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Older Adults with Many Chronic Medical Conditions — Meeting the Challenge

As we grow older, we might expect to develop a chronic condition — such as high blood pressure or diabetes — that must be carefully managed to ensure that we remain healthy and productive. Yet increasingly, many older adults are dealing with more than one chronic condition that requires regular care — a condition called multimorbidity.

“Several decades ago, many older adults had only one chronic medical condition,” explains Christine Ritchie, MD, MSPH, director of the UAB Center for Palliative Care. “But as we’ve become more successful at extending survivability of many chronic conditions — such as heart disease and diabetes — and because our society is aging, multimorbidity is on the rise.”

In 1999, more than 60% of Medicare beneficiaries had two or more chronic conditions — and 24% of them had four or more chronic conditions. Between the years 2000 and 2020, these numbers will increase and the number of Americans with multimorbidity is expected to jump from 60 million to more than 80 million.

“Multimorbidity presents significant challenges for both patients and medical providers,” observes Dr. Ritchie. “We must focus on how we can best support patients and their families in dealing with more than one chronic medical condition. Also, it’s important that medical providers meet the challenge of providing greater continuity of care for these unique patients.”

Challenges of Multimorbidity

Dr. Ritchie explains that in general, people with multimorbidity are more likely to have a poor quality of life, higher hospital costs, and higher rates of mortality. “Having more than one chronic condition also complicates treatment options,” she says. “Most studies of medications or treatments are single-disease studies — they don’t evaluate the impact of these treatments in individuals with multimorbidity.”

For patients living with more than one chronic medical condition, navigating appointments and self-care instructions can be overwhelming. “Multimorbidity can present problems with health literacy, or understanding how you should take care of your chronic condition,” explains Dr. Ritchie. “With each new condition, a new set of self-management expectations is added. As a result, many of these patients are likely to have difficulty understanding and following their medication schedules and physician instructions.”

Some older adults with multimorbidity are also dealing with an advanced illness — a serious, incurable and progressive condition or disease (such as Alzheimer’s Disease, heart failure, or advanced lung disease). “When you combine advanced illness and multimorbidity, a significant level of complexity results,” stresses Dr. Ritchie. She explains that these patients often have:

  • Greater functional decline, and
  • Changing values (being pain-free is often more important than doing what is needed to care for the chronic conditions)
Meeting the Challenge of Providing High-Quality Care

Dr. Ritchie stresses that a primary challenge to providing care for older adults with multimorbidity is that our current healthcare delivery system is not designed to deal with this problem. “Our healthcare system is designed to deliver acute care — not provide integrated care for chronic conditions. As a result, patients with multimorbidity tend to receive fragmented care.”

UAB is currently conducting a comprehensive research effort to determine the best ways of providing high-level care to older adults with more than one chronic condition. “Research is focused on determining ways of providing greater continuity of care to these patients,” says Dr. Ritchie. “Also, we want to determine the best methods of presenting health education and self-care information so that patients can better understand their conditions and what is required to manage them successfully.”

Article last updated: April 20, 2009 2:03 PM