**Dr. Sevgi Akarsu**

Professor, Department of Dermatology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey

**IV**

Hearing impairment, hearing loss, or deafness is also one of the leading causes of years lived with a disability. Untreated hearing loss negatively affects communication and social engagement, leading to reduced quality of life. In addition, it is a potentially modifiable risk factor for dementia. Presbycusis, also called age-related hearing loss, is one of the most frequent hearing disorders among elderly people. Similarly, presbycusis-related tinnitus and cognitive impairment are common disorders in older adults that are almost always unnoticed at the early stage. Identification of the complex and mutual interactions among hearing loss, tinnitus, and cognitive impairment in connection with decreased peripheral hearing perception and central nervous system dysfunction suggested that comprehensive assessment, intervention, and treatment in consideration of these three diseases are important to decay aging. On the other hand, some cases of sensorineural hearing loss associated with many immune-mediated inflammatory diseases with variable prevalence in the population have also been reported. Psoriasis, one of these

inflammatory diseases, is a common, lifelong multisystemic chronic disease that has multiple clinical types in a spectrum ranging from mild erythemato-squamous skin lesions to psoriatic arthritis. Like other diseases in this group, psoriatic disease is often accompanied by certain comorbidities such as metabolic syndrome, diabetes mellitus, cardiovascular disease, obesity, and psychiatric disturbances. However, physicians, especially dermatologists and rheumatologists, need to be more aware of the prevalence and clinical relevance of subclinical sensorineural hearing loss (as a neglected but important comorbidity) in psoriasis and psoriatic arthritis.

As a result of different physical, psychological, and cognitive challenges, multiple unnecessary or inappropriate drug use for self-care and disease management in patients with MCC leads to an increased risk of polypharmacy, inadequate treatment, adverse drug events, and drug–drug interactions. Recent reviews of multiple sclerosis show that the physical and psychiatric comorbidities (mostly hypertension, hyperlipidemia, chronic lung disease, depression, anxiety) are common and associated with disability progression, lesion accrual on magnetic resonance imaging, diminished quality of life, hospitalizations, and even mortality. However, little is known about how comorbidities influence multiple sclerosis-related treatment. Currently, there is no definitive treatment for this demyelinating disorder with an underlying neuroinflammatory disease process. It is suggested that relapsing-remitting multiple sclerosis is accompanied by decreases in serum endogenous enkephalins/endorphins and alterations in inflammatory cytokines. Low doses of naltrexone (an opioid receptor antagonist) to upregulate the body's own production of enkephalins has been shown by a number of clinical trials to be a safe adjuvant or primary treatment for relapsing-remitting multiple sclerosis. This alternative biotherapeutic continues to be associated with stabilizing multiple sclerosis, leading to improvement in peripheral spasticity and mental health composite scores without inducing any side effects. In addition, it does not appear to interfere with other disease-modifying therapies. Although traditional/complementary/alternative medicine practices have been often applied by physician/non-physician practitioners in recent years, it is highlighted that scientific investigations regarding potential benefits should be supported, and proven benefits need to be brought into modern medicine. There is evidence that traditional Chinese medicine for geriatric syndromes (including "Jia wei weng dan tang" and "ba wei di huang wan" treatments for dementia, "Yi-gan San" treatment for behavioral and psychological symptoms of dementia, "Banxia Houpo Tang" treatment for aspiration pneumonia, and "Da Jian Zhong Tang" treatment for

chronic constipation) are partly accepted by modern medical doctors.

**1**

**Chapter 1**

Perspective

**2. Definitions and prevalence of MCC**

*Sevgi Akarsu*

**1. Introduction**

Introductory Chapter:

Managing Multiple Chronic

than Single Disease-Focused

Holistic Approach Rather

Conditions - A Patient-Centered

A chronic health condition is simply defined as a physical, mental or cognitive disorder that lasts more than one year, requires long-term monitoring and treatment, deteriorates quality of life and causes certain difficulties associated with the physical, cognitive and/or psychological disabilities. We know perfectly well that the prevalence of chronic diseases is increasing rapidly all over the world, especially in low-income countries. It is also a well-proven fact that three-fifths of human deaths worldwide are attributed to four major noncommunicable chronic conditions such as cardiovascular disease (e.g., heart attack, stroke), cancers, chronic lung diseases (e.g., asthma, chronic obstructive pulmonary disease) and diabetes mellitus [1]. Globally, about one-third of all adults suffer from more than one chronic condition. Although there is lack of a precise and consistent term and definition to describe such patients, "multimorbidity", "multiple chronic conditions" (MCC), and "polychronic disease" are the most widely used terms interchangeably [2–4]. Currently, "MCC" is still very popular, easily understood and the most commonly used term in both academic medical literature and non-academic environments worldwide [3].

The term "MCC" refers to the presence of two or more chronic conditions simultaneously in the same individual; however, the number of chronic conditions included in the definition and what constitutes a chronic condition varies greatly among studies in literature [4]. Some authors define MCC as coexisting conditions including diseases, symptoms and risk factors, while others interprete it only as the manifestation of end-organ damage (the endpoints of a disease) as a result of certain risk factors [5]. Therefore, the prevalence rates of MCC which generally range from 9.4–58% for the whole population (from 16–58% in UK studies, 26% in US studies, 20% of Australians and 9.4% in Urban South Asians), are highly heterogeneous and show regional differences across the world [3, 6–8]. In a large study of 25,293 participants from 14 countries (Austria, Germany, Sweden, Spain, Italy,
