a hundred of internists have analyzed the main novelties in the field of multi-pathological patients -those who have two or more pathologies at the same time- and of advanced age, during the XIII Meeting of the Multipathological and Elderly Patient Group (PPyEA-SEMI) from Spanish Society of Internal Medicine (SEMI). This patient profile is increasingly common in the Internal Medicine Services of Spanish hospitals. According to what was stated during the meeting, until 40 percent of Internal Medicine patients meet this condition, that is, they are multi-pathological, and also frequently present clinical frailty, dependence and are polymedicated. Furthermore, it is estimated that 6 out of 10 (60 percent) of these patients have a high degree of dependency to perform basic activities of daily living (ABVD).
This population generally has a “high mortality rate during admission and during clinical follow-up, low quality of life related to perceived health, and a high prevalence of dependency on the caregiver. It presents a special susceptibility and clinical fragility that derives in a frequent demand for care”, say the experts.
The inauguration of the meeting has been in charge ofand Jesus Diez Manglano, president of the Spanish Society of Internal Medicine (SEMI); from Roman Cube Pillarcoordinator of the Group of Patients with Pluripathology and the Elderly (PPyEA) of SEMI, and of the Manuel Mendez Bailonpresident of the Society of Internal Medicine of Madrid and Castilla-La Mancha (SOMIMACA).
At this meeting, the main novelties regarding this type of patient in the diagnostic and therapeutic field were analyzed and the “importance of carrying out a comprehensive multidimensional assessment, both in patients with multiple pathologies and in elderly patients, was highlighted. which must include, in addition to the clinical assessment, an assessment of the patient’s functionality, their state of mind and their cognitive situation”.
“It is key to individualize care and establish an appropriate treatment plan in a consensual manner with the patient and their caregivers”
Roman Cube Pillarcoordinator of the SEMI Multipathological and Elderly Patient Working Group
In the words of Roman Cube Pillarcoordinator of the SEMI Multipathological and Elderly Patient Working Group, in these patients it is also key to “assess the risk-benefit balance of each of the prescribed treatments, since these patients are frequently polymedicated, and the treatment must be individualized. care and establish an appropriate treatment plan and in a consensual manner with both the patient and their caregivers”.
The profile of the multipathological patient
According to experts, polypathology is not only defined by the presence of two or more diseases, but by a special susceptibility and clinical frailty. It allows identifying those patients who have a frequent demand for care due to exacerbations and the appearance of interrelated pathologies that aggravate their situation, with progressive functional deterioration and a high risk of falling into the dependency and disability cascade, it was indicated at the meeting. The profile of polypathological patients hospitalized in Internal Medicine services has changed in recent years. Now, they are “older, more functionally impaired, dependent and have a stratification higher risk prognosis.
As stated during the meeting, the most prevalent pathologies of polypathological patients admitted to internal medicine services are heart disease (68 percent), followed by chronic kidney disease (49 percent), neurological (43 percent) and respiratory (32 percent) diseases.
Throughout the scientific meeting it was stressed that “it is the health system and not the patient, who must adapt to offer the best care and avoid harm to the patient himself”. Collaboration with other services, through interdisciplinary teams and, above all, the close and continuous relationship with Primary Care, is the “key element to keep the multipathological patient in their place of residence for as long as possible, bringing health care closer to the patient’s home.” patient”.
According to the specialists attending the meeting, it is important to avoid hospitalization in these patients except in essential cases, since the loss of functionality that occurs during these hospitalizations has been demonstrated, to promote specific care programs during admission to avoid functional deterioration and to high prevent fragmentation into multiple consultations, which increases the number of hospital visits to the detriment of quality of life and also increases the risk of polypharmacy. It is necessary to improve the coordination and continuity of care between different levels of care, primary care, social health centers or residences, to improve the quality of care for these patients, especially in care transitions, for example after hospital discharge, given that they are especially critical moments in which there must be adequate coordination to maintain the same therapeutic plan.
It is important to avoid hospitalization in these patients except in essential cases, since the loss of functionality that occurs during these hospitalizations has been demonstrated.
In the words of roman cube: “Internal medicine, given its global specialty and its vision of the patient as a whole, has been dedicated to chronic, multipathological and elderly patients for years, understanding that, through a process of collaboration with other specialties and fundamentally with Primary Care, it must offer a paradigm shift. In this sense, in addition to an adequate assessment of the patient’s physical problems, it is necessary to assess other aspects such as psychological, social, and the degree of repercussion of the pathologies on the patient’s global situation, the need for care and trying to improve quality of life and prevent progression to dependency.