RT Book, Section A1 Kane, Robert L. A1 Ouslander, Joseph G. A1 Abrass, Itamar B. A1 Resnick, Barbara SR Print(0) ID 57731403 T1 Chapter 4. Chronic Disease Management T2 Essentials of Clinical Geriatrics, 7e YR 2013 FD 2013 PB The McGraw-Hill Companies PP New York, NY SN 978-0-07-179218-9 LK accessmedicine.mhmedical.com/content.aspx?aid=57731403 RD 2024/03/29 AB Geriatrics can be thought of as the intersection of gerontology and chronic disease management (Kane, Priester, and Totten, 2005). At a time when medical care in general is awakening to the importance of good chronic disease care, geriatrics has been doing it for years. Many of the principles of geriatrics are basically those of good chronic care. Chronic disease management has two basic components. The first aims at preventing catastrophes (ie, emergency room visits and hospitalizations) by proactively monitoring patients' conditions and intervening at the first sign of a change in the clinical course. Ideally these interventions prevent some hospitalizations, primarily by providing more effective primary care that prevents the event, but secondarily by managing crises, when they occur, without hospitalization. Figure 4-1 illustrates the paths to chronic disease catastrophe. Multimorbidity is associated with polypharmacy, which, in turn, can lead to iatrogenic complications. The second basic component is palliative care. We tend to associate this type of care with end-of-life care, but its principles can be applied much more broadly.