Considering the healthcare needs of older people with multimorbidity: managing Alice.

Managing elderly patients with multimorbidity can be challenging to clinicians, particularly those in primary care. We discuss the complexities and challenges in this editorial.  Introducing Alice Alice is 82 years old. She has type 2 diabetes mellitus and is on metformin – she only takes one 500 mg tablet twice a day as she “can’t stand” the abdominal discomfort and loose stools if she takes more, even though the general practitioner (GP) has told her she should take one with each meal. She takes levothyroxine, has asthma (which is managed with a Seretide ® inhaler) and hypertension (which is controlled with ramipril). For the pain in her knees and feet, which the GP says is due to “wear and tear”, she takes paracetamol regularly, but does not feel it works – and it might not, given the recent paper in the Lancet [1] – so she uses a rubefacient, which makes her feel better. She was recently diagnosed with atrial fibrillation and, after much deliberation, agreed to start rivaroxaban. A year ago, Alice was given simvastatin by one of the practice nurses after having a blood pressure check, but often wonders why she needs to take this; and because the instructions are to take at night, Alice often forgets to take it. Journal of Comorbidity 2016;6(2):53–55