One of the greatest challenges in this field of health care today is dealing with the coexistence of multiple chronic conditions, which is called multiple comorbidities. An increase in the number of chronic conditions correlates with an increase in the number of inappropriate hospitalizations. Self-management, or taking care of your multiple chronic conditions, can be challenging because recommended activities for one condition may be made difficult because of another condition.
Chronic medical conditions include, but are not limited to, asthma, diabetes, cancer, chronic bronchitis, congestive heart disease, cirrhosis of the liver, depression, emphysema, hypertension and . Without effective treatment chronic conditions may lead to disability.
The incidence of chronic disease has increased as mortality rates have decreased. It is estimated that by 2030 half of the population of the USA will have one or more chronic conditions.
Chronic care is complex in nature because it extends over a prolonged period of time, requires input from a diverse set of health professionals, various medications and possibly monitoring equipment.
Frailty is a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with every day or acute stressors is compromised.
A frail person has trouble performing activities of daily living because of weakness or fatigue. Frail individuals are vulnerable to acute illness due to low activity level.
Frailty is a marker for worsening health status.
The Clinical Frailty Scale is used to help identify people in the five categories of people who have multiple chronic conditions and frailty and should consider using MOLST:
It is critically important to understand health status and prognosis as part of preparing for a thoughtful MOLST discussion, and share as you begin a thoughtful MOLST discussion.
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