Ageing is a universal phenomenon that has not only social but also economic, political, and health-related implications. With the advancement in healthcare facilities and better availability of health services, the geriatric population is gradually increasing. But, this group is at an increased risk of developing both physical and psychological co-morbidities due to age-related factors and changes in the social circumstances. The present chapter proposes the concept and issues related to co-morbidity in the geriatric population. After discussing the issues and consequences of medical and psychiatric co-morbidities, their effective treatment regime and care/management in relation to the geriatric population are addressed.
TopConcept Of Co-Morbidity
Feinstein described the term comorbidity as “any distinct additional entity that has existed or may occur during the clinical course of a patient who has the index disease under study.” (Feinstein, 1970). In psychiatry, co-morbidity refers to the co-occurrence of two or more medical or psychiatric conditions, which may or may not directly interact with each other within the same individual. The difficulty to define comorbidity emerges from several reasons. One of them is the very nature of health problems involved. Differentiating the nature of conditions is critical to the conceptualization of comorbidity, because simultaneous occurrence of loosely defined medical entities may signal a problem with the classification system itself (Kaplan & Ong, 2007). Another reason for the problems emerged in the conceptualization of comorbidity is difficult to determine the index disease (primary disease) (Schellevis et al., 1993) considering the definition of Felstein, 1970. Depending on the research, different diseases can be considered a disease index. The conceptualization of comorbidity becomes more problematic when considering diseases that might be viewed just as possible complications of other diseases (Valderas, 2007).
Comorbidities are frequently considered in the context of an index disease (e.g., a newly diagnosed cancer); yet, the index disease focus is not sufficiently comprehensive for a general nosology, and may not be suitable for use in primary care settings. Comorbidity is the total burden of biological dysfunction. Traditionally, comorbidity assessments primarily include overt diseases; because subclinical dysfunction and impairments are highly prevalent in older adults and contribute to health outcomes, particularly when they occur in multiple systems. Lifestyle issues, socioeconomic factors, and health care access and quality, genetic factors affect health outcomes and mitigate or accentuate the effects of comorbidity on outcomes. The effect of these factors on health may be captured, at least partially, by measurements of biological processes included in this nosology. Disabilities in activities of daily living representing interaction of an individual with her/his environment are also not included in this nosology.