Prioritizing care for older adults with multiple comorbidities: Working in the 'zone of complexity'

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Prioritizing care for older adults with multiple comorbid conditions is a challenging act of clinical judgment owing to the multidimensional and dynamic nature of each patient's health status. This clinical process is analogous to working within a complex adaptive system, where an intervention or change in one condition can produce unexpected outcomes. Except for decisions characterized by a high degree of professional agreement (e.g., influenza vaccination), most medical decisions affecting older adults occur within a 'zone of complexity' characterized by imperfect agreement regarding best practices and outcomes. An example is setting individual glycemic targets. Decisions within this zone are at best bounded by a few principles: first, ascertain the patient's preferences and goals; second, determine health status by identifying relevant comorbid conditions, function and frailty; third, consider the risks and benefits, and estimate the likelihood that any intervention will achieve the patient's healthcare goals within a time frame meaningful to the patient; and last, prioritize these through negotiation with the patient to achieve a plan that is workable within the context of the patient's life.

Original languageEnglish (US)
Pages (from-to)715-721
Number of pages7
JournalAging Health
Issue number6
StatePublished - Dec 2007


  • Clinical guidelines
  • Clinical judgement
  • Complex adaptive systems
  • Multiple comorbid conditions
  • Older adults
  • Prioritizing care
  • Quality indicators

ASJC Scopus subject areas

  • Geriatrics and Gerontology


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