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Multimorbidity and Patient-Centered Care
Multimorbidity and Patient-Centered Care in the Older Adult
Older adults commonly have multiple chronic conditions or diseases. The clinician is often required to prioritize and balance competing priorities to provide care to these individuals that is in accordance with patient and caregiver values, preferences, and goals. The American Geriatrics Society issued Guiding Principles for the Care of Older Adults with Multimorbidity in 2012. This document is a key resource in providing care to these older adults.
Steinman, MA, Hanlon JT. Managing Medications in Clinically Complex Elders “There’s Got to Be a Happy Medium”. JAMA 2010;304(14):1593-1601. (open access article)
Excerpt from above article: “The task for the clinician is not to determine whether too many or too few medications are being taken, but to determine if the patient is taking the right medications—tailored to the patient's individual circumstances, including his or her constellation of comorbidities, goals of care, preferences, and ability to adhere to medications.”
Reuben DB. Medical Care for the Final Years of Life: “When You’re 83, It’s Not Going to Be 20 Years”. JAMA 2009;302(24):2686-2694.
Excerpts: “To help Mr. Z remain independent for as long as possible, recommended care should be based on evidence whenever possible. For individuals of Mr. Z’s age and older, however, a conventional evidence-based approach is modified by 3 important caveats: prognosis, insufficient evidence, and patient goals and preferences.”
“In this phase, the evidence for many decisions may not fit the individual patient’s specific clinical situation or unique cluster of medical and social issues. Hence, the physician must rely on experience, knowledge, and clinical judgment. This combination of the science, wisdom, and skill of medicine is the key to providing the best care for older patients in their final years of life.”
Person-Centered Care: A Definition and Essential Elements, 2015. American Geriatrics Society - open access. An expert panel convened by the American Geriatrics Society released findings from a project defining “person-centered care.” Based on a comprehensive literature review and qualitative research, the panel describes an approach that puts individual values and preferences at the heart of care decisions, measuring success by attention to health and life goals in addition to traditional clinical outcomes.