Study finds care coordination improves health in older adults with multiple chronic diseases

A study from the Canadian Medical Association Journal published this week finds that older adults with two or more high burden chronic diseases, or multimorbidity conditions, can benefit from care-coordination strategies.

The study, conducted by Kastner and colleagues, states that 42.6% of older adults (age 65 or older) in Canada live with multimorbidity, compared to 65.8% in the United States. Living with multimorbidity means greater healthcare needs, but according to the study, only 55% of these older adults receive proper care in Canada or the U.S. Different intervention strategies have been created to address managing chronic diseases, but little research has been done on the potential impact of interventions specifically for older adults.

The authors performed a systematic review of all research and clinical trials published between 1990 and 2017 (in any language) on intervention and care needs for older adults suffering from two or more chronic medical conditions. They then selected the 25 studies that best matched their criteria and assessed the effects of the intervention methods used. 

Ultimately, the study concluded that care coordination strategies, including one or some combination of case management, self-management, education, and care pathways have the most potential for lowering HbA1c, reducing depressive symptoms, improving health-related functional status, and increasing the use of mental health services.

One example of these findings is that patients with depression and chronic obstructive pulmonary disease had reduced symptoms of depression when their care coordination involved case management, patient self-management, and patient education.

The authors suggest that one of the reasons for the lack of optimized strategies for managing multimorbidity is that clinical practice guidelines tend to focus on a single condition. Other reasons may be that patients find it difficult to manage multiple conditions, and providers get overwhelmed by the heterogeneous nature of multimorbidity. The authors suggest the optimal way to manage multimorbidity includes understanding health priorities from patient and provider perspectives.