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Review
. 2020 Oct 28;5(4):85.
doi: 10.3390/geriatrics5040085.

Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice

Pritti Aggarwal  1   2   3 , Stephen J Woolford  4 , Harnish P Patel  4   5   6
Affiliations
Review

Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice

Pritti Aggarwal et al. Geriatrics (Basel). .

Abstract

Multi-morbidity and polypharmacy are common in older people and pose a challenge for health and social care systems, especially in the context of global population ageing. They are complex and interrelated concepts in the care of older people that require early detection and patient-centred shared decision making underpinned by multi-disciplinary team-led comprehensive geriatric assessment (CGA) across all health and social care settings. Personalised care plans need to remain responsive and adaptable to the needs and wishes of the patient, enabling the individual to maintain their independence. In this review, we aim to give an up-to-date account of the recognition and management of multi-morbidity and polypharmacy in the older person.

Keywords: age-friendly care; comprehensive geriatric assessment; deprescribing; frailty; multi-morbidity; patient priority care; polypharmacy.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

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Figure A1
Flow chart for article selection.
Figure 1
Figure 1
Principles of comprehensive geriatric assessment (CGA). CGA is an evidence-based multidimensional and interdisciplinary assessment of medical, psychological, and functional capabilities aimed at developing an integrated plan for treatment and care. CGA is associated with favourable clinical and health care outcomes. The core principles of CGA include comprehensive history taking and multidisciplinary led assessment, culminating in goals for current and future management. They encompass the 5 tenets of age-friendly care: 1. what matters most to the patient, 2. multi-complexity management, 3. medication management, 4. mentation, and 5. mobility. These principles can be applied across any health and social care setting and have been shown to be highly effective in the management of older people living with frailty and multi-morbidity. The process is iterative and the key to its success is timely review and coordination so that the care plan generated from a CGA remains responsive to the patient’s needs [24,46,66,69,70].
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