The term ‘multiple long-term conditions’ (MLTC) refers to the co-existence of two or more chronic conditions (physical or mental) in a person. In medical and research circles, this has often been referred to as 'multimorbidity'. We use the term MLTC as we find it is better understood and preferred by patients, carers and the public.
MLTC is a significant and growing health challenge, with an urgent need for research to help better understand and inform treatment and care.
Miles Witham is Professor of Trials for Older People at Newcastle University, and is a lead researcher in the Newcastle BRC’s ageing, sarcopenia and multimorbidity theme.
Here he explains why the BRC’s research into MLTC is vital for both patients and the NHS:
Multiple long-term conditions are very common – especially as we age – and two-thirds of people will be affected by the age of 70. Definitions vary, but the term is usually applied only to chronic conditions (such as liver disease, or diabetes) rather than short term illnesses such as pneumonia. Some researchers describe combinations of different types of condition – for example infections and non-infectious disease, or physical and mental health conditions.
What is becoming clear is that diseases do not coexist randomly, but occur in patterns or groups. For instance, we have known for years that people with diabetes also tend to have high blood pressure and are more likely to have heart attacks or a stroke. The hope is that if we can understand the causes of these patterns of conditions, we can more effectively treat multiple conditions at once rather than looking at each condition separately.
So why are multiple long-term conditions important for us to study and better understand?
There are two main reasons.
The first reason is that they are important to patients. People with multiple long-term conditions do not live as long, and suffer from poorer health, which often impairs their ability to stay independent as they get older. Having multiple long-term conditions usually means having to take multiple treatments. At the moment we treat each condition separately, often using several treatments for each condition. This means that the number of tablets to be taken, appointments to see specialists, and exercise programmes and diets that a person needs to for their conditions increases dramatically depending on the number of multiple long-term conditions they have.
Recent research suggests that a patient with six long-term conditions would need to take an average of 18 tablets a day and spend 20 hours a week carrying out instructions on self-care and attending appointments! As well as the burden this puts on patients and carers, taking this many medications increases the chances of medication side effects – often because a medication benefiting one condition might worsen another.
The second reason is that MLTC are important to health services. People with multiple long-term conditions are frequent users of healthcare, whether through GP surgeries or through hospital admissions. Health services around the world have evolved to look after people with a single condition or people with a short-term illness; they have not been designed to give effective care to people with multiple long-term conditions. There is an urgent need to redesign our health services so that they are fit for purpose, given that most of our healthcare spending now goes on looking after people with long term conditions.
Understanding patterns of MLTC and their underlying causes is important, so that we can find solutions that can improve the symptoms of multiple diseases with a single treatment, rather than responding to each disease individually.
Our work aims to understand these patterns and mechanisms, and also understand the consequences of multiple long-term conditions – for instance how they affect physical function for older people. These insights will then allow us to design and test new medicines, lifestyle approaches and therapies that are effective at either preventing or treating multiple long-term conditions at any age.
Overcoming these challenges is a large and complex task, but the work of the Newcastle BRC is at the forefront of improving the health of people living with multiple long-term conditions.
Find out more about our research into ageing and multiple long-term conditions