Living with Multiple Chronic Conditions (MCC)

MCC is when you’re living with 2 or more health problems that are ongoing (chronic). For instance, a person may have 2 or 3 or more of these conditions:

Allergies	Degenerative disk disease	HIV
Arthritis	Dementia	Insomnia
Asthma	Depression	Irritable bowel syndrome (IBS)
Atrial fibrillation	Diabetes	Kidney disease
Bladder control problems	Heart disease	Obesity
Cancer	Hepatitis	Osteoporosis
COPD	High blood pressure	Substance use
Chronic pain	High cholesterol	Thyroid problems

Some conditions are more complex and may interact with one another. Or some medicines and treatments for 1 condition may make another condition worse. For instance, if you have heart disease you may be told to exercise regularly. This can be a problem if you also have arthritis, or neuropathy (nerve pain) in your feet and legs. Learn as much as you can about your treatment options. Work with your healthcare providers to develop the best possible treatment plan. The plan should help you do what is important to you.

It’s most common in older adults. About 1 in 4 older adults are living with MCC. But many younger adults also have MCC. Not all conditions require a lot of managing but some do. Not all conditions are preventable, but many are. To lower your risk for some conditions, no matter what your age, do what you can to move more, sit less, and keep a healthy diet and weight. Talk with your healthcare provider for more information.

When you have 2 or more health problems, you may have a lot to handle. This includes:

• Keeping up with health screenings for many conditions to prevent more problems
• Many medicines you need to remember to take at certain times
• Multiple medical appointments that interrupt your schedule, or be hard to get to
• Advice from different providers who may not know the care plans for your other conditions
• Symptoms that can make daily tasks harder
• The cost of appointments, tests, and medicines
• Dealing with your insurance company
• Dealing with employment issues due to difficult symptoms or lots of appointments

And taking multiple medicines can be a problem. Some medicines may:

• Change the way other medicines you take work
• Have side effects that make other conditions worse
• Not be safe to take when you have another health condition
• Cause new symptoms

A vital part of having MCC is making sure each of your healthcare providers knows about all of your conditions. For instance, you may have providers such as these:

• Primary care provider
• Cardiologist
• Oncologist
• Allergist
• Pharmacist
• Physical therapist
• Mental health
• Counselor
• Financial counselor
• Other types of counselors

But these providers may not talk to each other. A lot of medical offices don’t share information. You will need to tell all your providers about all the care you are getting. This can help them find better treatment options for you and prevent problems. It may be helpful to identify 1 of your providers as the main manager of your care. Usually this is a primary care provider.

You are also responsible for making sure each provider is up to date on your health. To do this:

• Keep track of all your appointments in a calendar or a list.
• Keep a diary of your symptoms. Note if your symptoms are better or worse.

It can be hard to communicate with all of your providers on your own. Ask a family member or friend to come to appointments with you. Bring these things to each appointment:

• A list of all of your health conditions
• The calendar or list of all of your scheduled appointments
• The diary of your symptoms
• Your most recent tests and results
• A list of all your medicines and their refill dates
• Your medicines in their bottles
• A list of all vitamins, herbs, and other supplements you take
• A notebook and pen to take notes

At each appointment:

• Make sure each provider looks at your file to see what you talked about the last time you saw them.
• Ask if there is any change in medicine or doses.
• Ask for medicine refills if needed.
• Ask questions about your test results and if there are any changes to your care plan. Write down the answers in the notebook.
• Ask for the after-visit summary. Share this with your other providers.

Ask your healthcare providers questions if there is anything you’re not sure about. You can ask them at an appointment. Or you can contact them through a messaging system or by phone. Ask how best to get in touch. You may have questions such as:

• Is my condition better, worse, or the same?
• How are my other conditions affecting my health?
• What are the benefits and risks of this medicine or treatment?
• How long will this medicine or treatment take to work, or start to work?
• What kinds of side effects may I get?
• How will this medicine or treatment affect my other conditions?
• How will it affect medicine I already take?
• Are there clinical trials for treatments that address more than 1 of my conditions?
• Is there anything I need to do differently to manage my daily care in other ways?
• How do I get help after office hours, and on weekends and holidays?

Tell your provider if:

• A medicine or treatment is not working, or causing side effects you can’t manage
• Your medical plan is too difficult or confusing to follow, and you’re not able to follow it as needed
• If you are having trouble paying for or getting any medicine or other treatment

When you have chronic health conditions, having a healthy lifestyle is even more important. You can help prevent new problems with healthy lifestyle choices. This means:

• Getting physical activity as often as you can
• Eating healthy foods every day, such as whole grains, vegetables, and lean protein
• Not smoking
• Not drinking too much alcohol

Talk with your healthcare provider for specific advice that suits you and the chronic conditions you have.

When you have 2 or more health conditions, you may have a lot of choices to make over time. Think about what your priorities are. What matters most to you? What will give you the best quality of life?

Talk with your healthcare providers about:

• What symptoms bother you the most
• What your goals of treatment are
• What medicines have side effects that you can’t cope with
• If there are any medicines you don’t want to take
• If there are any tests you can delay or skip
• What costs you are more able to pay now
• What is most important to you today, next week, next month, next year

Ask your healthcare provider’s office or hospital system if they have a care management program. You may be assigned a case manager. This person can help you organize your care between different offices. You may qualify for services, such as:

• Home healthcare services, such as bathing or blood draws
• Transport to and from appointments
• Home delivery of meals or local nutrition programs to help you get healthy foods
• Financial counseling

You can get more information about support from groups like these:

• Family Caregiver Alliance at caregiver.org
• Caregiver Action Network (CAN) at caregiveraction.org
• American Society on Aging at asaging.org
• National Institute on Aging at nia.nih.gov
• American Cancer Society at cancer.org
• COPD Foundation at copdfoundation.org
• American Heart Association at heart.org
• American Diabetes Association at diabetes.org