Author: Durso, Samuel C

Source: Aging Health, Volume 3, Number 6, December 2007 , pp. 715-721(7)

Publisher: Future Medicine

Abstract:

Prioritizing care for older adults with multiple comorbid conditions is a challenging act of clinical judgment owing to the multidimensional and dynamic nature of each patient''s health status. This clinical process is analogous to working within a complex adaptive system, where an intervention or change in one condition can produce unexpected outcomes. Except for decisions characterized by a high degree of professional agreement (e.g., influenza vaccination), most medical decisions affecting older adults occur within a ``zone of complexity'' characterized by imperfect agreement regarding best practices and outcomes. An example is setting individual glycemic targets. Decisions within this zone are at best bounded by a few principles: first, ascertain the patient''s preferences and goals; second, determine health status by identifying relevant comorbid conditions, function and frailty; third, consider the risks and benefits, and estimate the likelihood that any intervention will achieve the patient''s healthcare goals within a time frame meaningful to the patient; and last, prioritize these through negotiation with the patient to achieve a plan that is workable within the context of the patient''s life

Keywords: clinical guidelines; clinical judgment; complex adaptive systems; multiple comorbid conditions; older adults; prioritizing care; quality indicators

Document Type: Research article

DOI: http://dx.doi.org/10.2217/1745509X.3.6.715

Affiliations: 1: Johns Hopkins School of Medicine, Division of Geriatric Medicine and Gerontology, John R Burton Pavilion, 5505 Hopkins Bayview Circle, Baltimore, MD 21224, USA., Email: sdurso@jhmi.edu

Publication date: 2007-12-01

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• Aging Health leading coverage of current and emerging topics relating to the safe and effective management of therapy in the elderly, all subject to rigorous peer review. The journal focuses on the most important advances and highlights their relevance in the clinical setting. The journal has been designed to deliver essential concise information in an easily assimilable format - vital for the increasingly time-constrained professional.
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