The American Geriatrics Society (AGS) convened a panel of experts, led by Cynthia M. Boyd, M.D., M.P.H., and Matthew K. McNabney, M.D., both of Johns Hopkins University School of Medicine, that outlined steps that patients with multiple ailments and their caregivers can take to improve their care, emphasize quality of life and reduce the risk of adverse treatment side effects or interactions.
The AGS recommends following these strategies to help you and your doctor develop a customized care plan that's safe, manageable and effective:
Ask your provider to thoroughly explain your care options. He or she should give you all the information you need to carefully evaluate your choices while focusing on the outcomes that matter most to you. You may wish to include loved ones or caregivers in your decisions.
And if you later have concerns about your treatment choice or would like to try a different approach, inform your doctor. It's common for disease states and symptoms to fluctuate, so what was once a top health care priority for you may not be one now.
Explore all treatment options.
When you're coping with multiple ailments and therapies, you're more likely to be at risk for adverse effects. Make every effort to learn how one intervention affects another and any tradeoffs you may have to make between benefits and risks. Ask your doctor to explain the benefits of a treatment, or a combination of treatments, and possible adverse effects. Ask him or her to identify all potential outcomes of each treatment option you’re presented with.
Make sure you fully understand what to expect by asking these questions:
- How will treatment affect the aspects of my life that are important to me?
- Does the treatment have increased risks of disability, loss of independence or poorer quality of life?
- What would happen if I decide not to undergo treatment?
- What is my prognosis, or chance of recovery?
- How long will the treatment take to have a beneficial effect?
State your preferences.
Once you've obtained adequate information about all your potential treatment strategies, weigh each therapy's benefits against its potential side effects or interactions. You may regard the side effects to not be worth the benefits.
Also, consider that a therapy for one ailment may weaken the effects of a therapy for another. You must choose which condition you would prefer to treat most aggressively. Obviously, any illness that's an immediate threat to your life or well-being should take top priority even if it means postponing therapy for an ongoing condition.
The best care plans take into account factors such as life expectancy, ability to function and quality of life. For example, your independence may be more important to you than prolonging survival time if treatment comes with a heightened risk of disability. Understand how each option figures into your preferences and goalsthen make sure all your providers understand the outcomes most important to you.
If you're having trouble deciding your priorities, the Agency for Healthcare Research and Quality offers an online health priorities tool you can use to rate your preferences at effectivehealthcare.ahrq.gov/options/tool/.
Consider nondrug options.
Past studies have shown that the more chronic conditions a person has, the more drugs he or she is prescribed and the less likely he or she is to adhere to a drug regimen. In addition, the more drugs you take, the more apt you are to experience potentially dangerous drug interactions. Ask your doctor to suggest ways to achieve a beneficial outcome without drugs, which can range from implanting a pacemaker to physical therapy or lifestyle changes.
For example, ankles swollen from fluid buildup can be treated by elevating legs and wearing compression stockings instead of taking diuretics, which can cause side effects.
Because research about treatment effects on older adults with multiple ailments is limited, your doctor may not be able to predict exactly how an intervention or a combination of treatments will affect you. If you’re experiencing a side effect from therapy, tell your doctor.
Ask for help.
There's no doubt that managing multiple ailments can be complicated, confusing and burdensome. If treatment instructions are too difficult to follow or remember, consult your doctor. Ask him or her for simpler instructions in writing. Your doctor may also be able to consolidate complex drug-dosing schedules.
And speak up if your treatment causes a financial burden. Your doctor may be able to suggest solutions to help you overcome cost constraints.
Source: Prepared by the Editors of The Johns Hopkins Medical Letter: Health After 50