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GERICLINICS

Clinical case · Multimorbidity

Seven conditions, fourteen medicines and one goal

A 79-year-old woman with diabetes, heart failure, kidney disease, atrial fibrillation and COPD has had a fall with kidney injury and is struggling with her treatment. Assess interactions and burden, find out what matters to her, and agree a plan that does less harm without simply doing less.

Advanced 20 minNeeds clinical reviewPro · free in beta

You will learn to

  • Assess interactions between conditions and treatments, and the overall treatment burden
  • Use the person's most and least desired outcomes to set priorities and realistic goals
  • Deprescribe safely and spot under-treatment, then coordinate and document the plan

Presentation

Step 1 of 10

A 79-year-old woman is referred after a hospital stay three weeks ago. She fell at night and was found to have an acute kidney injury.

She says, "I take so many tablets I feel drugged in the mornings, and I'm at a clinic every other week. I just want to stay in my own flat."

References

  1. Muth C, van den Akker M, Blom JW, et al. The Ariadne principles: how to handle multimorbidity in primary care consultations. BMC Med. 2014;12:223. doi:10.1186/s12916-014-0223-1 · PubMed 25484244
  2. van Poelgeest E, Seppala L, Bahat G, et al. Optimizing pharmacotherapy and deprescribing strategies in older adults living with multimorbidity and polypharmacy: EuGMS SIG on pharmacology position paper. Eur Geriatr Med. 2023;14(6):1195–1209. doi:10.1007/s41999-023-00872-0 · PubMed 37812379
  3. Youn JC, Kim D, Cho JY, et al. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment. Int J Heart Fail. 2023;5(2):66–81. doi:10.36628/ijhf.2023.0011 · PubMed 37180564
  4. Boccardi V, Bahat G, Balci C, et al. Challenges, current innovations, and opportunities for managing type 2 diabetes in frail older adults: a position paper of the European Geriatric Medicine Society (EuGMS)—Special Interest Group in Diabetes. Eur Geriatr Med. 2025;16(4):1231–1247. doi:10.1007/s41999-025-01168-1 · PubMed 40014274
  5. Bolt J, Carvalho V, Lin K, Lee SJ, Inglis C. Systematic review of guideline recommendations for older and frail adults with type 2 diabetes mellitus. Age Ageing. 2024;53(11):afae259. doi:10.1093/ageing/afae259 · PubMed 39572394
  6. Gregson CL, Armstrong DJ, Bowden J, et al. UK clinical guideline for the prevention and treatment of osteoporosis. Arch Osteoporos. 2022;17(1):58. doi:10.1007/s11657-022-01061-5 · PubMed 35378630

Last updated 2026-10-22.

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