TY - JOUR
T1 - Decision Making for Older Adults With Multiple Chronic Conditions
T2 - Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity
AU - Boyd, Cynthia
AU - Smith, Cynthia Daisy
AU - Masoudi, Frederick A.
AU - Blaum, Caroline S.
AU - Dodson, John A.
AU - Green, Ariel R.
AU - Kelley, Amy
AU - Matlock, Daniel
AU - Ouellet, Jennifer
AU - Rich, Michael W.
AU - Schoenborn, Nancy L.
AU - Tinetti, Mary E.
N1 - Funding Information:
Financial Disclosure: Supported in part by the John A. Hartford Foundation, the Robert Wood Johnson Foundation, and the Gordon and Betty Moore Foundation. We affirm that everyone who has contributed significantly to the work has been acknowledged. Conflicts of Interest: Cynthia Boyd, MD, MPH: She received a royalty for coauthoring an article on multimor-bidity for UptoDate. Cynthia Daisy Smith, MD: Her spouse is employed by Merck and Company, and they own stock and stock options in the company; she is employed by the American College of Physicians. Fred Masoudi, MD: He has a contract through the University of Colorado with the American College of Cardiology for his role as Chief Science Officer of the National Cardiovascular Data Registry. Caroline S. Blaum, MD, MS: She has nothing to disclose. John Dodson, MD, MPH: He has no relationships with industry. Ariel R. Green, MD, MPH: She has nothing to disclose. Amy Kelley, MD, MSHS: She has nothing to disclose. Daniel Matlock, MD: He has nothing to disclose. Jennifer Ouellet, MD: She has nothing to disclose. Michael W. Rich, MD: He has nothing to disclose. Nancy L. Schoenborn, MD: She has nothing to disclose. Mary E. Tinetti, MD: She has nothing to disclose. Author Contributions: Cynthia Boyd, MD, MPH: concept and design, interpretation, preparation of manuscript.
Funding Information:
Financial Disclosure: Supported in part by the John A. Hartford Foundation, the Robert Wood Johnson Foundation, and the Gordon and Betty Moore Foundation. We affirm that everyone who has contributed significantly to the work has been acknowledged. Conflicts of Interest: Cynthia Boyd, MD, MPH: She received a royalty for coauthoring an article on multimorbidity for UptoDate. Cynthia Daisy Smith, MD: Her spouse is employed by Merck and Company, and they own stock and stock options in the company; she is employed by the American College of Physicians. Fred Masoudi, MD: He has a contract through the University of Colorado with the American College of Cardiology for his role as Chief Science Officer of the National Cardiovascular Data Registry. Caroline S. Blaum, MD, MS: She has nothing to disclose. John Dodson, MD, MPH: He has no relationships with industry. Ariel R. Green, MD, MPH: She has nothing to disclose. Amy Kelley, MD, MSHS: She has nothing to disclose. Daniel Matlock, MD: He has nothing to disclose. Jennifer Ouellet, MD: She has nothing to disclose. Michael W. Rich, MD: He has nothing to disclose. Nancy L. Schoenborn, MD: She has nothing to disclose. Mary E. Tinetti, MD: She has nothing to disclose.
Publisher Copyright:
© 2019 The American Geriatrics Society
PY - 2019/4
Y1 - 2019/4
N2 - 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.
AB - 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.
KW - AGS guiding principles
KW - multimorbidity
KW - multiple chronic conditions
UR - http://www.scopus.com/inward/record.url?scp=85062795179&partnerID=8YFLogxK
U2 - 10.1111/jgs.15809
DO - 10.1111/jgs.15809
M3 - Article
C2 - 30663782
AN - SCOPUS:85062795179
SN - 0002-8614
VL - 67
SP - 665
EP - 673
JO - Journal of the American Geriatrics Society
JF - Journal of the American Geriatrics Society
IS - 4
ER -