When Multiple Conditions Strike – Five Important Steps to Improving Care for Older Adults

When caring for older patients with multiple health problems, following standard clinical guidelines for each individual condition may hurt more than help, according to a new report by the American Geriatrics Society (AGS) that outlines how clinicians can tailor care to better meet these patients’ unique needs.

More than half of adults 65 and older have at least three chronic conditions, such as heart disease, diabetes, arthritis, high blood pressure, or Alzheimer’s disease.

“Increasingly, healthcare providers are asked to follow standard clinical guidelines — recommendations for care based on research that weighs their safety and effectiveness — but these guidelines often fail to take into account the needs of older adults with multiple health problems,” explained Dr. Cynthia Boyd of the Johns Hopkins University School of Medicine, who chaired the expert panel that developed the new report with colleague Dr. Matthew McNabney, also of the Johns Hopkins School of Medicine.

McNabney noted, “if a clinician caring for an older adult with these common conditions were to prescribe the medications that standard guidelines recommend for each of these conditions individually, the patient could end up taking too many medications, and running significant risks of drug interactions and potentially harmful side effects.”

Titled “Patient-centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach from the American Geriatrics Society,” the new report was published in the online edition of the Journal of the American Geriatrics Society and is available at americangeriatrics.org.

A wealth of related resources, 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 report outlines five essential elements, or guiding principles, of quality care for older adults with multiple health problems:

• Consider patient preferences. The clinician should help patients, and sometimes their family or friends, understand their options for care. Once they understand these options, the patient and healthcare provider should work together to make decisions consistent with the patient’s preferences.

• Interpret medical research and evidence. Healthcare providers need to look at the available research to be sure a given treatment approach is suitable for a specific patient, and understand whether there is much uncertainty about whether the approach is likely to work for older adults with multiple health conditions. When deciding which treatments to choose, clinicians and patients should focus on the outcomes
that are most important to the individual patient.

• Make clinical decisions in the context of risks, benefits, burdens, and prognosis. When possible, clinicians should discuss with the patient what is likely to happen both with and without each available treatment. Among other things, healthcare providers should try to determine, and share with the patient, how long it will likely take to benefit from certain treatments. All of this is useful information for patients who are deciding which treatments are more important to them, and which are less important.

• Assess the complexity and feasibility of treatment options. Healthcare providers should keep in mind that older patients are more likely to stop following parts of treatment regimens if they are too complicated, confusing, or burdensome.

• Optimize treatments and care plans. Clinicians should try to maximize benefits and minimize risks from treatments within an overall treatment plan. Among other things, they should prescribe non-drug treatments whenever appropriate to reduce potentially harmful drug interactions and other side effects.

“These new AGS guiding principles present important information to help clinical providers integrate strategies and approaches to clarify individual patient goals, and to maximize health outcomes and quality of life for individuals with multiple chronic conditions,” noted Dr. Anand Parekh, deputy assistant secretary for Health (Science and Medicine) at the U.S. Department of Health and Human Services.

“Older patients with multiple health problems are a heterogeneous group,” said AGS President Dr. James Pacala. “Consequently, treatment options should differ from patient to patient. More flexible approaches to care are essential for this population. This report provides clinicians, patients, and families with invaluable guidance on how to individualize approaches to managing multiple health problems.” v

This article was prepared by the American Geriatrics Society, a not-for-profit organization of more than 6,000 health professionals devoted to improving the health, independence, and quality of life of all older people.