Comorbidities and Premorbid Health

Following a hospital stay, a lower premorbid level of health generally means the outcomes will be worse off, simply because the patient is starting at a functional level that is lower than average. Consequently, these people as well as those with multimorbidities can struggle in programs designed specifically for just one chronic condition as they have more issues impacting physical performance (Smith et al. 2012). Compliance with exercise is understandably difficult when there are a multitude of other health issues to keep in mind, so when noting the effects of the patient’s medications and prescribing exercise, carefully consider each individual’s specific needs based on how they present and what they feel they would need to adhere to any treatments.

Exercise has been shown to be beneficial for people with multimorbidities across a plethora of conditions (Zgibor et al. 2016) and specific interventions that target functional impairment, which exercise can provide, could also be effective in managing people with multimorbidities (Smith et al. 2012). It is crucial therefore that patients continue healthy exercise behaviour within the boundaries of their health status to maintain functional capacity and quality of life.

People living with multimorbidities tend to draw on their past experiences of exercise and their perceptions and beliefs around health to guide their current exercise behaviour (Simonik et al. 2016). Using leadership principles to help shape these beliefs and experiences into something that will empower the patient and facilitate their progress towards an independent, compliant exercise routine would be beneficial to improving and/or maintaining function. Given a functional goal approach to exercise is best for patients with multimorbidities, exercise programs, like their health status, will be very individualised. It is up to the clinician then to show the client what they could be achieving and then engage them with collaborative goal setting and collaborative exercise prescription in a manner that avoids any barriers to exercise, such as how best to manage any symptoms like pain during exercise (which is normal, just not too much pain), to ensure that these patients have the best outcomes.

Looking at a wider scope of health practise, the current health system favours a biomedical approach due to the time constraints within clinical settings. It is undoubtedly effective when multiple conditions are present, but taking the extra step to a biopsychosocial approach can reap even more rewards for the patient. On top of that, spending the extra time at the beginning to consider the psychosocial factors of each multimorbidity patient, such as their barriers and facilitators to treatments and becoming more of a case manager for them (Smith et al. 2016), would end up saving time in the long run as it considers the method with the greatest chance of improving health, rather than applying a “one shoe fits all” method of exercise prescription and then scratching heads when the client discontinues their program later on. Explore avenues to shape the system of whatever setting you work in, or if you’re the patient, be active and engaged, make sure they ask you what works best for you!

PR cinderella
(Google images)

– RJ

References:

Simonik, A., Vader, K., Ellis, D., Kesbian, D., Leung, P., Jachyra, P., Carusone, S. C., & O’Brien, K. K. (2016). Are you ready? Exploring readiness to engage in exercise among people living with HIV and multimorbidity in Toronto, Canada: a qualitative study. BMJ open, 6(3), e010029.

Smith, S. M., Soubhi, H., Fortin, M., Hudon, C., & O’Dowd, T. (2012). Managing patients with multimorbidity: systematic review of interventions in primary care and community settings. Bmj, 345, e5205.

Zgibor, J. C., Ye, L., Boudreau, R. M., Conroy, M. B., Vander Bilt, J., Rodgers, E. A., Schlenk, E. A., Jacob, M. E., Brandenstein, J., Albert, S. M., & Newman, A. B. (2016). Community-Based Healthy Aging Interventions for Older Adults with Arthritis and Multimorbidity. Journal of Community Health, 1-10.

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