An expert group of geriatricians, cardiologists and general physicians has identified an action framework and a set of action steps to guide care for older adults with multiple chronic conditions. The steps are based on the American Geriatrics Society’s Guiding Principles for the Care of Older Adults with Multimorbidity and are published at a time when it is acknowledged that there are conflicting recommendations on the issue.
The action steps include:
- Identify and communicate health priorities and trajectory: this includes using a validated approach to identify patients’ health priorities and assessing and communicating patients' health trajectory.
- Stop, start or continue care based on health priorities, potential benefit versus harm and burden and health trajectory: medications deemed inappropriate should be stopped and treatments that are no longer indicated should be discontinued, whereas medication cascades should be avoided.
- Align decisions and care among patients, caregivers and other clinicians with patients' health priorities and health trajectory: this includes affirming shared understanding of patients' health priorities and the information that informs decision-making, as well as aligning decisions when patient and clinician have different perspectives or when clinicians have different perspectives or recommendations.
The action steps are published in the Journal of the American Geriatrics Society.