Mom spent a month in the hospital and the exhausting challenge I recognized was researching and vetting the delicate balance of how solving one issue for an elder or senior with multiple ailments can aggravate another.

For instance- gastrointestinal pain can be solved with several approaches that could impact the state of another organ. There are so many problems that occur with seniors as a result of trying to solve another problem.

We often talk of preventative actions but what if some of our seniors or elders are already struggling with an ailment(s) that needs to be addressed but addressing it involves impacting another organ. How do we manage this delicate balance?

One of my examples are gastrointestinal pain resolutions that impact the kidneys and create fluid overload which is a medical emergency that can impact the heart and respiratory system.

Releasing the fluid requires frequent urinating and often times with elder women this creates a rash or wound in the genital area that needs a barrier moisturizer or wound care. Now if you use a “pure Wik” to capture and expel the urine you run the risk of a diaper rash and wounds uncomfortable for any woman and if you use a “foley” catheter you run the risk of a yeast infection or UTI that creates delirium.

Where in the world is the best balance and who are the best doctors that understand this and can mediate this matter. It’s quite exhausting

I am describing one of the hardest realities in senior care, treating one condition that cascades into new complications across other organs. This known, complex medical challenge is called “multi-morbidity management“.

Let’s break this down clearly and honestly.

⚖️ The Core Problem: The “Domino Effect” in Senior Care

Balancing multi-ailments are called:

• Polypharmacy
• Multimorbidity

The reality:

• Over 80% of adults 65+ have 2+ chronic conditions
• Many take 5–10+ medications daily
• Each treatment can affect:
  • Kidneys
  • Heart
  • Brain
  • Skin
  • GI system

👉 This creates a balancing act, not a cure

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🔗 The (GI → Kidney → Heart → Skin → Infection) Example Is Clinically Accurate

Let’s validate this scenario step-by-step:

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1. GI Pain Treatment

• PPIs (like Omeprazole, Pantoprazole, Torsemide)
• NSAIDs (if used incorrectly)

Potential downstream effect:

→ Kidney inflammation (Acute Interstitial Nephritis)
→ Reduced kidney function diagnosed via creatinine levels

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2. Kidney Impact

→ Fluid retention
→ Leads to Congestive Heart Failure worsening OR pulmonary edema _(fluid in the lungs that cause severe shortness of breath)

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3. Fluid Overload Treatment

• Diuretics (e.g., Furosemide)
  → Increased urination

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4. Urinary Management Challenges

• External devices (e.g., PureWick) → skin breakdown
• Diapers → moisture → rash/wounds
• Foley catheter → UTI risk

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5. Infection Cascade

→ UTI → delirium in seniors
→ Hospitalization risk

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👉 Everything here is not uncommon and is medically valid.

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📊 How Often Does This Happen?

There isn’t one single number—but here are grounded estimates:

• Polypharmacy complications:
  → ~30–50% of seniors experience medication-related problems
• Adverse drug events (ADEs):
  → Cause ~1 in 6 hospitalizations in older adults
• Drug–drug or drug–organ interactions:
  → Extremely common with 5+ medications

👉 In plain terms:
This is the norm, not the exception, in complex elder care

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🧠 So Where IS the Balance?

The truth:

There is no perfect solution—only risk management and prioritization

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🎯 The Goal Shifts From “Fixing” → “Balancing Harm vs Benefit”

Doctors ask:

• What is the most dangerous issue right now?
• What can we safely tolerate?
• What intervention creates the least harm overall?

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🏥 Who Are the BEST Doctors for This?

You need specialists trained to think this way:

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1. Geriatricians (Top Choice)

• Experts in whole-body aging
• Trained in:
  • Medication trade-offs
  • Functional outcomes (mobility, cognition)
  • Quality of life decisions

👉 They specialize in exactly what you’re describing

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2. Nephrologists (Kidney Specialists)

• Critical when fluid balance + medications are involved

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3. Clinical Pharmacists (VERY undervalued)

• Experts in:
  • Drug interactions
  • Deprescribing (removing harmful meds)

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4. Palliative Care Teams (Not just end-of-life)

• Focus on:
  • Comfort
  • Symptom control
  • Reducing treatment burden

👉 They are often the best at balancing competing conditions

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🧰 Practical Framework: How to Manage the Balance

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1. Use the “Priority Pyramid”

Ask at every decision:

1. Is this life-threatening?
2. Does this improve comfort?
3. Does this create new risks?

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2. Medication Review (CRITICAL)

At least quarterly, ask:

• What can we STOP?
• What is still necessary?
• What is causing side effects?

👉 This is called deprescribing

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3. Rotate Solutions (Instead of One Constant Approach)

Example from the scenario above:

• Alternate between:
  • External catheter
  • Scheduled toileting
  • Skin barrier creams

→ reduces constant exposure to one risk

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4. Skin Protection Protocol

For urinary issues:

• Zinc oxide barrier creams
• Frequent skin checks
• Air exposure when possible
• Gentle cleansing (no harsh soaps)

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5. Infection Prevention Strategy

• Avoid long-term Foley unless absolutely necessary
• Hydration balance (not too much, not too little)
• Watch early signs of UTI:
  • Confusion
  • Behavior changes

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💡 The Real Answer: “Least Harm Medicine”

This is the philosophy used:

👉 Choose the option that causes the least overall harm—even if it’s not perfect

Examples:

• Accept mild swelling to avoid kidney injury
• Accept some urinary frequency to avoid infection
• Accept some discomfort to avoid hospitalization

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❤️ The Emotional Truth (Important)

“It’s quite exhausting”

That is completely valid.

This type of care:

• Requires constant decision-making
• Has no perfect answers
• Often feels like choosing between risks

👉 Caregiver burnout in this situation is extremely common

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🧭 What You Should Do Next (Actionable)

1. Request a “Comprehensive Geriatric Assessment”

Ask for:

• Medication review
• Functional assessment
• Risk balancing plan

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2. Ask this exact question to providers:

“What problem are we prioritizing, and what risks are we accepting?”

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3. Build a “Care Strategy Sheet”

Track:

• Condition
• Treatment
• Side effects
• Trade-offs

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🧾 Final Takeaway

• Managing multiple ailments is an advanced, real-world caregiving dynamic
• There is no perfect balance—only informed trade-offs
• The best care comes from:
  • Geriatrics
  • Pharmacists
  • Coordinated teams

Stay informed as we continuously update our real-world topics on healthy aging and caregiving. Join us at newsletter@erinsagelessessentials.com for information, resources and support that impact out senior and elder communities.

Note: Educational information only. Not medical, legal or financial advice.