Multiple chronic conditions

Caring for older adults with multiple chronic conditions can create challenging situations. For example, some treatments may be harmful to older adults who live with and manage several chronic conditions. In some cases, several treatments might be available but healthcare providers; may not know which are best for a particular individual.
In other cases, older adults and caregivers could even receive different treatment recommendations; depending on the healthcare providers who offer guidance. Most important of all, managing care for multiple chronic conditions can make it difficult; to focus on what matters most to us as individual a key priority when we think about the high-quality; person-centered care we all want and need as we age.

In 2010, the American Geriatrics Society (AGS) convened a panel of medical experts; to address how to provide the best care for older adults living with multiple chronic conditions. The panel reviewed a host of clinical studies and developed; the AGS Guiding Principles for the Care of Older Adults with Multimorbidity as a result.

Key principles

The expert panel identified five “key principles” that healthcare providers should follow to support the best care for older adults with multiple chronic conditions:
1. Include personal preferences in care decision-making. Older adults who have multiple chronic health conditions should be asked; how they wish to make medical decisions affecting their care. Whenever appropriate, caregivers and family members should also be involved in these discussions.
2. Understand the limits of evidence on treatment options. Clinicians must understand that specific, evidence-backed answers to questions about the best medical choices for individual older adults may not exist. That’s because every older adult and every health situation is unique.

Life expectancy

3. Weigh benefits versus harms. When addressing multiple chronic conditions for an older individual, clinicians must consider how a person might be burdened by one medical plan or treatment versus others. They also must weigh the benefits of treatment options, as well as information on the person’s functional status (their ability to perform daily activities such as bathing and eating), life expectancy (how long they are likely to live), and quality of life.
4. Consider if treatment is manageable. When sharing recommendations, clinicians must account for the complexity of a treatment and whether it suits an older adult’s particular situation.
5. Make the best informed choice possible. Ultimately, healthcare professionals also must try to choose therapies that have the most benefit, pose the least harm, and will work to enhance an older person’s quality of life.

These steps include:

1) Identify and communicate your health priorities.
* Health Priorities and Decision-Making. There are many reasons we might make a decision about different health tests or treatments, but the best care possible supports decisions based on our personal needs and preferences. Hence, the first step toward supporting that type of care is identifying those needs and preferences.
2) Stop, Start, or Continue Care Based on Health Priorities, Potential Benefits/Harms, and Health Trajectory.
* Understanding “Harmful Treatments” and “Medical Uncertainty.” “Do no harm” is a guiding principle for all of our health care. It’s also a principle that’s especially important for people who may be managing multiple treatment plans and how they interact (especially if they may result in unintended consequences when managed together).
3) Align Decisions and Care for Us, Our Caregivers, and Our Clinicians Based on Our Health Priorities and Health Trajectory.
* Seeking Agreement on Health Priorities & Health Information. But two critical steps for anyone living with multiple chronic conditions are (1) identifying our own health priorities and (2) getting information on how treatment options can help us achieve our health priorities.