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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."


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

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. Accessed May 23, 2014.

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 past ...

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