Multiple Chronic Conditions (MCC)
Chronic conditions such as diabetes, arthritis and hypertension are common, expensive, and increasing (Mokdad, 2000).The number of people suffering from MCC (two or more chronic conditions) is increasing nation-wide and especially prevalent in adults over the age of 65. Approximately 62% of older adults nationally suffer from multiple chronic conditions (Anderson et al., 2004). This rate increased by 8% from 2000-2010 (CDC, 2012). In Illinois, the rates are considerably higher, with 77.5% of older adults reporting two or more chronic conditions (Amerson et al, 2015). Data from the Illinois Cook County Health System indicates that rate of MCC is rising by 1-2% per year. (Cook County Health and Hospitals System, unpublished data).
In the context of MCC, geriatric syndromes (falls, malnutrition, disability, frailty, and increased dependence), are common and lead to considerable personal suffering (CMS, 2012; Fried et al., 2001; USDHHS, 2010). MCC are associated with more rapid health decline and both decreased quality of life and psychological well-being (Fortin et al., 2006). MCC also negatively affect the health care system due to associations with increased emergency room visits, hospital stays, and post-operative complications, as well as fragmented or disorganized care (Fortin et al., 2007). In all, MCC explain 84% of national health care spending (Yoon et al., 2014; USDHHS, 2010).
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- Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians: American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. J Am Geriatr Soc 2012.
- Minimizing inappropriate medications in older populations: a 10-step conceptual framework. Scott IA, Gray LC, Martin JH, Mitchell CA. Am J Med. 2012;125(6):529.
- The increasing burden of harm resulting from the use of multiple drugs in older patient populations represents a major health problem in developed countries. Approximately 1 in 4 older patients admitted to hospitals are prescribed at least 1 inappropriate medication, and up to 20% of all inpatient deaths are attributable to potentially preventable adverse drug reactions. To minimize this drug-related iatrogenesis, we propose a quality use of medicine framework that comprises 10 sequential steps: 1) ascertain all current medications; 2) identify patients at high risk of or experiencing adverse drug reactions; 3) estimate life expectancy in high-risk patients; 4) define overall care goals in the context of life expectancy; 5) define and confirm current indications for ongoing treatment; 6) determine the time until benefit for disease-modifying medications; 7) estimate the magnitude of benefit versus harm in relation to each medication; 8) review the relative utility of different drugs; 9) identify drugs that may be discontinued; and 10) implement and monitor a drug minimization plan with ongoing reappraisal of drug utility and patient adherence by a single nominated clinician. The framework aims to reduce drug use in older patients to the minimum number of essential drugs, and its utility is demonstrated in reference to a hypothetic case study. Further studies are warranted in validating this framework as a means for assisting clinicians to make more appropriate prescribing decisions in at-risk older patients.
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