By Cynthia Boyd
A new report issued by the American Geriatrics Society (AGS) outlines how clinicians can tailor care to better meet the unique needs older adults with multimorbidity. More than half of adults 65 and older have at least three chronic conditions, such as heart disease, diabetes, and arthritis.
Entitled Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society, the new report was published in today’s early, online edition of the Journal of the American Geriatrics Society (JAGS) and is available at www.americangeriatrics.org, in conjunction with a longer version of the documents with more complete references. A wealth of related information, tips, and tools for both clinicians and the public are also available on the AGS website.
To help both clinicians and patients make complex treatment decisions, the expert panel that developed the report has outlined five essential elements, or guiding principles, for quality care for older adults with multimorbidity:
- Preferences: Elicit and incorporate patient preferences* into medical decision-making for older adults with multimorbidity.
By using the term “patient” preferences, we aim to keep the patient central to the decision-making process while recognizing that family and social supports play a vital role in management and decision-making whether or not cognitive impairment is present.
- Interpreting the evidence: Recognizing the limitations of the evidence base, interpret and apply the medical literature specifically to older adults with multimorbidity.
- Prognosis: Frame clinical management decisions within the context of risks, burdens, benefits, and prognosis (e.g. remaining life expectancy, functional status, quality of life) for older adults with multimorbidity.
- Clinical Feasibility: Consider treatment complexity and feasibility when making clinical management decisions for older adults with multimorbidity.
- Optimizing Therapies and Care Plans: Utilize strategies for choosing therapies that optimize benefit, minimize harm, and enhance quality of life for older adults with multimorbidity.
The report also describes the urgent need for research to develop and implement evidence-based practices for each of these areas.
Cynthia Boyd, MD MPH
Associate Professor of Medicine
Division of Geriatric Medicine and Gerontology
Johns Hopkins University School of Medicine