Older patients, multiple comorbidities, polymedication… should we treat everything?

In this narrative review, options for guiding medical decision-making in the care of elderly patients with multiple coexisting chronic diseases are discussed. Although older adults form a heterogeneous group, many seniors present with moderate to severe functional impairment, complex biomedical or psychosocial conditions and frailty. Multiple comorbidities are a frequent occurrence, leading to polymedication and an increased risk of iatrogenic disease. Recognizing the interactive and dynamic nature of these multiple concomitant conditions introduces complexity into the evaluation of the risk-benefit ratio of available therapies. Therapeutic guidelines for single disease entities do not usually account for possible multimorbidity. Sophisticated modeling of the dynamic nature of multiple comorbidities, drug-disease and drug-drug interactions, and their effect on the response to healthcare, are being published and will be helpful in deciding what should be treated and how. Furthermore, patient values, engagements and concerns should enter the medical decision-making process to ensure that the chosen therapeutic strategy is coherent, appropriate and likely to be followed.