Would you rather breathe or see?

That’s the question put to my mom by her doctor regarding the medication she takes to combat her COPD and breathing problems. Unfortunately, a nasty side effect of her inhaler has caused her to develop glaucoma and she’s now on medicine for that. Hopefully, the new medication will slow her eyesight deterioration enough to allow her to keep driving and watching movies. And hopefully, her arthritis medication won’t add to her problems.

While this particular trade-off is fairly straightforward (what’s the use in seeing, if you are dead?), the more than 50 percent of older adults in the United States with more than three chronic conditions often face a very complex task in making decisions about their treatments. It’s not easy for clinicians who care for these patients, either. Multiple health problems lead to multiple medications, which can interact dangerously with each other. Most clinical guidelines focus on a single disease and most clinical trials on which guidelines are based haven’t included older adults.

Trying to take the most aggressive approach to treating all conditions may lead to a regimen so burdensome that it isn’t followed at all. Fortunately, the American Geriatrics Society (AGS) has just released new resources to help both providers and patients as they grapple with multiple chronic conditions, or “multimorbidity.”

The AGS convened an expert panel to develop a set of guiding principles to help clinicians, people with these conditions, and their caregivers navigate complex treatment decisions associated with multimorbidity. The principles are broken down into the following categories:

• Considering patient preferences
• Considering available medical research
• Making treatment decisions based on possible risks, benefits and prognosis
• Assessing treatment options, and
• Optimizing treatments and care plans

Click above for a printable PDF of the Multimorbidity Pocket Card.

For providers, along with the full-length and summary papers published in the Journal of the American Geriatrics Society, the AGS also created a very clinician-friendly pocket card, and has made slide sets available on the topic.

The AGS’s Foundation for Health in Aging has taken this information and put it into patient-oriented materials. They have a very nice tip sheet called Living With Multiple Health Problems: What Older Adults Should Know. The AGS is trying to raise awareness of these issues and resources more broadly through a media campaign, and you can join the conversation on Twitter with the hashtag #3orMore.

We think this work is vitally important. We have included multiple chronic conditions as one of the priority areas to tackle in the Hartford Foundation’s new strategic plan and future grantmaking. We see it as a high-leverage opportunity to make improvements in our health care system, particularly in special populations with high rates of multimorbidity, such as those eligible for Medicare and Medicaid (see Going Where the Money Is by Chris Langston ). The U.S. government agrees and launched a national initiative out of the Department of Health and Human Services two years ago on multiple chronic conditions.

There is much more to do, particularly as we continue to redesign care delivery and payment using quality measurements as our guideposts. These changes are happening quickly, and we need to think carefully about what kind of care will be incentivized and whether it is in the best interests of older adults with complex multiple conditions. Providers need even more sophisticated tools to help them and their patients in clinical decision making.

And my mom—and all of those older adults facing similar difficult decisions—need better and clearer guidance as they weigh their options, manage their conditions, and try to live the best life they can. We owe them no less.

This is the first in an occasional series of Tools You Can Use on the Health AGEnda blog.