Health Care Professionals > Clinical Practice > Multimorbidity > Guiding Principle: IV. Clinical Feasibility Domain

Guiding Principles for the Care of Older Adults with Multimorbidity

Guiding Principle: IV. Clinical Feasibility Domain

Consider treatment complexity and feasibility when making clinical management decisions for older adults with multimorbidity.

How to Use in Clinical Practice

Goal	Tools, Resources, Strategies
Assess ability of the older person with multimorbidity to adhere to the treatment plan on an ongoing basis.	Consider: Treatment complexity increases with multimorbidity. Assessments must be individualized. Patient-centered discussions must occur in collaboration with the support system (family, caregivers). Tools available to measure medication management capacity: Medication Management Ability Assessment (MMAA) (1) Drug Regimen Unassisted Grading Scale (DRUGS) (2) Hopkins Medication Schedule (HMS) (3) Medication Management Instrument for Deficiencies in the Elderly. (MedMaIDE) (4)
Clinical feasibility and individual preferences should inform treatment choices.	Key considerations: Evidence-based medicine alone is not an adequate guide; Reliance on condition-specific guidelines results in overly complex regimens that reduce adherence.
Identify treatment complexity with patient participation.	Discuss adherence and individual preferences with the older adult with multimorbidity; Suggest education programs that teach patients self-management skills for setting realistic goals and learning how to reach them.
Address conflicts between wishes of prescribers versus those of the older adult with multimorbidity.	Discussion and re-evaluation must be ongoing; Patient education should be provided; Care transitions offer good opportunities to re-evaluate adherence and treatment complexity.

References

1. Patterson TL, Lacro J, McKibbin CL, Moscona S, Hughs T, Jeste DV.
Medication management ability assessment: results from a performance-based measure in older outpatients with schizophrenia. J Clin Psychopharmacol. 2002;22(1):11-9.
2. Edelberg HK, Shallenberger E, Wei JY. Medication management capacity in highly functioning community-living older adults: detection of early deficits. J Am Geriatr Soc. 1999;47(5):592-6.
3. Carlson MC, Fried LP, Xue QL, Tekwe C, Brandt J. Validation of the Hopkins Medication Schedule to identify difficulties in taking medications. J Gerontol A Biol Sci Med Sci. 2005;60(2):217-23.
4. Orwig D, Brandt N, Gruber-Baldini AL. Medication management assessment for older adults in the community. Gerontologist. 2006 Oct;46(5):661-8.