Tratamiento para pacientes con pluripatología, el reto sanitario del S.XXI

The doctor. Cruz Jentoft is a recognized expert in Geriatrics, author of the book Life begins at fifty , and publisher and co-author of more than forty scientific books. In the following article he explains the treatment of patients with pluripathology, a disease that with age is more and more frequent.

Multilingualism or multi-morbidity is the coexistence of several chronic diseases in the same person. There are a large number of diseases that have no cure, such as arthritis or Alzheimer's. Even when we overcome a serious acute illness, such as myocardial infarction, there are often chronic diseases or sequelae. In a long enough life, a person can suffer many chronic diseases while they can interact with each other.

From what age does pluripatology usually appear?

The possibility of pluripathology increases with age. In the 50-54 age bracket, almost half of people have two or more diseases. The figures are increasing markedly when they are over 65 years. When it reaches the 85, it is frequent that part of the society suffers more than five chronic diseases at the same time.

Common diseases that make up pluripathology

The most common diseases are those that suffer most of society: cardiovascular and osteoarticular. The former include frequent problems such as high blood pressure or diabetes mellitus. Others are chronic obstructive pulmonary disease, neurodegenerative diseases or chronic kidney disease. There are other less serious ones that can also be associated, such as prostate hyperplasia or dermatological problems. Cancer, which until now was a disease from which someone could be cured or die, is increasingly becoming a chronic disease.

Treatment for patients with pluripathology

The first temptation is to treat each of the diseases in the best possible way, with all the treatments available. This can be a problem, since not all diseases are equally important, since they do not affect the quality of life or mental or physical abilities. In addition, treatments for some diseases can worsen other coexisting, drug interactions multiply and polypharmacy itself is a risk, making the patient's life complicated.

The health system is poorly prepared to deal with pluripathology, so the patient spends many hours visiting different specialists who rarely understand or coordinate with each other.

The treatment should focus on the needs of the person and the impact of each disease, as well as their quality of life and the independence that they allow the pathologies. It is possible that some diseases remain untreated, depending on their position on the priority list.

What aspects should be improved in this area?

Two aspects need to be improved: on the one hand, the fragmentation of the health system and its difficulty in dealing with complex patients, especially when they have some degree of physical or mental disability; and, on the other hand, the lack of research due to the complexity. Clinical trials are done with patients who usually suffer from a single relevant disease. The clinical guidelines of each scientific society hardly consider the impact of diseases that do not correspond to that organ, so much remains to be done. With this in mind, pluripathology can be understood as the health challenge of the XXI century.