Guidelines for elderly patients with multimorbidity: How to cope with a dark night without fear

摘要

The epidemiological transition has produced a society with a growing number of the elderly affected by multiple chronic diseases which often requires polypharmacy. Despite being the main users of medications, the elderly are largely underrepresented in clinical trials, especially if they have multimorbidity. It follows that the results of these trials are not applicable in the real world and potentially harmful. In order to breach the wall of this complexity, several suggestions have been put forward, from new clinical trial methodology, simulation models, and the use of patient-centered as opposed to disease-centered indicators. It is likely that comparative effectiveness research will accelerate the shift toward a focus on ''universal'' outcomes on which all diseases exert an effect. I believe that there is no ''one-size-fits-all'' solution in this area, but two ideas come to my mind. Why do we not invest more in educating our future geriatricians? And why do we not invest in public awareness campaigns?