Pluripathology is defined by the coexistence of two or more chronic diseases in the same person. Chronic disease is understood as a pathology that prevails persistently over time, without the option of cure but with the option of stabilization. Thus, the progressive aging of the population is accompanied by a high prevalence of multi-pathological patients. In fact, it is estimated that in the year 2050, 27% of the population in Spain will be people with chronic problems.
The pluripathological patient usually corresponds to a profile of frailty with functional and/or cognitive dependence with a probable result of high use of care resources (hospital, socio-healthcare or residence) and high mortality. For this reason, the figure of the geriatrician is essential for the clinical management of the multi-pathological patient, with the aim of coordinating the intervention of the different specialists and guaranteeing a global vision of the person to ensure his or her health and quality of life.
Chronic diseases of the pluripathological patient
The main pathologies typical of the chronic patient are:
a) Cardiac diseases: cardiovascular risk factors, such as hypertension, diabetes, or cholesterol favor the appearance of these diseases. Ischemic heart disease and arrhythmias are the main exponents and their main manifestation is heart failure.
b) Respiratory diseases: Smoking is one of the main causes of this group of pathologies, mainly represented by chronic bronchitis.
c) Neurological diseases: Dementia is one of the degenerative diseases typical of the geriatric population, without forgetting the sequelae of stroke or Parkinson’s disease.
d) Oncological diseases: In a high percentage of cases, cancer has gone from being a fatal to a chronic disease.
These diseases are generally interrelated, which justifies the high risk of a cascade of decompensations in the face of an intercurrent process, such as a respiratory or urinary infection, which can lead to a high probability of hospitalization.
The geriatrician is crucial to your quality of life.
Physician-patient communication is always important, but in the case of the multi-pathological patient it is indispensable. The patient should be aware of his chronic diseases and the warning signs that may indicate a possible decompensation of the same and immediately contact his referring physician to optimize the treatment.
If we talk about the treatment for cases of pluripathology, we will talk about the prescription of a large number of medications necessary for each of the different diseases that affect the patient. The internist or geriatrician will be responsible for ensuring the reconciliation of all this medication according to the pathologies of each patient, guaranteeing the appropriate doses and avoiding the prescription of inappropriate drugs or those whose risk makes it advisable to seek therapeutic alternatives.
Currently, the main Spanish hospitals are creating Pluripathological Patient Units to guarantee expert management of these patients from a multidisciplinary point of view. That is, integrating different professionals such as the physician, nurse, social worker and physiotherapist, in order to favor individualized and planned care with these highly vulnerable people.