Do critical illness survivors with multimorbidity need a different model of care?

Abstract

There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person’s existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person’s medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.

Qualitative Insights Into Patients' and Family Members’ Experiences of In-Hospital Medication Management After a Critical Care Episode

“…Further research is required to inform how HCPs can deliver these practices routinely and effectively. 38 …”

Socioeconomic Status Plays a Moderating Role in the Association Between Multimorbidity and Health-Related Quality of Life Among Cancer Patients

“… 38 This poses greater demands on the existing comprehensive nursing model. 39 , 40 An immediate priority is to establish and execute efficient screening and evaluation tools for evaluating the physical and mental health statuses of patients. Nursing interventions targeted at addressing physical-mental multimorbidity should encompass psychotherapy, medication management, and social support.…”

Temporal change in multimorbidity prevalence, clustering patterns, and the association with mortality: findings from the China Kadoorie Biobank study in Jiangsu Province

“…The rapid aging of populations worldwide is increasing the prevalence of the coexistence of two or more chronic diseases simultaneously. Such multimorbidity brings heavy burdens and significant challenges to patients, caregivers, medical professionals, and healthcare systems (1)(2)(3). However, evidence-based decisionmaking regarding multimorbidity conditions remains problematic.…”