Addressing the current challenges for the delivery of holistic care

Abstract

Contemporary challenges for holistic care include frailty and ageing, multimorbidity, polypharmacy, caregiver involvement, palliative and supportive care, cultural and socioeconomic issues, and gender inequalities. Frailty is a growing health problem among older people, especially women, and linked with an increased risk in mortality, disability, and cognitive decline. Patients with cardiovascular disease (CVD) often present with other comorbidities such as diabetes, obesity, cancer, depression, arthritis, frailty, and cognitive impairment, which require a tailored ‘person-centred’ holistic approach using skilled clinical judgement and good communication and should draw upon a range of resources, including informal carers, friends, and family, who often provide considerable support to people with multimorbidity. Polypharmacy, the concurrent use of multiple medications by a person, is a growing issue, especially among older people with multimorbidity. Problematic polypharmacy occurs where the benefits of one or more of these medicines are not realized, patients experience inappropriate or avoidable adverse drug reactions, or patients are non-adherent. Regular medicines review, evaluation of adherence, and appropriate deprescribing are essential. Many patients with advanced CVD and serious symptoms require palliative care which should be integrated with usual cardiovascular care from diagnosis. Cultural and socioeconomic issues are increasingly being recognized as important determinants of the cause and outcome of CVD and should be considered in any intervention, such as health behaviour change, when holistically assessing a patient with CVD. Females with CVD should be provided with equal access to care, a prompt diagnosis, and treatments based on the guidelines and recommendations at the same rate and intensity as their male counterparts.