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Learning Objectives
Discuss implications of multiple chronic conditions for older adults and their families, the health care system, and society.
Describe one common clinical challenge in the care of a person with multiple chronic conditions.
Explain suggested approaches to the care of an older adult with multiple chronic conditions.
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Key Clinical Points
Having multiple chronic conditions is the most common condition—over 63% of Americans older than 65 years have at least two chronic medical conditions.
A challenge in providing care to older adults with multiple chronic conditions is reconciling their care with the specific clinical practice guidelines and recommendations for each of their conditions, given the increased likelihood for polypharmacy and treatment burden.
Focusing on older adults’ goals and priorities for their health care, what matters most, is key to providing care in the context of multiple chronic conditions.
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Worldwide, one in three adults has more than one chronic condition, and in the United States, more than half of older adults have three or more chronic conditions. Multiple chronic conditions present unique challenges for older adults, their families, and clinicians. Older adults with multiple chronic conditions are at greater risk of death, functional decline, diminished quality of life, and long-term care placement. Clinicians who care for adults with multiple chronic conditions have limited evidence to draw upon and are often asked to follow disease-specific guidelines with conflicting and interacting treatment plans. Providing person- and family-centered care for older adults with multiple chronic conditions is a key skill of geriatric medicine.
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This chapter will review the epidemiology and impact of multiple chronic conditions for individuals, clinicians, and society. We will also discuss common challenges that result when caring for someone with multiple chronic conditions and present a suggested approach to caring for older adults with multiple chronic conditions. We will also briefly review the evidence for interventions focused on older adults with multiple chronic conditions. Many chapters in this book focus on individual organ systems and common diseases. This introductory focus on multiple chronic conditions will provide an important context to be considered as each of the subsequent organ- and disease-specific chapters are read.
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A challenge in addressing the topic of multiple chronic conditions is the lack of consensus around terminology and definitions of the terms used. Two of the most commonly used terms or phrases to describe this issue are “multiple chronic conditions” and “multimorbidity.” While comorbidity is often used synonymously, comorbidity refers to the presence of a second condition in reference to an index condition. For example, a clinician focused on treating hypertension might consider a patient’s comorbid chronic renal disease when choosing an appropriate therapy. When older adults have multiple chronic conditions, it is disjointed and disease-centric to consider each disease as being “index” in sequence, and many times to patients there is not ...