Managing Multiple Chronic Conditions in Older Adults

As we live longer, more and more older adults are living with multiple chronic conditions (MCC)—not just diabetes or heart disease alone, but several health problems that overlap and interact. This reality can make day-to-day life complicated, stressful, and expensive for older adults, families, and care providers.

This blog post is a plain-language summary of the educational module “Managing Multiple Chronic Conditions (MCC): Challenges in the Care of Older Adults”, created for interprofessional geriatric training.

We’ll walk through:

What MCC is and why it matters
The biggest challenges in caring for older adults with MCC
Guiding principles for better, safer care
A practical approach to care: what families, caregivers, and clinicians can actually do
How to use this information when you need it

What Are Multiple Chronic Conditions (MCC)?

The term multiple chronic conditions (MCC) usually means two or more long-term health conditions that, together, have a negative impact on a person’s health, function, or quality of life and require complex care, decision-making, and coordination.

Examples of chronic conditions include:

Diabetes
Hypertension (high blood pressure)
Heart disease
COPD or chronic lung disease
Stroke
Arthritis, osteoporosis
Depression, anxiety, dementia

For many older adults, it’s not just one disease but five, six, or more, along with multiple medications, frequent appointments, and functional challenges (falls, poor mobility, sleep problems, etc.).

The document highlights a case example: Mrs. Roberts, a 77-year-old widow with numerous chronic conditions, 21 medications, and four regular doctors. She’s trying her best, but her health care has become a full-time job.

Why MCC Matters: Prevalence & Impact

MCC is not rare. In fact, it is the norm among older adults:

Around one-quarter of U.S. adults have MCC.
Among adults aged 65–79, over one-third have multiple chronic conditions.
By age 80 and older, about 70% live with multimorbidity.

MCC is linked to:

Higher rates of hospitalization and readmissions
Greater risk of nursing home placement
Treatment complications and drug–drug interactions
Frailty, disability, and functional limitations
Lower quality of life and emotional distress
Very high health-care costs and utilization

When mental health issues like depression or anxiety are added to the mix, managing care becomes even more complex—for both patients and providers.

The Core Problem: Our System Is Built for “One Disease at a Time”

Most of modern health care operates in “disease silos.”

Guidelines focus on one condition (e.g., diabetes, heart failure, COPD) as if the person has nothing else going on.
Specialists each focus on their organ system or condition.
Treatment targets (like “ideal” blood sugar or blood pressure) don’t always make sense when someone has many conditions, limited mobility, and a shorter life expectancy.

For someone like Mrs. Roberts, following every single disease-specific guideline to the letter could mean:

Taking too many medications
Attending too many appointments
Experiencing more side effects than benefits
Feeling overwhelmed, confused, and discouraged

This is why the document argues strongly that we must move from a single-disease mindset to an MCC-oriented, person-centered approach.

Key Challenges in Managing MCC

The module identifies several major challenges:

1. Conflicting Clinical Guidelines

Each condition has its own guideline. When a person has several conditions, these guidelines:

May conflict with each other
Often ignore frailty, functional status, or life expectancy
Rarely consider the total treatment burden for the patient

This leaves clinicians and families wondering: Which guideline should we follow first?

2. Competing Priorities

For patients and families:

There’s a constant balancing act between illness burden, treatment burden, and quality of life.

For clinicians:

There’s limited time in each visit.
They must decide what matters most today: blood sugar? mood? falls? pain? family stress?

3. Polypharmacy (Too Many Medications)

Polypharmacy is extremely common in older adults with MCC:

Many take 5 or more medications, often far more.
There’s high risk of inappropriate prescriptions, drug interactions, falls, confusion, and hospitalization.
Over-the-counter drugs and herbal supplements are often not reported to providers, increasing risk.

4. Limited Evidence for Complex Patients

Most clinical trials:

Exclude older adults with multiple conditions, functional impairments, or cognitive issues.
Focus on one disease at a time.

This means that for real-world patients like Mrs. Roberts, the evidence is often weak or missing, and clinicians must rely on judgment, shared decisions, and individualization.

Guiding Principles for Better Care

The document lays out five guiding principles for managing MCC in older adults.

1. Start With Patient Preferences

Care should begin with what matters most to the patient, not just what’s on the problem list.

That includes:

Their primary concerns (pain, sleep, walking, staying at home, seeing grandchildren, etc.)
How much testing, treatment, and risk they are willing to accept
Their cultural values, lifestyle, and decision-making style

Preferences can change over time, so these conversations must be ongoing, not one-time events.

2. Recognize the Limitations of Evidence

When applying research to a patient with MCC, clinicians should ask:

Does this study actually include people like my patient?
Are the outcomes measured (e.g., lab numbers) the ones that matter to this person (e.g., function, independence, symptom relief)?
What are the harms and burdens vs. the real-world benefits?

3. Use Prognosis to Inform (Not Dictate) Decisions

Prognosis—an estimate of remaining life expectancy—helps frame decisions:

Some treatments only help if someone lives long enough to see the benefit.
For frail older adults, it may be more important to avoid side effects and hospitalization than to push aggressive long-term risk reduction.

