Multimorbidity

Abstract

Multimorbidity, defined by the co-occurrence of multiple chronic diseases, increases with age and represents several challenges for care, in health systems designed with a ‘single-disease approach’. Especially, multimorbidity is one of the geriatric conditions which needs to be assessed and managed in intensive care units (ICU). The assessment of chronic medical conditions is a one of the steps helping to decide an ICU admission and the intensity of ICU treatments and will also be helpful to manage the patient once admitted in the ICU. Apart from the treatment of the acute event resulting in ICU admission, management of chronic underlying diseases is crucial to avoid a cascade of exacerbations. Old patients with multimorbidity admitted to the ICU are more prone, in addition to the acute illness, to develop other subsequent organ failures and finally have an increased related mortality. In the first part of the present chapter, we summarize current knowledge on multimorbidity in older persons: definitions, epidemiology, consequences and models of care. The second part of this chapter is dedicated to provide tools to assess multimorbidity at the bedside of the patient at triage and to anticipate and prevent future failures of chronic health conditions during the ICU stay.