Multi-complexity
The first deep dive we’ll take is right into the 4M’s of a healthy aging system. But we’ll start with the overarching “M” of Multi-complexity.
As we age, our lives become naturally much more complex. From social interactions to emotional health to medical conditions, the aging adult faces many more challenges than a younger adult. Some people are fortunate enough to plan and prepare for the aging process, but life happens fast and can leave many adults feeling overwhelmed.
As geriatricians, we guide our patients the best we can through the aging process. In the United States a person may choose to start seeing a geriatrician around the age of retirement, or when they qualify for Medicare. At time, the average remaining life expectancy is around 20 years. (So an adult who lives to the age of 65 on average lives to their young/mid 80s). That’s not to say that the “Golden Years” are all golden. 20% of adults over 65 would rate their health as fair to poor, and that’s not including adults who are living in a nursing facility. Many report at least one chronic medical condition, and in practice most older adults have more than one. Heart disease, hypertension, diabetes, depression, insomnia, and the list goes on. Chronic medical conditions are not the only medical concern; as we age we are more likely to have serious medical conditions like cancer, dementia, vascular disease, heart failure, chronic obstructive pulmonary disease, etc. These chronic and serious medical conditions combined with the psychosocial aspects of aging lead to significant complexity when making decisions!
Most adults imagine spending their retirement years living independently in the home they loved and lived in for much of their life and/or with their family, what is called aging in place. Unfortunately, not every person has the resources or social support structure to make this possible. An estimated 47% of men and 58% of women over 65 will need long-term care at some point their lives, and the chance increases with age. So many factors go into the institutionalization of an older adult, it is impossible to review them all. Functional disability is the largest contributor, but again the Multi-complexity of every older adult contributes to that disability. Not everyone declines on the same path or at the same pace.
Viewing the individual person through this lens is one of the things that provides a geriatrician, or other healthcare provider, the framework to help guide medical decision making.
Over the next few weeks we’ll cover the actual 4M’s of “what Matters, Medication, Mentation, and Mobility” all while maintaining the Multi-complexity of the older adult.
Key Points:
Aging is a challenging, complex process
Ensure your healthcare provider is viewing your case through the lens of Multi-complexity
