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J Am Geriatr Soc. 2019 Jan 21. doi: 10.1111/jgs.15809. [Epub ahead of print]

Framework for Decision-making for Older Adults with Multiple Chronic Conditions: Executive Summary of Action Steps for the AGS Guiding Principles on the Care of Older Adults with Multimorbidity.

Author information

1
Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
2
American College of Physicians, Philadelphia, PA.
3
University of Colorado Anschutz Medical Campus, Aurora, CO.
4
Department of Medicine, New York University School of Medicine, New York, NY.
5
Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
6
University of Colorado School of Medicine, Denver, CO.
7
Department of Internal Medicine, Yale School of Medicine, Yale School of Public Health, New Haven, CT.
8
Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO.

Abstract

Caring for older adults with multiple chronic conditions (MCCs) is challenging. The American Geriatrics Society (AGS) previously developed The AGS Guiding Principles for the Care of Older Adults with Multimorbidity using a systematic review of the literature and consensus (Table 1). The objective of the current work was to translate these principles into a framework of Actions and accompanying Action Steps for decision-making for clinicians who provide both primary and specialty care to older people with MCCs. A workgroup of geriatricians, cardiologists, and generalists: 1) articulated the core MCC Actions and the Action Steps needed to carry out the Actions; 2) provided decisional tips and communication scripts for implementing the Actions and Action Steps, using commonly encountered situations: 3) performed a scoping review to identify evidence-based, validated tools for carrying out the MCC Actions and Action Steps; and 4) identified potential barriers to, and mitigating factors for, implementing the MCC Actions. The recommended MCC Actions include: 1) Identify and communicate patients' health priorities and health trajectory; 2) Stop, start, or continue care based on health priorities, potential benefit versus harm and burden, and health trajectory; and 3) align decisions and care among patients, caregivers, and other clinicians with patients' health priorities and health trajectory. The tips and scripts for carrying out these Actions are included in the full MCC Action Framework available in the supplement (www.GeriatricsCareOnline.org). This article is protected by copyright. All rights reserved.

KEYWORDS:

AGS Guiding Principles; multimorbidity; multiple chronic conditions

PMID:
30663782
DOI:
10.1111/jgs.15809

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