Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
Nat Rev Dis Primers. 2022 Jul 14;8(1):48. doi: 10.1038/s41572-022-00376-4.
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
多种疾病（个体中同时存在两种或多种疾病）是一个日益严峻的全球性挑战，对个人、护理人员和社会都有重大影响。在社会经济条件较差的社区，多种疾病的发生时间提前了十年，与过早死亡、功能和生活质量较差以及医疗保健利用率增加有关。多种疾病发展的潜在机制复杂、相互关联且多层次，但与衰老和潜在的生物学机制以及健康的更广泛决定因素（如社会经济贫困）有关。关于多种疾病的预防知之甚少，但关注社会心理和行为因素，特别是针对人群的干预措施和结构性变革，可能是有益的。大多数临床实践指南以及医疗保健培训和实施都侧重于单一疾病，导致护理有时不够充分，甚至可能有害。多种疾病需要以人为本的护理，优先考虑对个人和个人护理者最重要的事项，确保护理得到有效协调且尽量减少干扰，并与患者的价值观保持一致。干预措施可能很复杂，需要多方面的措施。尽管越来越多的研究探讨了多种疾病的干预措施，但仍缺乏支持任何方法的证据。迫切需要增加对多种疾病研究和培训的投资，并对医疗保健进行重新配置，以支持多种疾病的管理。
