Patient‐Centered Care for Older Adults with Multiple Chronic Conditions: These are the Polypathological Patients!

Abstract

We read with interest the article of the American Geriatrics Society Expert Panel (AGSPE), describing patient-centered care for older adults with multiple chronic conditions (PMCs).1Within the population of PMCs, polypathological patients (PPs) stand out. This new notion has been introduced in the management of PMCs, arising from the needs of clinicians to approach the problems of PMC. PMCs are considered PPs when they have chronic diseases from two or more of eight predefined categories.2 These categories were established using criteria of established organ failure (independent of the primary disease), frequent chronic conditions with high mortality or the potential to become unstable, or frequent comorbidities when mental or functional impairment thresholds were definitively reached.2 The PPs constitute a homogenous population in terms of advanced age, complexity, high mortality, limited functionality, and vulnerability.2-4 These individuals probably reflect the same population that the AGSPE calls “older adults with multiple chronic conditions.” The homogeneity among these characteristics makes it clear that this new patient-centered notion of PP is solid and will make it possible to establish comprehensive intervention strategies designed for the main PP healthcare problems, as the expert panel suggests.1 This approach will become a cornerstone in the near future of most healthcare systems, because the effect of this population is not only qualitative, but quantitative as well. Hospital-based PP data from Andalusia (a region of southern Spain with 8,424,102 inhabitants) from 2000 to 2010 are detailed in Table 1 using the discharge information of the Minimum Basic Dataset from 33 Andalusian hospitals. Ten percent of the 6,286,704 discharges were PPs, with a continuous increase of this population over the study period.5 This increase was similar in medical and surgical Diagnosis-Related Groups (a system to classify hospital cases into one of originally 467 groups, to identify the “products” that a hospital provides), with a parallel increasing trend in discharges of older adults. Our data are concordant with those obtained in primary care settings 6 and reflect this emergent epidemiological–clinical paradigm to which clinicians, investigators, healthcare systems, and medical education institutions must attend. This is not an epidemic, but rather, at least in part, a social achievement as a result of previous generations' efforts, albeit an achievement that requires a deep adaptation of global healthcare systems. PP discharges, n (%) ≥3 categoriesaa ≥3,4, or 5 definitory categories of polypathological patients, this reflects the increasing complexity and disease's burden. , n (%) ≥4 categoriesaa ≥3,4, or 5 definitory categories of polypathological patients, this reflects the increasing complexity and disease's burden. , n (%) ≥5 categoriesaa ≥3,4, or 5 definitory categories of polypathological patients, this reflects the increasing complexity and disease's burden. , n (%) Conflict of Interest: The authors have no conflicts of interest to report. Author Contributions: All authors contributed substantially to the work. Sponsor's Role: No sponsor.