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KEY POINTS

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  • Multiple chronic conditions (MCCs) present challenges to elderly people and their healthcare providers.

  • Geriatric syndromes are not specific diseases but a constellation of symptoms common in older adults.

  • The extensive use of medications by the geriatric population increases the risk of adverse drug events (ADEs), drug-drug interactions, disease-drug interactions, food-drug interactions, and often contributes to medication nonadherence among patients.

  • Poor care coordination and insufficient communication among providers caring for a patient is a cause ADEs in older adults.

  • The prescribing cascade commonly contributes to what is referred to as polymedicine or polypharmacy.

  • Healthcare delivery for people with MCCs is often fragmented, less effective, complex as well as confusing, and more expensive.

  • As older adults move from one healthcare setting to another they are vulnerable to consequences of poor communication between settings and between providers.

  • Many of the existing clinical practice guidelines do not take into consideration populations with physical disability, multiple medications, and multiple comorbidities, all of which are commonly seen in older adults.

  • Providing care to older adults with complex conditions requires a specific skill set and knowledge about geriatric pharmacotherapy.

  • The Beers Criteria, STOPP/START, and the Medication Appropriateness Index (MAI) provide a va-riety of methods to assess medication appropriateness.

  • Little research exists to help identify the most effective means to improve health outcomes in pa-tients with multiple chronic conditions.

  • Patients with complex multiple conditions need a team approach to improve and coordinate care.

  • Caregiver burden describes the toll on people providing care and has been defined as "a multidimensional response to physical, psychological, emotional, social, and financial stressors associated with the caregiving experience."

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CHARACTERISTICS OF THE AGING POPULATION

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Older adults—those aged 65 and older—numbered 40.4 million, or 13.1% of the entire population, in the Unites States in 2010. In the 10 years between 2000 and 2010 the older adult population increased by 5.4 million or 15.3%, almost twice the rate of those younger than 65, and is expected to increase by 36% in the next decade (Figure 11-1).1, 2 By 2030 the number of older people is expected to be at 72.1 million—more than twice that of 2000. The 2010 US census identified 53,365 individuals aged 100 years or older, a 53% rate of increase from 20 years earlier, and this trend will continue. Among older adults, women outnumber men by a ratio of 1.32-to-1; for those 85 years and older the female-to-male ratio increases to 2.06-to-1.2

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Figure 11-1.

There will be a steep rate of increase in the older adult population over the next 25 years.

Source: Reproduced with permission from Aging. Projected Future Growth of the Older Population.

http://aoa.gov/AoARoot/Aging_Statistics/future_growth/future_growth.aspx. Accessed May 23, 2014.

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On average, a 65-year-old woman can expect to live an additional 20 years and her male counterpart another 17.3 years. Over the ...

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