Integrating Guidelines, CKD, Multimorbidity, and Older Adults

Clinical practice guidelines provide guidance in decision making relating to diagnosis, management, and treatment in specific areas of health care. They play an essential role in the evaluation and synthesis of an ever-expanding evidence base and are of increasing importance in aging societies with a high prevalence of overlapping disease comorbid conditions. Integration of chronic disease guidance is essential, particularly in older people, in order to understand critical disease interactions and the potential adverse effects that individual guideline statements may engender in different disease areas. This requires a need for flexibility that not only recognizes the differences in patients' characteristics, but also their preferences for medical interventions and health outcomes. The question is how this can be achieved. In this article, we look at the standardization of clinical practice guidelines from the chronic kidney disease standpoint and consider how tools for integrating guidelines, such as the ADAPTE process and the knowledge-to-action cycle, can be used to guide appropriate decision making and take account of patient choice in older adults with multimorbidity.