Stepping Up Geriatric Care When Multiple Problems Present

More than half of adults 65 years and older have at least 3 chronic conditions, such as heart disease, diabetes mellitus, arthritis, high blood pressure, and Alzheimer disease, according to the American Geriatrics Society (AGS). For physicians caring for older patients who have multiple health problems, following standard clinical guidelines for each individual condition may hurt more than help, a recent AGS report, “Patient-Centered Care for Older Adults with Multiple Chronic Conditions: A Stepwise Approach,” concluded. Essential elements on how clinicians can tailor care to better meet these patients’ unique needs were outlined.

If a clinician caring for an older adult with several common conditions were to prescribe the medications that standard guidelines recommend for each condition individually, the patient could take too many medications and risk drug interactions and adverse effects, it was noted. To help clinicians and patients make sound treatment decisions, the report offered the following guiding principles:

1. Consider patient preferences. Help patients and their family or friends understand their care options. Once they do, work together to make decisions consistent with the patient’s preferences.

2. Interpret medical research and evidence. Look at the available research to make sure that a given treatment approach is suitable for a specific patient and determine whether there is much uncertainty about whether it is likely to work for older adults with multiple health conditions. When choosing treatments, focus on the outcomes that are most important to the patient.

3. Make clinical decisions in the context of risks, benefits, burdens, and prognosis. Discuss with the patient what is likely to happen with and without each treatment option. Try to determine, and share with the patient, how long it probably will take to benefit from certain treatments.

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

5. Optimize treatments and care plans. Try to maximize benefits and minimize risks from treatments within an overall treatment plan. To reduce potentially harmful drug interactions and other adverse effects, prescribe nondrug treatments whenever appropriate.

More flexible approaches to care are essential for the older patient population, it was noted. The report was published in an online edition of the Journal of the American Geriatrics Society.