This resource supports student nurses, student nursing associates and early career nurses in understanding and identifying multimorbidity— the coexistence of two or more long-term health conditions in a patient.

Multimorbidity is becoming increasingly common. Now more than ever, nursing students must be equipped to recognise the complex ways in which long-term conditions interact and impact patient care. 

Understanding the range of conditions

Managing multimorbidity requires recognising the interplay between conditions, adapting care plans accordingly and making holistic, person-centred decisions in practice.

These conditions may include:

• defined physical or mental health diagnoses (such as diabetes, schizophrenia or infectious diseases)
• ongoing conditions (such as learning disabilities), symptom complexes (like frailty or chronic pain)
• sensory impairments (such as sight or hearing loss)
• alcohol or substance misuse.

Learning objectives

• Define multimorbidity and identify common long-term conditions involved.
• Recognise how these conditions interact and influence patient care.
• Discuss key considerations with practice supervisors/assessors.
• Use additional resources to support learning in university and placement settings.

How to use this resource

1. Start by reviewing the condition summaries.
2. Use the condition interaction list to identify condition pairs of interest.
3. Explore the corresponding interaction sections for focused learning. 

This is a long-term condition where the body cannot effectively regulate blood glucose. Diabetes UK data shows that 4.4 million people in the UK live with diabetes.

Type 2 diabetes is the most common type of diabetes. Approximately 90% of people with diabetes have type 2 diabetes (T2DM), 8% have type 1 diabetes (T1DM), 2% have rarer types and 1.2 million people could be living with it, but are yet to be diagnosed.

Type 1: Autoimmune, insulin dependent.

Type 2: Insulin resistance or insufficient production.

Symptoms: Frequent urination, thirst, fatigue, blurred vision.

Key Test: HbA1c > 48 mmol/mol indicates Type 2 diabetes. 

This is persistently elevated blood pressure (BP), which increases the risk of heart failure, stroke and kidney disease.

There are two numbers used to describe BP. It’s measured in millimetres of mercury (mmHg) and is written like this: 130/80mmHg.

1. The first number is the systolic pressure. This is the maximum amount of pressure your heart uses when beating to push the blood around your body.
2. The second number is the diastolic pressure. This is the least amount of pressure your heart uses when it is relaxed between beats.

Target clinic BPs are*:

Under the age of 80 — clinic BP below 140/90 mmHg; ABPM/HBPM below 135/85 mmHg.

Over the age of 80 — clinic BP below 150/90 mmHg; ABPM/HBPM below 145/85 mmHg.

Postural hypertension (a condition where BP rises suddenly when a person stands up)— BP target should be based on standing BP.

Frailty or multimorbidity — clinical judgement should be used.

*These are dependent on other conditions and patient clinical assessment.  

COPD is a collective term for progressive lung diseases, including chronic bronchitis and emphysema. These conditions cause long-term breathing difficulties due to airflow obstruction that is not fully reversible.

Chronic bronchitis: Defined clinically as a productive cough (with sputum) lasting for at least three months in each of two consecutive years.

Emphysema: A pathological diagnosis referring to damage and destruction of the alveoli — the tiny air sacs in the lungs responsible for gas exchange. Healthy lung parenchyma appears spongy and pink grey in colour, with thin-walled alveoli providing a large surface area for oxygen and carbon dioxide exchange.

Symptoms: Persistent breathlessness, chronic cough and sputum production.

Causes: Primarily caused by smoking but can also result from long-term exposure to environmental pollutants (for example, fumes, dust, chemicals) and, in rarer cases, genetic factors such as alpha-1 antitrypsin deficiency.

IBD is a chronic, relapsing-remitting, non-infectious inflammatory disease of the GI tract. It describes two conditions:

Crohn's disease: A lifelong condition where parts of the digestive system become inflamed.

Ulcerative colitis: A long-term condition where the colon and rectum become inflamed with ulceration.

Signs and symptoms of IBD include:

• diarrhoea
• stomach aches and cramps
• blood in stool
• tiredness
• weight loss.

IBD often coexists with other long-term conditions, including diabetes, making joined-up care essential for safe and effective treatment.