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Multimorbidity (with polypharmacy)

Multimorbidity is defined by the World Health Organization as the co-occurrence of two or more chronic medical conditions in one person.21

Multimorbidity increases markedly with age. In a Scottish study, multimorbidity was prevalent in 81.5% of individuals aged 85 years and over, with a mean number of 3.62 morbidities.22

The figure below (courtesy of iSYMPATHY) shows multimorbidity in Scotland.

The most prevalent chronic conditions23 in primary care were:

  • hypertension (33.5%)
  • hyperlipidemia (33.0%)
  • depression (18.7%)

The presence of multiple morbidities results in a combined negative effect on physical and mental health, and can affect a person’s quality of life, limiting daily activities and reducing mobility.24

The over 60-year-old population uses nearly three times more medicines as the general population, with adherence to long term medication ranging between 25-70%.25 

The major predictors of risk of experiencing medication-related harm26 are age, number of multi-morbidities and number of medications taken. People with multiple morbidities utilise primary care services twice as much, and are three times as likely to be hospitalised, than those without multiple long-term conditions.8,26 This carries with it a large economic burden27 for health care services.

Care should be person-centred and co-ordinated to ensure the greatest possible individual outcomes. This is most achievable when there is integrated care that places the individual at the centre.

Scottish Government has various work streams driving the improvement in patient centred care at national, board and patient level including Person-centred care28, Polypharmacy Guidance8 and Realistic Medicine.9