Multimorbidity

What are the treatment options for hyprtension?

ACE inhibitor (ARB if <55) Ca channel blocker or thiazide diuretic Statin Stop smoking and alcohol Healthy diet and exercise Reduce salt and caffeine intake Annual bloods, urine and BP checks

What are the treatment options for heart failure?

ACE inhibitor or ARB Diuretic B blocker Statins Spironolactone Stop smoking and alcohol Annual flue vaccine Pneumococcal vaccine Regular bloods and BP checks

What are the treatment options for CKD?

ACE inhibitors or ARB Ca blocker or diuretic Statin Exercise, stop smoking, healthy weight Diet advice for K, PO4, salt and calorie intake Regular BP, bloods and urine tests Annual flu vaccine Pneumococcal vaccine

How might HT treatment conflict with CKD?

ACE inhibitors reduce eGFR

What factors incraese the risk of multimorbidity?

Age and deprivation

How might OA treatment conflict with CKD or heart failure?

Anti-inflammatories increase fluid retention which can aggravate heart failure or CKD

How might ca channel blockers cause leg oedema?

Cause vasodilation which can increase peripheral oedema

Differential diagnoses for a new cough

Chest infection (pneumonia or bronchitis) Worsening heart failure ACE cough Post nasal drip Allergy Reflux Viral URTI

Differential diagnoses for new leg oedema

Dependent oedema Worsening heart failure Ca channel blocker side effect Proteinuria from CKD (low albumin) Varicose veins/eczema DVT

How can lifestyle and disease impact ageing?

Diet Physical activity Lonliness Anxiety People can be biologically younger than they are chronologically if they are very healthy

How might treatment for heart failure conflict with CKD?

Diuretics can be nephrotoxic and impede renal perfusion

Why is it complex to treat multimorbidity?

Lots of drugs and tests needed NICE guidelines based on single conditions in young people, which is difficult to apply to comorbidity in the elderly

Why is multimorbidity a problem?

More common than unimorbidity Reduced QOL and worse health outcomes Difficult to manage Increasing osts and ageing population

What are the treatment options for osteoarthritis?

Paracetamol, NSAIDs, capsaicin PPI cover Opiates Intra-articular injections Exercise and diet Footwear advice Walking aid, heat/physiotherapy Joint replacement

How should multimorbidity be managed?

Patient centred care Focus on what is important to the patient and what will benefit them the most Reducing the impact of AODL Impact of chronic pain and depression causes worse health outcomes Personalised treatment plan

What is comorbidity?

Presence of one or more conditions/diseases

What is multimorbidity?

When a person has 2 or more long term health conditions

Differential diagnoses for new SOB

Worsening heart failure COPD Chest infection Anaemia Heart block AF Tachycardia or bradycardia Deconditioning