Synopsis
Prioritise person-centred care for adults with multiple long-term conditions by reducing treatment burden, reconciling competing recommendations and agreeing outcomes that matter to the individual.
- Multimorbidity means two or more long-term conditions; combinations of physical and mental illness, frailty, pain, sensory loss and substance dependence may interact clinically and socially.
- Consider a tailored multimorbidity approach when care is fragmented, treatment burden is high, medicines create risk, function is declining or the person struggles to follow multiple single-disease plans.
- Start with the person’s goals, current symptoms, function, mental health, social context and treatment workload before optimising individual biomarkers.
Reasoning priorities
Define the outcomes the person values and current capability.
Translate priorities into measurable daily outcomes rather than assuming disease targets are the primary goal.
Worked reasoning
An 82-year-old with five long-term conditions, twelve medicines and recent falls wants to stay independent but feels dizzy after morning tablets.
- Assess postural symptoms, falls injury, hydration, cognition, mood, function, adherence, support and urgent causes; reconcile every medicine with indication, timing and prescriber.
- Map competing benefits and harms, including blood-pressure lowering, sedative or anticholinergic load, renal function, fracture risk and the patient’s priority of safe walking.
- Agree a final coordinated plan that addresses immediate fall risk, changes the most plausible harmful treatment with the responsible prescriber, simplifies timing and preserves clearly valuable symptom or secondary-prevention therapy.
- Verify with lying and standing observations or other indicated monitoring, a defined symptom and falls review, written ownership, pharmacist communication and a contingency if symptoms or disease control worsen.