If you think one chronic disease is bad, try having three,” says Michael Bowen, a 66-year-old retired businessman in San Mateo, Calif. He’s among the roughly 50 percent of Americans age 65 and up who have at least three chronic illnesses--in his case arthritis, diabetes, and heart disease. “It can seem like each new problem doesn’t just add to the burden but multiplies it,” Bowen says.

Fortunately, there are many steps you can take to make living with multiple health problems easier. “People who take an active role in managing their diseases can not only improve their physical health but also ease the emotional problems that often develop,” says Kate Lorig, Dr.P.H., director of the Patient Education Research Center at Stanford University’s  School of Medicine in California.

Being involved is especially important because the stakes are high. People with several chronic diseases are far more likely than those with just one to be hospitalized and to die early, research has found. Moreover, “the cost of their care rises exponentially, too,” says Elizabeth Bayliss, M.D., who has studied the effect of multiple diseases on overall health at the University of Colorado Health Sciences Center in Denver.

Treatment for the various problems is often complex and sometimes contradictory, since the different health conditions may require drugs or even lifestyle advice that work at cross purposes. For example, weight-bearing exercise may be helpful if you have osteoporosis because it strengthens the bones, but harmful if you also have diabetes, which makes the feet vulnerable.

“You live the treatment plan every day,” Lorig says, so “you know when it becomes overwhelming, causes side effects, or just doesn’t seem to make sense.” It’s up to you to watch for those problems and discuss them with your doctor or other experts when they arise.

To encourage that sense of involvement, the experts and patients we talked with recommend the following strategies:

Identify: Pinpoint the specific difficulties you face, such as drug side effects or financial worries.
Prioritize: Arrange those problems in order from most to least vexing.
Communicate: Ask your doctor to focus on your most important problems.
Collaborate: View your doctor as a partner and seek others--pharmacists, nurses, patient advocates, financial counselors, and fellow patients--who can help resolve your problems.
Educate yourself: Learn about your diseases from classes or reliable books, articles, or Web sites.


Here are some issues where communicating well with your doctor is crucial.

My doctor wants to talk about my blood pressure but I’m more worried about my arthritic knees.

Doctors and patients often have different priorities. For example, patients might focus on problems causing symptoms right now, while their doctors might concentrate on more serious but less immediately disabling disorders. Or their doctors may want to treat every medical problem, including minor ones, potentially creating an overwhelming regimen. Those factors can cause patients to abandon treatments, such as medication for hypertension that’s causing no symptoms, and can lead doctors to overlook problems that don’t threaten health but do distress the patient. “Be honest with your doctor about what’s most troublesome or worrisome to you,” Lorig says, “but listen to what your doctor is worried about too.” Then negotiate a plan that addresses both concerns.

I see one doctor for my arthritis and another for my diabetes, but no one is overseeing all my care.

People with chronic conditions often should see specialists, since they can provide superior care for many complicated health problems. But it’s still essential to have a primary-care doctor who oversees your care, performs routine exams, and treats everyday problems like muscle sprains. For your primary doctor, you could choose someone who specializes in your most serious problem, such as an endocrinologist if you have diabetes, provided he or she agrees to do the general tasks as well.

I can’t keep track of what my doctors tell me to do.

Patients typically remember about half of what they hear in the doctor’s office. The sicker you are, the more crucial--and difficult--it becomes to retain that information. Try these strategies:

• Take notes or tape-record your visit.
• Bring a friend or family member to take notes, help you remember details, and raise concerns you overlook.
• Repeat key points. If you don’t understand a medical term, ask for an explanation in simpler terms or ask the doctor to show a model or draw a diagram.
• Request a treatment plan from each doctor that includes which drugs and tests to take and when to return for visits.
• Get a copy of your medical records. If you can, seek practices that use electronic medical records, which are easier to read and are probably more accurate.

My doctor doesn’t have time to answer all my questions.

