Providing care for individuals across all age demographics is not the same. Just as providing care for infants and adolescents differs from that of an adult, so too is caring for the elderly. Geriatric medicine is not simply general medicine for those >65 years old. Aging individuals develop a constellation of medial comorbidities that involve a myriad of treatment options. Individuals pursue a wide range of treatments attempting to preserve their current level of independence, maintain a certain quality of life, and limit the potential for functional and cognitive decline. Multimorbidity, frailty, and polypharmacy seem to interlace themselves across the continuum of care when treating older adults. As the current population continues to live longer, providers need to develop a balanced approach to treating multiple comorbidities with appropriate therapeutic interventions all while preserving their patients’ current level of independence and quality of life.
ESSENTIALS OF DIAGNOSIS
Identify and incorporate patient preferences into medical decision making.
Discuss medical decision making as a balance between expected benefit, potential risk, and treatment burden.
Develop a collaborative plan with an acceptable level of complexity.
Optimize treatment benefit while reducing harm and enhancing quality of life.
More than half of older adults have three or more chronic diseases that can have a cumulative impact on their health. Individuals who are diagnosed with multiple chronic conditions, or multimorbidity, have higher rates of morbidity, mortality, polypharmacy, adverse drug effects, and institutionalization; higher healthcare costs; and a lower quality of life. Unfortunately, older individuals with multimorbidity are commonly excluded, or poorly represented, in clinical trials and observational studies. This makes data analysis and clinical recommendations difficult to interpret for these patients. Moreover, most practice guidelines only focus on the management of an isolated disease. Older adults with multimorbidity are heterogeneous in terms of illness severity, functional status, prognosis, personal priorities, and risk of adverse events even when diagnosed with the same pattern of conditions. One of the unique challenges in providing quality care to older adults is the interpretation of clinical trials and guideline recommendations and translating those results into a treatment plan that is acceptable for each patient. Developing a treatment plan for multimorbidity patients involves five key elements: establishing patient preferences; reviewing pertinent literature; determining the disease prognosis; constructing a management plan; and optimizing quality of life.
Establishing Patient Preferences
Older individuals with multimorbidity face many more treatment decisions than their peers without such medical complexity. There is an ever-growing number of clinical guidelines, all directed to improve the outcome of one specific disease state. Unfortunately, limited data are available to guide the management of several disease states coinciding with one another, and providers who simply adhere to the guidelines may not adequately account for individual patient preferences. Those with multimorbidity should evaluate and prioritize treatment options within the constructs of personal and cultural desires. Some decisions ...