The key is to offer to discuss prognosis, not force it, and to use it gently to guide priorities.

4. Consider Clinical Feasibility

Even the “best” treatment doesn’t help if it’s impossible to follow.

Clinicians should ask:

Can this person realistically manage this many medications and appointments?
Do they have help at home, transportation, language support, or cognitive capacity?
How can we simplify the regimen while still protecting health?

5. Optimize Therapies and Minimize Harm

This often means:

Stopping or reducing medications that are no longer beneficial
Avoiding treatments with long time to benefit in patients with limited life expectancy
Choosing options that improve function and quality of life, even if they’re less aggressive on the disease markers

A Practical Approach to Care: What Good MCC Care Looks Like

The document suggests three pillars for managing MCC in older adults:

1. Holistic, Patient-Centered Care

Care teams should:

Look at all conditions together, not in isolation.
Explore what the older adult wants from treatment (e.g., “I want to stay independent,” “I want fewer hospital visits”).
Address how conditions and treatments interact and affect daily life.

Examples:

Combining visits or tests where possible
Reducing unnecessary appointments
Sharing a unified care plan with all clinicians and caregivers

2. Assess Illness & Treatment Burden

This means systematically checking:

Symptoms and disease control (pain, breathlessness, mood, sleep)
Frailty, function, and risk of falls
Mental health (e.g., PHQ-9 for depression), cognitive status (e.g., MoCA), and ADLs/IADLs
Medication list for potential harm and redundancy

A key insight: “Doing less may be best.”

Sometimes the most compassionate, effective care is to simplify: fewer medications, fewer procedures, more focus on comfort, mobility, social connection, and emotional well-being.

3. Ensure Care Coordination & Continuity

Older adults with MCC need:

A clearly identified primary care provider or lead clinician
One or more team members responsible for care coordination
Clear communication across specialists, hospitals, rehab, home care, and family
Planned follow-up and instructions on how to access care during changes or crises

Innovative care models like PACE, GRACE, Guided Care, and Patient-Centered Medical Homes are examples of systems designed to support exactly this kind of coordinated MCC care.

How Families, Caregivers & Clinicians Can Use This Information

When you’re facing a situation like Mrs. Roberts—an older adult with multiple conditions, many prescriptions, and frequent appointments—this framework can help you regain a sense of control.

Here’s how to use it in real life:

For Families & Caregivers

Bring a complete medication list (including OTC and supplements) to every appointment and ask:
“Which of these still helps? Which could we lower or stop?”
Ask the clinician:
- “What are the top 2–3 priorities for Mom’s health right now?”
- “Are there safer, simpler ways to treat this?”
- “What would happen if we focused more on comfort and function than perfect lab numbers?”
Share the older adult’s own goals:
- “She mainly wants to avoid the hospital.”
- “He wants enough energy to attend church or see his grandchildren.”

For Older Adults

Don’t be afraid to say:
- “This is too much for me to manage.”
- “I’m more worried about my balance and falls than my cholesterol.”
Ask your provider to explain benefits vs. risks for each major treatment.
Ask if there is a way to simplify your regimen:
- Fewer medication times per day
- Combination pills (if appropriate)
- Fewer monitoring visits or tests

For Health-Care Providers

Use the five guiding principles as a mental checklist during visits.
Make time—even just a few minutes—to ask:
- “What is your biggest concern today?”
- “What matters most to you in the coming months?”
Prioritize medication review at regular intervals for patients with MCC.
Involve the interprofessional team:
- Pharmacists for deprescribing and medication reconciliation
- Social workers/case managers for support and navigation
- Physical/occupational therapists for function and fall prevention
- Mental health professionals for depression, anxiety, and caregiver stress

When to Revisit This Guide

You can return to this framework whenever:

A new condition is diagnosed
There’s a major change in function (e.g., new falls, confusion, weight loss)
You notice medication overload or side effects
There are repeated hospitalizations or ER visits
The older adult or family expresses: “This is just too much.”

At those moments, it’s a good time to pause, step back, and ask:

“Are we treating the person, or just treating the diseases?”

Using a structured, patient-centered approach to MCC can help real people like Mrs. Roberts feel safer, more supported, and more in control—as they navigate the very real challenges of aging with multiple chronic conditions.

Source
Based on the educational slide set “Managing Multiple Chronic Conditions in Older Adults – Phase 3 (One Slide Per Page)” (interprofessional geriatric training module).

Disclaimer
This blog post is for general information and education only. It does not provide medical advice, diagnosis, or treatment and should not replace consultation with a licensed physician or qualified health professional. Always talk with your health-care provider about your specific medical conditions, treatment options, and any changes to your medications or care plan. If you are experiencing a medical emergency, call 911 or your local emergency number immediately.

Daily Living Tips, Senior Education

Managing Multiple Chronic Conditions in Older Adults: A Practical Guide for Families & Care Teams