To maximize your time with the doctor, prepare a list of questions, ask your most important ones first, and persist if he or she interrupts. Still, your doctor may not have enough time to answer them all. Here are some other resources:

Health coaches. Some doctors and insurance companies now use specially trained nurses, dietitians, and therapists to provide detailed counseling to patients  either in person or over the phone.

Classes. Many health-maintenance organizations, senior centers, and health agencies offer patient-education classes.

Online information. The most comprehensive online health site is run by the National Library of Medicine.

Multiple diseases usually mean multiple medications, which significantly increase both the cost and the risks of treatment.

I can’t manage all the medications my doctor says I need.

The more drugs you take, the harder it is to take them properly, which undermines their effectiveness and increases the risk of side effects. Indeed, about 40 percent of people who regularly take at least five drugs, and nearly all who take at least 10 suffer one or more adverse drug events. The following steps can make a complex drug regimen easier and safer:

• Periodically review with your doctor all the drugs and supplements you take. Ask if any interact dangerously with each other or pose special risks for you, and if any can be reduced or eliminated.
• Take medicines on a regular schedule. Use calendars, timers, or pillboxes to help keep you organized.
• Post your schedule for taking drugs in a convenient place.
• Ask your doctor if you can take them  in a simpler way, such as once a day.
• Keep drugs where you’ll notice them, not in bathroom medicine cabinets, where they’re not only hidden but also exposed to heat and humidity.
• Know what to do if you miss a dose or take an extra one.

I can’t afford all the drugs my doctor has prescribed.

In addition to periodically reviewing your medications, consider these money-saving steps:

Look for generics. Check Consumer Reports Best Buy Drugs to learn whether generics are more cost-effective than brand-name drugs for your condition; if they are, ask your doctor about switching.

Compare prices. Go to Consumer Reports Consumer Reports Health, find your drug, and click on Compare Prices. Or call pharmacies or check their Web sites.

Buy in bulk. Ask your doctor to prescribe 90-day supplies of your medications. And ask whether your insurer will mail drugs directly to you.

Check drug-assistance programs. If you’re uninsured, ask your state or local health-care office or local senior center  about programs that provide prescription-drug assistance. For programs offered by drug companies or pharmacy benefit managers, go to www.pparx.org or www.rxoutreach.com, respectively.

Check federal programs. To see if you’re eligible for drug savings from Medicaid or Medicare, go to www.cms.hhs.gov. If you sign up for a Medicare drug plan or discount drug card, periodically re-evaluate the offerings by visiting www.medicare.gov.

“Often, the hardest part of managing chronic disease is juggling all the medications and doctors’ visits, and dealing with the fatigue and depression,” says Lisa Ferretti, M.S.W., an expert on aging at the University at Albany, State University of New York.

Taking care of all my problems leaves me tired and depressed.
Gaining control of the diseases can often help ease both problems. Here are some other steps:

Stay active. Ask your doctor to refer you to a physical therapist for advice on exercise, since physical activity not only helps many chronic diseases but often eases depression and boosts energy.

Ease stress. Anything that helps you relax--social support, meditation, music, or yoga, for example--can help you cope with chronic diseases. Many hospitals and clinics can refer you to programs that teach relaxation techniques.

Get treatment. Talk therapy and, if necessary, antidepressants are often overlooked options for people with depression stemming from chronic disease.

Managing my diseases seems like a full-time job.

Between all the lab tests, doctors’  appointments, and medical stuff I have to do at home, it used to seem that I didn’t have time for the rest of my life,” Bowen says. “But with experience, I’ve found ways to incorporate that into my daily routine, so that I manage the disease, not the other way around.”

Ordering your medications in advance and online is one way to streamline your care. Here are some other ideas:

• Ask your doctor about measuring blood pressure or blood sugar at home.
• Establish a regular schedule for performing those tests, taking medication, and doing other home-care measures.
• Ask if your doctor will answer questions by e-mail or fax.
• Ask if the practice offers group visits with other patients who have the same health problems.