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Comorbidity: definition, factors and risks

More and more numerous with advancing age, comorbidities are sources of difficulties in the choice of prescriptions and of risk factors for the prognosis of the disease during treatment. The 2020 Covid-19 pandemic is one illustration of this. Explanations.

Definition: what is a comorbidity?

“Co-morbidity” is defined by the presence at the same time in the same person of several chronic diseases which each require long-term care (Haute Autorité de santé HAS 2015 *). 

This term often overlaps with the definition of “polypathology” which concerns a patient suffering from several characterized conditions resulting in a disabling overall pathological state which requires continuous care. 

Social Security defines the term “Long Term Affections” or ALD for 100% coverage of care, of which there are 30. 

Among them, are found:

  • dijabetes;
  • maligni tumori;
  • cardiovascular illnesses ;
  • HIV;
  • teška astma;
  • psihijatrijski poremećaji;
  • itd

An Insee-Credes survey showed that 93% of people aged 70 and over had at least two illnesses at the same time and 85% at least three.

Risk factors: why is the presence of co-morbidities a risk?

The presence of co-morbidities is associated with polypharmacy (prescription of several drugs at the same time) which can pose a problem due to drug interactions. 

More than 10% of people over 75 take between 8 and 10 medications per day. These are most often patients with ALD and the elderly. 

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It should be noted that certain chronic pathologies are sometimes caused by younger people such as diabetes, psychiatric disorders or malignant tumors. 

Co-morbidities also constitute an additional risk of complications in the event of an acute illness such as Covid-19 (SARS COV-2) or seasonal flu. In the presence of comorbidities, the organism is more vulnerable.

Comorbidities and Coronavirus

The presence of co-morbidities is an important risk factor for complications during infection with SARS COV-2 (COVID 19). While age is a significant risk factor in itself, the presence of cardiovascular diseases such as hypertension, a history of heart attack or stroke can lead to cardiac arrest or a new stroke due to energy resources needed by the body to fight against the coronavirus. Obesity or respiratory failure are also co-morbidities that increase the risk of complications from infection with SARS COV-2 (COVID 19).

 

Comorbidities and cancer

The chemotherapy treatments implemented as part of a cancer treatment will promote the occurrence of thromboses (blood clots) in the blood circulation due to a state of inflammation of the whole organism linked to the presence of the tumor. These thromboses can be the cause of:

  • flebitis;
  • cardiac infarction;
  • moždani udar;
  • plućne embolije. 

Finally, chemotherapy can also affect kidney (blood purification) and liver function and the production of white and red blood cells, which can cause complications.

What therapeutic approach in the presence of comorbidities?

The first step is to prioritize treatments, focusing on the most effective drugs and avoiding drug interactions. This is the role of the attending physician who knows his patient well and how he reacts to each treatment. It also ensures coordination between the various stakeholders by asking, when necessary, their advice and expertise. 

 
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Regular medical follow-up is also necessary to adapt treatments to changes in diseases and their context. The attending physician must also remain vigilant to the psychosocial consequences of these comorbidities such as depression, disability or poor quality of life. 

Finally, when an acute illness occurs, hospitalization is more easily indicated for close monitoring of vital functions (oxygen in the blood, blood pressure, blood sugar, temperature) and to be able to remedy it as quickly as possible if necessary.

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