the needs of older patients with multimorbidity in the healthcare services were: A frequent problem in older female patients; High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality
In order to reduce the burden of several chronic diseases, healthcare professionals need to focus more on the patients’ experiences, physical and mental health, as well as their social functioning
Summary
Fortin et al [5] demonstrated that patients with multimorbidity were open to the participation of nurses in primary care practice They expected greater accessibility for both themselves and for other patients. A cross-sectional study by Noël et al [8] compared the self-management learning needs and willingness to encounter non-physician care providers of patients with multimorbidity and those with a single chronic illness. They concluded that the self-management learning needs of patients with multimorbidity are extensive and that they prefer team-based primary care [8]
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