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KEY POINTS
Multiple chronic conditions (MCCs) present challenges to older adults 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, and 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 of 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, The Screening Tool of Older Person’s Prescriptions (STOPP) / Screening Tool to Alert Doctors to Right Treatment (START), and the Medication Appropriateness Index (MAI) provide a variety of methods to assess medication appropriateness.
Little research exists to help identify the most effective means to improve health outcomes in patients with MCCs.
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 years—numbered 46.2 million, or 14.5% of the entire population, in the United States in 2014. 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 aged <65 years, 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, a 53% rate of increase from 20 years earlier, and this trend is expected to continue. Among older adults, women outnumber men by a ratio of 1.32 to 1; for those aged ≥85 years, the female-to-male ratio increases to 2.06 to 1.2
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