Geriatric co-management has the potential to significantly optimize care for older adults living with multiple sclerosis (MS) by addressing the complex interplay of aging-related changes and the unique challenges posed by MS. As people with MS age, their healthcare needs become more multifaceted, often involving not only neurological symptoms but also age-associated conditions such as frailty, cognitive decline, mobility limitations, and comorbidities. A geriatric co-management approach integrates the expertise of geriatricians with neurologists and other specialists to provide comprehensive, coordinated care tailored to the older MS population.
Multiple sclerosis is a chronic neurological disease characterized by immune-mediated damage to the central nervous system, leading to symptoms such as muscle weakness, spasticity, fatigue, cognitive impairment, and sensory disturbances. While MS often begins in young adulthood, advances in disease-modifying therapies have increased life expectancy, resulting in a growing number of older adults living with MS. Aging itself brings physiological changes that can exacerbate MS symptoms or complicate their management. For example, older adults may experience reduced mobility due to both MS progression and age-related musculoskeletal decline, increased risk of falls, and cognitive changes that can affect medication adherence and self-care.
Geriatric co-management involves a multidisciplinary team approach where geriatricians assess and manage age-related issues such as frailty, polypharmacy, cognitive impairment, and functional decline alongside neurologists who focus on MS-specific treatment. This collaboration allows for a more holistic understanding of the patient’s health status and priorities. Comprehensive geriatric assessment (CGA) is a key component of this model, providing a structured evaluation of medical, psychological, functional, and social domains. Through CGA, clinicians can identify reversible factors contributing to disability, optimize medication regimens to reduce side effects and interactions, and develop personalized care plans that support independence and quality of life.
One of the main advantages of geriatric co-management in MS care is improved symptom management. Older adults with MS often face overlapping symptoms from both aging and MS, such as fatigue, balance problems, and cognitive difficulties. Geriatricians bring expertise in differentiating these symptoms and tailoring interventions accordingly. For example, physical therapy and neurorehabilitation can be adapted to address both MS-related neurological deficits and age-related muscle weakness or joint problems. Cognitive stimulation and mental health support are also critical, as depression and anxiety are common in MS and can worsen with aging. Social support networks and mental health resources can be integrated into care plans to enhance emotional well-being.
Medication management is another crucial area where geriatric co-management can optimize outcomes. Older adults frequently take multiple medications for various chronic conditions, increasing the risk of polypharmacy and adverse drug reactions. Geriatricians can review and rationalize medication regimens, ensuring that disease-modifying therapies for MS are balanced with treatments for other conditions, minimizing side effects and interactions. They also support adherence through education and monitoring, which is vital since consistent medication use can slow MS progression and reduce relapses.
Functional status and mobility are central concerns in older adults with MS. Geriatric co-management promotes interventions that maintain or improve physical function, such as tailored exercise programs, assistive devices, and home modifications. These measures help prevent falls, enhance safety, and preserve independence. Rehabilitation specialists, including physiotherapists and occupational therapists, play an integral role in this team, providing targeted therapies that address both neurological impairments and age-related physical limitations.
Cognitive impairment in MS can be compounded by age-related neurodegeneration. Geriatricians are skilled in assessing cognitive function and distinguishing between MS-related cognitive changes and other causes such as dementia. Early identification allows for timely interventions, including cognitive rehabilitation, medication adjustments, and support for daily living activities. This comprehensive approach helps maintain cognitive health and supports decision-making capacity.
Psychosocial factors are also critical in the care of older adults with MS. Aging can bring social isolation, loss of independence, and emotional challenges. Geriatric co-management teams
