Author's personal copy Analysis of multimorbidity in individual elderly nursing home residents. Development of a multimorbidity matrix Gunnar Akner * Department of Geriatric Medicine, O ¨ rebro University Hospital, 701 85 O ¨ rebro, Sweden 1. Introduction Age is by far the strongest risk factor for the development of health problems. Thus, a large and growing group of elderly people develop several simultaneous chronic diseases and persistent consequences of injuries, e.g., stroke, fractures, etc. (Guralnik, 1996). This situation is designated ‘multimorbidity’, defined as any co-occurrence of diseases. Other terms used to describe this situation are comorbidity, multiple pathology or disease clustering (Van den Akker et al., 1998; Gijsen et al., 2001). Multimorbidity has been reported to occur in up to 78% of subjects aged 80 and over (Van den Akker et al., 1998). Patients with multimorbidity with accompanying need for integrated clinical analysis are common in generalist medicine specialities such as internal medicine, geriatric medicine and general practice (family medicine). However, current medical records do not support a presentation of a comprehensible cross- sectional overview of clinical multimorbidity (type and degree of health problems) and how the course of various health problems and measurements develop over time, but rather serve as a diary where symptoms and signs of various acute, subacute and/or chronic health problems are dealt with as they appear. The described situation is true for patients of all ages, but becomes especially problematic in care of the elderly. Similarly, in scientific studies in geriatric medicine/care of the elderly, the patient population is characterized by age, gender, physical function, mental function, admissions to hospital, etc. Sometimes there is also a description of some major diseases among the patients. However, there is rarely any attempt to provide a detailed description of the clinical problem burden from the individual patient’s perspective. There is no existing gold standard to categorizing and assessing multimorbidity. It has been expressed in different ways: (i) by describing the co-occurrence of specific diseases in individuals with an index disease, (ii) by counting the number of diseases present in one individual or (iii) by a comorbidity index that combines the number and severity of the diseases (Gijsen et al., 2001). It remains to be established in multimorbidity research and medical recording how the simultaneous occurrence of acute and chronic diseases, complications to diseases and treatment, as well as consequences of injuries should be structured and visualized to best describe an individual’s total burden of disease at a certain point in time. A recent systematic review identified 13 different methods of measuring comorbidity (De Groot et al., 2003) of which some have been validated regarding various outcome variables in the elderly such as medication usage, functional disability, acute Archives of Gerontology and Geriatrics 49 (2009) 413–419 ARTICLE INFO Article history: Received 15 July 2008 Received in revised form 10 December 2008 Accepted 15 December 2008 Available online 29 January 2009 Keywords: Multimorbidity of the elderly Comorbidities of the elderly Taxonomy Nursing home residents Clinical analysis Evaluation of health status Medical records ABSTRACT The chronic multimorbidity in individual elderly people is rarely documented in its entirety in present medical records, neither as cross-sectional overview nor as longitudinal time-course of various health problems. This obviously hampers an integrated clinical analysis. This work was aimed at evaluating the chronic multimorbidity in individual elderly patients and developing a method to map, quantify and grade the prevalence of the multimorbidity. An explorative study in 70 nursing home residents (55 women), mean age 85 was performed. Information on health problems was obtained through history, clinical examination and medical records. A 19-item multimorbidity matrix that maps, quantifies and grades the chronic morbidity in individual patients is presented. The 70 residents exhibited 275 different health problems; the top 3 items being neuropsychiatric, cardiovascular and gastrointestinal ones. The residents had a mean of 17 different chronic health problems and were prescribed a mean of 6.6 continuous medications per day. There was a significant correlation between the number of continuous drug prescriptions and both quantitative and graded multimorbidity-scores. The presented multi- morbidity matrix provides a useful taxonomic overview over the health situation in individual multimorbid elderly and constitutes the basis for ongoing work to develop and renew the electronic health record into an ‘‘interactive health analysis system’’. ß 2009 Published by Elsevier Ireland Ltd. * Tel.: +46 70 620 48 46. E-mail address: gunnar.akner@comhem.se. Contents lists available at ScienceDirect Archives of Gerontology and Geriatrics journal homepage: www.elsevier.com/locate/archger 0167-4943/$ – see front matter ß 2009 Published by Elsevier Ireland Ltd. doi:10.1016/j.archger.2008.12.009