Volume 67, Issue 4 p. 665-673
Special Article

Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity

Cynthia Boyd MD, MPH

Cynthia Boyd MD, MPH

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

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Cynthia Daisy Smith MD

Cynthia Daisy Smith MD

American College of Physicians, Philadelphia, Pennsylvania

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Frederick A. Masoudi MD, MSPH

Frederick A. Masoudi MD, MSPH

Department of Medicine (Cardiology), University of Colorado Anschutz Medical Campus, Aurora, Colorado

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Caroline S. Blaum MD, MS

Caroline S. Blaum MD, MS

Department of Medicine, New York University School of Medicine, New York, New York

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John A. Dodson MD, MPH

John A. Dodson MD, MPH

Department of Medicine, New York University School of Medicine, New York, New York

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Ariel R. Green MD, MPH

Ariel R. Green MD, MPH

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

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Amy Kelley MD, MSHS

Amy Kelley MD, MSHS

Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York

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Daniel Matlock MD, MPH

Daniel Matlock MD, MPH

Department of Medicine (General Internal Medicine), University of Colorado School of Medicine, Denver, Colorado

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Jennifer Ouellet MD

Jennifer Ouellet MD

Department of Internal Medicine, Yale School of Medicine, Yale School of Public Health, New Haven, Connecticut

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Michael W. Rich MD

Michael W. Rich MD

Department of Internal Medicine, Washington University School of Medicine, St Louis, Missouri

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Nancy L. Schoenborn MD

Nancy L. Schoenborn MD

Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland

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Mary E. Tinetti MD

Corresponding Author

Mary E. Tinetti MD

Department of Internal Medicine, Yale School of Medicine, Yale School of Public Health, New Haven, Connecticut

Address correspondence to Mary E. Tinetti, MD, Yale School of Medicine, 333 Cedar St, PO Box 208025, New Haven, CT 06520. E-mail: [email protected]Search for more papers by this author
First published: 21 January 2019
Citations: 151

This framework is approved and endorsed by the American Geriatrics Society.

The American College of Physicians (ACP) endorses this article, affirming the value of the framework to the practice of internal medicine. This article is not considered ACP policy.

The American College of Cardiology supports the general principles in the document and believes it is of general benefit to its membership.

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. 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 work group 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 vs 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). J Am Geriatr Soc 67:665–673, 2019.