Multimorbidity in Elderly

This book is aimed to readers interested in improvement of the quality of care for the elderly with complex multimorbidities and complex treatment programs. It comprises an illustrated analysis of multimorbid elderly patients with a strong focus on the individual. Fourteen connected systematic faults in present Swedish elderly care are identified, each of which standing in the way of appropriate, smooth-running elderly care. Together these faults constitute a strong barrier for quality improvement in elderly care over time. The book proposes the DTF-model = Diagnosis-Treatment-Follow up as a core structure for improved health analysis and management over time. The DTF-model should be the basis in the renewal of the medical record, from todays retroactive, passive diary into a proactive "interactive health analysis system", focused on full transparency, participation, co-responsibility and empowerment. The book outlines how a suitable health care organization for multimorbid elderly could be organized and staffed with full integration between regular health care and clinical research.