When More Becomes Harm: The Art of Managing Multimorbidity and Multicomplexity in Older Adults

Abstract

Multimorbidity and multicomplexity are increasingly becoming the norm in geriatric clinical practice, with a recent Indonesian multicentre study revealing that 80.7% of older outpatients present with multiple coexisting conditions. This editorial discusses the limitations of conventional single-disease guidelines when applied to complex older adults, where simultaneous treatments often lead to polypharmacy, cumulative anticholinergic burdens, and potential adverse outcomes. Highlighting findings from a recent study in Acta Medica Indonesiana, which found polypharmacy in 43.9% of Indonesian geriatric outpatients but a low rate of high anticholinergic burden (1.8%), the editorial underscores the concept of "appropriate polypharmacy" under close clinical monitoring. To effectively navigate multicomplexity defined by the intricate interactions between pathophysiology, treatment effects, functional status, and social context, clinicians must look beyond rigid numerical targets and adopt patient-centered frameworks such as the Geriatrics 5Ms. Central to this approach is the art of judicious deprescribing, utilizing validated criteria like the AGS Beers or STOPP/START to optimize care and minimize harm. Ultimately, modern geriatric care requires a fundamental shift from merely extending lifespan to enhancing health span, focusing on "What Matters Most" to the patient. Integrating these competencies into medical education is vital to prepare future frontline clinicians for the realities of aging populations.