Polymorbidity
Important Note
It may be more helpful to abandon the term “co-morbidity” – which implies that there is one MAIN problem and that there are multiple “co-morbidities” – in favour of the term “polymorbidity” – which acknowledges that with multiple chronic problems, they are ALL active and ALL interacting ALL the time.
The classic ED paradigm of “one patient/one problem” should be abandoned when dealing with older patients. We need to assess each patient in the context of all of their problems.
Older people often have several different chronic conditions that interact with each other.
Think of the older person who has all of:
- Hypothroidism on thyroxin
- Depression on SSRI
- Chronic pain on opioids
- Polymyalgia rheumatica on prednisone
- Adrenal insufficiency from a pituitary microadenoma
- NIDDM on insulin
And now she is presenting with “weakness”.
Is it a flare of one of them? A flare of several of them? Is it a medication effect? Or is it a completely new problem – like pneumonia or a UTI – that is having an effect on all of them?
Discussion: Polymorbidity
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Poly co-morbid
i like the concept of polymorbidity
ok
Múltiples morbilidades juntas
geriatric patients can have multiple complaints
Thank you! It’s difficult to teach docs/PAs to unlearn the single problem paradigm, but so true in older patients.
NIDDM (NON-insulin dependent diabetes mellitus) on insulin???
ok
feeling bad with symptomatic bradycardia
sad
vague complaints can be hard to pinpoint
several meds
so true
kk
ok
I concur
it could be a combination of many things that are currently there or might be something new.
ok
kk
good to know
ok
ok
always
acute abdomen.
UTI
HYEAH
UTI
.
none
agreed
You’ve to keep your differentials broad
yas
yes
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flahflohalo aofjaoifja ajfoiaj elderly
okay
P[
ok
so many possibilities
!
very helpful information.
.
..
ok
Ok
.
Brings up a great point that could get missed
high probability
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OK
ok
I know
difficult to tease out the cause(s)
Which came first ???
could be any
ok
high probability
k
yes
YES A GREAT POSSIBILITY EXIST
this is so true. patients with multiple disorders and on many different drugs when presenting with weakness is not always to point to one of her illnesses or medication as we must remember all these the patients medical conditions all affect her at the same time and in their one body so it cannot be looked at in isolation. so history and physical is always best to help identify and eliminate to help one get closer to a diagnosis
multiple meds and difficulty Hx
It makes sense to use the term polymorbidity if the have several active health conditions, just as we used the term polypharmcy.
agreed
love the polymorbidity term! will definitely keep that one
Have never heard of anyone having an issue with the term “co-morbidity” but will try to start using “polymorbidity.”
All interacting all the time
good lesson
Importante tratar de obtener una historia Bee cómo comenzo todo y la valoración de familia o cuidador
ok
interesting to note polymorbidities as opposed to comorbidities
agree
PMh and comorbids
Like the use of polymorbidity
belching in an elderly male with NSTEMI
all diseases interact with each other
more digging
Difficult, lots of digging required.
We my try to find out “which came first”–ie high sugars, infection, but we have to treat all the problems that are impacting the success of the outcome which is especially true in the elderly
polymorbidity vs comorbidity cues me to think of the many medical conditions present
yes
agreed
Get off the over medication
it can be a combination of both.
medication interactions on polymorbidity due to side-effects makes it challenging to determine a diagnosis
polymorbidity makes dx more challenging
polymorbidities make elderly diagnoses more difficult
meds and history very important
Polymorbididties make sorting out the current issue that brought the patient to the ER very complex!
Clearly this patient has multiple chronic illness. I think often it is multi or polymorbidity in our elderly vs single disease causing teh main issue with comorbidities however I think it is also important to not attribute to multiple automatically and work through the differentials.
polymorbidity seems more appropriate.
Can be tough to determine
I agree
It may be a completely new problem
excellent
All disease interact with each other.
An extensive medical history and long medication lists make it difficult to zone in on a chief complaint. Further complicating matters is when pt’s use multiple pharmacies.
could be all
good shift of thinking like asking an open ended question instead of a closed ended question
I like the concept of poly morbidity – different way of looking at a patient and their problems
polymorbidity just rose to the top of my lexicon
I think poly morbidity only can be resolved by diagnosis of exclusion
I think that paradigm should just be abandoned, period. It is wishful thinking and a convenient excuse. Many medical students and residents are taught that and take it to heart and completely miss things. Doesn’t mean we have to solve every problem in the ED.
ok
will use polymorbidity from now on
polymorbidity seems more appropriate
new word for me
poly – meaning many, combines with morbidity of the poly persuasion to be bad
multiple co-morbidities-hard to sort out
multi-morbidity is common term; the American Geriatrics Society had a program “3ormore” to help physicians manage multiple chronic illnesses
I agree that the term ‘co-morbidity’ is a bit of a misnomer. We use the term ‘pre-existing medical condition’, but this may also lead to the same assumptions (that there is one main problem, and other conditions that ‘pre-date’ this). So poly-morbidity sound like a good way of putting it.
i agree
la mayoría de los pacientes adultos llegan a emregnecias de esta forma
si se presentan
Podría producir presentaciones atípicas …
Might produce atypical presentations…
All of those meds.
Poly morbidity is a real challenge
I agree with reena
multi-morbid
xx
Have to look into everything unless the pt provides clues that could narrow down the search
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Multiple meds / multiple issues needs multiple minds.
This is a classical comorbid case with multiple meds, needs careful history and exam.
difficult with so many meds and history
I find the in severe dementia category, especially FTD is it difficult to tease out new behaviours (aggression, pacing, violence) due to an acute change (UTI, pneumonia) versus progression of their disease.
difficult with multiple meds and multiple abnormal labs
cholelithiasis and in elderly man presenting with confusion