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Comorbidity

What we know

Prevalence of many diseases increases with age so many older people have more than one illness (comorbidity). Comorbidity is associated with poorer quality of life and increased risk of frailty. Frailty with ageing and comorbidity can make prognostication can become difficult. Care planning discussions may be beneficial in recognising the need for palliative care, and reducing burdensome medication and treatments. Prioritising treatments requires an assessment across all health issues with respect for a person’s wishes.

What can I do?

Consider flagging older adults with comorbidities and multiple medications for a review of polypharmacy.

Liaise with the family and the person to find out their priorities for health care and suggest a family meeting to formalise these preferences.

Direct families to palliAGED website – Families for further information on care planning.
 

 

What can I learn?

Read this article from the Australian Family Physician (2012): Appropriate prescribing and deprescribing in robust and frail older patients.

STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation. Lavan AH, Gallagher P, Parsons C, O’Mahony D.  Age and ageing. 2017 Jan 23.
 
Watch the presentation from Dr Polly Edmonds: Managing Comorbidities at the End of Life (3MB pdf). 

Predicting prognosis within a Palliative Approach Framework (445kb pdf) from the PA Toolkit.

Read Australian Guidelines: Managing comorbidities and deprescribing in palliative care - Therapeutic Guidelines - Palliative care: version 4 (subscription required).

Read American Guidelines: American Geriatrics Society, (2012), Guiding principles for the care of older adults with multimorbidity: An approach for clinicians.
 

 

What can my organisation do?

Implement screening of polypharmacy for older adults in Residential Aged Care (RAC) with multimorbidity using:

 

Page updated 24 May 2017