Aging, multimorbidity and polypharmacy:
which strategies for the Third Millennium
The goals and challenge of this International Seminar are to promote more effective and focused clinical and research approaches to multimorbidity in the oldest old, taking into account different European healthcare scenarios, experiences and expertises.
In the European Union (EU) the number of people aged >75 years is projected to double by the year 2060, comprising 20% of the total population. These changes will lead to an increase of 20 to 40% of the costs necessary to maintain the existing quality of healthcare services. Multimorbidity is almost constant in the oldest old and has such adverse consequences as higher mortality, poorer quality of life and functional status. Elderly people with multimorbidity are usually treated with multiple medications, and polypharmacy leads to drug interactions, adverse reactions, poor compliance, heightened health service use, inadequate coordination of care and higher treatment burden.
Current therapeutic guidelines are based upon randomized clinical trials, that enroll only highly selected, relatively young patients suffering from a single disease. This population is obviously very different from the oldest old and very few of the available guidelines take into due account multimorbidity and overall medication burden.
This background highlights the need of making drug prescription more appropriate and personalized, also ensuring that decision making takes into account patients’ life expectancy, concerns and priorities.
There is also a need to bolster a patient-centered approach instead of the current disease-focused efforts, that inevitably lead to fragmentation of healthcare of the elderly and inappropriate use of facilities.
REPOSI is a collaborative study promoted by the Italian Society of Internal Medicine (SIMI) and the Institute of Pharmacological Research Mario Negri based in Milan, Italy.
The original aim of the study was to activate an observational network of internal medicine departments in order to enrol, monitor and study elderly patients and estimate the prevalence of individuals with polypathologies and/or under polytherapies.
In 2008, a pilot phase was completed with the participation of 38 departments of internal medicine and geriatrics linked to SIMI, and enabled to enroll a cohort of 1.332 patients and the publication of 7 articles in peer-reviewed international journals. All registry participants are mentioned as co-authors.
In 2010, a new data collection was completed with the enrolment of new 1400 patients, thus enabling network expansion to 70 departments. The resulting database enabled as many as 13 data analysis proposals in a number of clinical areas which will hopefully generate further journal publications. The positive results obtained encouraged the creation of a third phase of data collection in 2012 with the involvement of new departments.
This seminar is meant to discuss on the results obtained and draw conclusions that may be useful for the internal medicine physicians in this era of ageing populations.