Integrative Biomedical Research
Integrative Biomedical Research (Journal of Angiotherapy) | Online ISSN 3068-6326
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Multimorbidity in Ageing Populations: Redefining Clinical Guidelines for Combined Disease Management
Ahmed Saadi khlaf 1*, Asif Hasan Abdulrazaq 2, Nawar Bahaa Abdulsahib 3,
Integrative Biomedical Research 10 (1) 1-8 https://doi.org/10.25163/biomedical.10110900
Submitted: 19 December 2025 Revised: 07 February 2026 Accepted: 15 February 2026 Published: 17 February 2026
Abstract
Population ageing has pushed multimorbidity-the co-occurrence of two or more chronic conditions-from clinical exception to structural norm, yet clinical practice guidelines remain built almost entirely around single diseases. We conducted a structured narrative synthesis of epidemiological cohorts, interventional trials, and pharmacological mechanism studies addressing multimorbidity, polypharmacy, and guideline-driven iatrogenic harm in older adults, organized around four analytic dimensions: epidemiological patterning, intervention efficacy, drug-class mechanisms, and disease-specific guideline conflicts. Multimorbidity prevalence ranged from roughly 35% to over 80% across cohorts, socially patterned by education, income, and geography, while polypharmacy independently predicted hospitalization, renal decline, and mortality. Interdisciplinary, pharmacist-involved medication reviews reliably improved prescribing appropriateness, yet this improvement did not consistently translate into reduced hospitalization or mortality-a persistent "process-outcome gap" evident even in large cluster trials. Molecular and clinical mechanism data further revealed how single-disease guidelines collide at the bedside, producing prescribing cascades and drug-drug interactions across cardiovascular, renal, and neuropsychiatric domains. Genuine progress appears to require replacing chronological age thresholds with frailty-based, mechanism-anchored prescribing frameworks embedded directly into clinical workflows and electronic health records.
Keywords: multimorbidity, polypharmacy, ageing, clinical practice guidelines, deprescribing, frailty, inflammaging
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