Speakers and organizers of the symposium (from left to right): Martin Roland, Stewart Mercer, Susan Smith, Jeanet W. Blom, Amaia Calderón, Davide Vetrano, Christiane Muth, Jose M Valderas, Laura Fratiglioni, Luigi Ferrucci, Mary E Tinetti, Graziano Onder, Cynthia Boyd, Alessandra Marengoni, Maria Eriksdotter, Mieke Rejken, Kristina Johnell, Ellen Nolte.

Lessons learned

Conceptual issues:

  • Frailty, multimorbidity and disability overlap substantially at an individual level but are distinct constructs: a high proportion of individuals meeting the criteria for one do not meet those for others. Definitions of each construct may need to be tailored to each specific purpose and context.
  • A life-course approach will help in understanding the complexity behind these three constructs by providing a framework that encompasses the physical and social environment, as well as biological mechanisms.
  • Research on patterns of multimorbidity has the potential to address common disease pathways, contextualize disease accumulation, and develop efficient preventive and curative interventions. Future research needs to establish the internal and external validity of such clusters, their social determinants, longitudinal patterns of association, gender differences, and interactions with other geriatric syndromes.

 

Clinical care:

  • Models of care are still informed by single-disease approaches, but a model consistent with the challenges of multimorbidity is still lacking; i.e. multiple conditions with multiple etiological factors and multiple management options, and involving a wide range of health professionals.
  • In the clinical management of people with multimorbidity, the presence of conflicting priorities means that trade-offs and personalized management are necessary; i.e. the use of outcomes that are meaningful to patients (e.g. function), the formulation of explicit priorities and goals, and appropriate interventions both in terms of time to and absolute benefit, and burden.
  • Continuity of care offers an instrument to potentially maximising the effectiveness of multidisciplinary care teams while ensuring patient centredness. While care continuity is expected to improve satisfaction and outcomes, reduce costs, and lead to more appropriate decisions, evidence is still scant.

 

Health policy:

  • Performance assessment frameworks for people with multimorbidity should focus not only on the use of therapies likely to benefit these patients, but also on those unlikely to benefit or even likely to harm them. They also need to capture patients’ voices (both in the form of patient experiences and patient-centred outcomes -PROMs and PREMs-) and to establish whether patient preferences and values inform decision-making.
  • The design of healthcare systems for patients with complex needs will benefit from attention to the following key issues: patient selection and targeting, patient engagement, caregiver involvement, coordination of care, information systems, workforce planning, aligning funding and incentives, enabling innovation, and learning from experience.