How to Manage Multiple Health Problems

Overview

Published: 10/22/2012

by Carrie Steckl, Ph.D.

Photos

Harriet is beginning to worry about her husband, Stanley, who now struggles with arthritis and chronic obstructive pulmonary disease in addition to the diabetes and heart disease he has lived with for years. Both in their 80s, Harriet feels overwhelmed by the number of medications Stanley is taking (upwards of 12 now) as well as the complicated treatment regimen his doctor has prescribed. She feels like they are dealing with each health condition separately instead of treating Stanley as a whole person. He experiences too many side effects, and she is exhausted from trying to juggle the load.

 

If this sounds familiar, you are not alone: the majority of older adults live with three or more chronic illnesses. And while the medical community has been quite diligent about creating detailed clinical guidelines to effectively manage the treatment of these conditions, we have a problem.

 

You see, each set of clinical guidelines lives in its own vacuum, which means that doctors follow them that way, too. When diseases are treated separately within the same person, complications – and even harm – can result. For instance, if you have a loved one with arthritis and dementia, chances are that heavy-duty pain killers such as opioids have been prescribed to treat the arthritis pain. But opioids can worsen cognition, which may not be desirable given your family member’s dementia diagnosis. Yet the doctor may not consider this if the arthritis guidelines are viewed separately from the dementia guidelines.

 

Luckily, members of the American Geriatrics Society began to realize the problems inherent in this “single-disease” focus. They began to explore ways to improve the treatment of older adults by gaining a better understanding of how to treat a person with multiple health problems. And through those discussions, they arrived at a very important realization: that older adults and their caregivers should have a say in how those multiple conditions are treated.

 

That’s right – you have a voice! Your values and preferences should count in matters as complex and important as how to manage a loved one’s multiple health challenges. Your family member might not want to take a drug that has horrible side effects, even if that means he may not live quite as long. And that’s his right to express those wishes and to collaborate with the doctor about alternative treatment protocols.

 

To help families work with their doctors to manage multiple health problems, the American Geriatrics Society developed a tip sheet called, “Living with Multiple Health Problems: What Older Adults Should Know.”  The tips include:

 

  • Obtain as much information as possible about all treatment options available.
  • Make sure your health care providers are aware of – and understand – your health care priorities.
  • Tell the doctor if the treatment plan is too difficult to manage or if a particular treatment doesn’t seem to be working.
  • Weigh the benefits and risks of each treatment, and consider maximizing treatments that have the fewest side effects.

 

The tips are common sense, but they needed to be explicated as a way of empowering older adults and their caregivers to play a more active role in their medical care. You are encouraged to take stock of your loved one’s current situation and have discussions – both with your family member and the medical team – about ways to improve quality of life, both now and in the future.