The personal impact of having multiple health problems

Some health problems are more serious than others and conditions affect people in different ways. The impact that multiple health problems have on individuals might vary according to how well their conditions are controlled. The causes of a person’s illnesses, whether they can be explained or not, might also influence the impact on them. Having multiple health conditions can affect people’s ability to work and limit what they can do in their social lives. Things like pain, low mood, mobility, finance problems, fatigue, etc. can all be made worse with multiple conditions. It may be possible to cope well with one or two conditions but because everything mounts up, it makes each smaller thing so much harder to cope with. Multiple contacts with the health service might also put people at increased risk of harm or unintended consequences (‘Risks and potential harms for patients‘). The people who spoke to us varied in their attitudes to their illnesses and whether they were able to accept and adapt to them (or not).

A family history of illness was reported by Nigel (diabetes), Anne X (heart trouble) and Lottie (epilepsy). Lottie felt that it was unfair that she had inherited high cholesterol rather than her brother, especially when she already had epilepsy. Other people did not have family histories (or were not aware of them). Another key issue seemed to be whether people had always lived with health problems or whether they appeared later in life. Gogs became ill after retirement whereas Val had health problems since childhood. They reported very different experiences.

Gogs had always been well. When she fell ill in her 70s she was angry that she could not do not do the things she used to. After 2 years, she has not come to terms with her illness.

Gender Female

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Val sees herself as someone who used to be a competitive person who wanted to get things done. As she has got older she has changed her personality so as not to make her pain worse.

Age at interview 70

Gender Female

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Although people live with multiple health problems at all stages of life, the numbers increase with age such that most people over 65 years old have 2 or more long-term disorders*. This was reflected in the people we interviewed, with most being older rather than younger. However, the experience can be very different. Amy was hospitalised for a serious illness in her early 20s and came out with a range of health problems. Mohammed was hospitalised following a heart attack in his 50s and found to also have diabetes.

Amy tries to be positive but worries that things will get worse in the future. She tries to keep her thoughts to herself rather than discussing them with family members.

Age at interview 25

Gender Female

Age at diagnosis 22

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Mohammed believes that people have to recognise their age and adapt accordingly. He compares the body to a motor car where an old one cannot perform as well as a new one.

Gender Male

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The issues of stigma and whether people looked ill or not also had an impact on how they coped with their health problems. Amy was embarrassed about using a walking stick so preferred to endure more pain instead. Farza’s tics presented problems in public. Kevin had been made fun of for having a limp and using a walking stick. On the other hand, John said that people didn’t think he was ill as there were no visible signs. Nigel said that he looked well but felt terrible. He had lived with depression for most of his adult life and was diagnosed with numerous physical conditions in his 40s.

Some conditions were seen as more stigmatising than others by the people we interviewed including; epilepsy and mental health problems. Also with epilepsy, people might look completely healthy unless having a seizure. Lottie felt that she had to justify herself all of the time for not being able to do things because of her epilepsy.

Nigel thinks other people do not understand how unwell he feels because his conditions cannot be seen. He says people need to keep faith, fight the symptoms and carry on with things.

Age at interview 58

Gender Male

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Farza has multiple mental health problems and life can be very hard. Farza has to cope alone because family members do not understand. Verbal tics are very embarrassing in public.

Age at interview 41

Age at diagnosis 15

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Lottie refers to the invisible nature of her conditions and wonders what she might have achieved without them. Memory problems mean that she can’t recall key events in her life.

Age at interview 37

Gender Female

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Other people had problems speaking about their health problems whether or not they felt a stigma or that their conditions could not be seen by others. Pat doesn’t tell people about her diabetes unless she has to inject insulin in public. On the other hand, Anne Y had found that being open with her family and friends about her epilepsy and ‘joking about it’ made it easier to deal with. Tammy referred to a kind of dual personality, where she would complain about her problems to family members (or health care workers) but put on a brave face for other social contacts.

Tammy does not mention her problems to outsiders. However, her family see a different side to her. She wonders whether it is good for her to pretend to be well in front of others.

Age at interview 45

Gender Female

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Anne feels embarrassed to go to the doctor. She finds having multiple health conditions depressing and humiliating. She tries to console herself by imagining people worse off.

Age at interview 79

Gender Female

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These issues were important as they were linked to people’s use of health services, or support groups, and whether they could get assistance from others as opposed to struggling to cope alone (see also ‘Peer support‘). All the people that we interviewed were engaged with health services to different degrees, although Graham was an unusual case in that he had mostly refused medicines for his health conditions (rheumatoid arthritis and labyrinthitis – an ear problem that affects balance) preferring exercise programmes based on his own research. Such an account contrasts with that of people like Mohammed (see above) who instead saw his health problems largely as technical matters to be sorted out by trained health professionals. Pat, appeared wary of technological intervention and preferred to manage her conditions with diet or complementary therapies. However, in a sort of conversation with herself, she realised that her advancing age and the progressive nature of her diabetes meant that such technology might now be necessary. These issues are considered in more detail in other topics (see ‘Causes of health problems: certain and uncertain‘, ‘Prioritising multiple health problems‘ and ‘Strategies used to cope with multiple health problems‘).{

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*Barnett, K., Mercer, S.W., Norbury, M., Watt, G., Wyke, S. and Guthrie, B., 2012. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. The Lancet, 380(9836), pp.37-43.