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?