| Course | HLTH 8815 Gerontology & Healthy Aging |
|---|---|
| Week | Week 4 |
| Paper type | Multimorbidity memo |
| Length | About 700 words, 4 pages |
| Format | Memo, APA 7 citations |
| School | Walden University |
| Program | PhD in Public Health |
| Updated | October 2026 |
Free sample paper for HLTH 8815 Week 4
Memorandum
To: Program Committee, Composite County Health Department
From: Healthy Aging Program Analyst
Date: Month Day, Year
Re: Conflicting instructions across the diabetes, heart failure, arthritis and falls prevention classes
Purpose
The department runs four disease-specific classes for older residents: diabetes self-management, heart failure self-care, arthritis exercise and falls prevention. Each class hands out its own instructions. Many residents attend two or more, and about a third of the residents enrolled in the heart failure class this year also attended the diabetes class. This memo lays the four sets of handouts side by side, identifies where they collide for a person following them together, and recommends which instructions should give way.
Why Collisions Happen
Disease-specific guidance is written for one condition at a time. Boyd et al. (2005) applied clinical practice guidelines for five common conditions to a hypothetical 79-year-old woman with all five and found that following them would require 12 medications taken at 19 doses across five times a day, along with a complex set of nonpharmacological activities, several of which could interact or conflict. Tinetti et al. (2012) argued that multimorbidity is the most common chronic condition among older adults and that care designed one disease at a time fails people who have several. Our classes reproduce the same problem in health education. People juggling several of these diagnoses tend, in addition, to be frail, a state of reduced reserve marked by weakness, slowness, exhaustion, low activity and unintended weight loss (Fried et al., 2001), which makes four separate exercise routines and four daily checklists especially unrealistic for the people most likely to receive them.
The Handouts Side by Side
Table 1
Where the Four Classes' Instructions Collide
| Topic | Diabetes class | Heart failure class | Arthritis class | Falls class | Collision | |
|---|---|---|---|---|---|
| Fluids | Drink water freely; avoid sugary drinks | Limit fluids to about 2 liters a day | Not addressed | Stay hydrated to avoid dizziness | Diabetes and falls handouts encourage drinking; heart failure handout limits it | |
| Salt | Not emphasized | Strict sodium limit | Not addressed | Not addressed | Diabetes meal plans include canned foods high in sodium | |
| Exercise | Walk 30 minutes most days | Walk as tolerated; stop if breathless | Daily range-of-motion and strengthening | Balance exercises three times a week | Four separate routines; total time over an hour daily | |
| Foot care | Inspect feet daily; never walk barefoot | Weigh yourself daily before breakfast | Wear supportive shoes | Remove throw rugs; wear nonslip footwear at home | Compatible, but four separate daily checklists | |
| Low blood sugar | Carry glucose tablets; eat if shaky | Not addressed | Not addressed | Sit down if dizzy | Dizziness instructions do not mention checking blood sugar | |
Handout contents summarized for a composite department.
Which Instructions Should Give Way
The committee needs a rule for collisions. I recommend the following order. First, instructions that prevent acute danger take priority: the heart failure fluid limit outweighs general hydration advice for residents with heart failure, and the diabetes instruction to check blood sugar should be added to the falls handout's advice on dizziness. Second, where routines compete for time, they should be merged rather than added: one combined daily routine of about 30 minutes can include walking, strengthening and balance work. Third, where instructions are compatible but numerous, they should be consolidated into a single daily checklist covering weight, feet and blood sugar.
How the Committee Can Check the Result
A combined handout is only useful if residents can follow it. Before adopting it, the committee could ask ten residents who attend two or more classes to use the draft for two weeks and keep a short log of what they did each day. Their logs would show whether the merged routine is realistic, whether any instruction is still being dropped and whether the checklist is easier than four separate sheets. The instructors could then revise the handout before it goes to every class.
Recommendations
1. Form a small working group from the four classes to produce a combined handout for residents with two or more of the conditions.
2. Ask each resident at enrollment which other classes they attend and give them the combined version.
3. Train instructors to ask what matters most to each resident, so that advice can be adjusted to that person's priorities.
References
Boyd, C. M., Darer, J., Boult, C., Fried, L. P., Boult, L., & Wu, A. W. (2005). Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: Implications for pay for performance. JAMA, 294(6), 716-724. https://doi.org/10.1001/jama.294.6.716
Fried, L. P., Tangen, C. M., Walston, J., Newman, A. B., Hirsch, C., Gottdiener, J., Seeman, T., Tracy, R., Kop, W. J., Burke, G., & McBurnie, M. A. (2001). Frailty in older adults: Evidence for a phenotype. The Journals of Gerontology: Series A, 56(3), M146-M156. https://doi.org/10.1093/gerona/56.3.M146
Tinetti, M. E., Fried, T. R., & Boyd, C. M. (2012). Designing health care for the most common chronic condition: Multimorbidity. JAMA, 307(23), 2493-2494. https://doi.org/10.1001/jama.2012.5265
The Walden HLTH 8815 Week 4 instructions
Students write a memo applying the concept of multimorbidity to a real or composite program. Faculty expect the memo to show concretely how guidance designed for single conditions collides when one person must follow several sets at once. The strongest memos lay the guidance side by side, identify specific conflicts and overloads, and propose a rule for deciding which instructions should give way. Evidence on the burden of following multiple guidelines and on multimorbidity as a design problem should support the argument. Faculty also value attention to the people most likely to receive several sets of advice, who are often frail. Recommendations should be discrete decisions a committee can approve, and a plan for testing the revised approach with residents strengthens the memo.
How the HLTH 8815 Week 4 example is put together
First comes the purpose, with the share of heart failure class members who also sit in the diabetes class. A section cites Boyd and colleagues' guideline exercise, Tinetti and colleagues on multimorbidity as the most common chronic condition, and Fried and colleagues' frailty phenotype. Table 1 compares the four classes on fluids, salt, exercise, daily checks and low blood sugar, naming each collision. A section proposes a priority rule: instructions preventing acute danger first, competing routines merged, compatible checks consolidated. A section describes a two-week trial with residents who attend two or more classes. Three numbered recommendations cover a working group, a combined handout at enrollment and instructor training in asking what matters most.
Where the marks sit in the HLTH 8815 Week 4 rubric
This memo succeeds when the collisions are specific and the proposed rule resolves them. Observing that people with several conditions get a lot of advice adds nothing new; a table that shows exactly where two handouts contradict each other, and a rule that settles each case, adds a great deal. Evidence should be cited accurately, especially the Boyd guideline exercise. Attention to frailty shows awareness of who receives the most advice. Recommendations are strongest when they are discrete and assignable. A plan to test the combined handout with residents shows the author expects to be checked. Memo conventions, a clear subject line and concise headings make the document usable by its audience.
HLTH 8815 Week 4 help: mistakes that cost marks
Multimorbidity memos often describe the problem in general terms and recommend coordination. That leaves a committee with nothing to decide. To write a stronger memo, collect the actual instructions each program gives and set them side by side. Mark where they contradict, where they compete for time and where they simply pile up. Propose a rule for which instruction gives way in each case. Support your argument with evidence on the burden of multiple guidelines. Think about who receives the most advice and what they can manage. Offer numbered recommendations and a way to test the change with residents. A memo on the programs your course describes can be prepared on request.
Get a HLTH 8815 Week 4 example written to your instructions
Which programs or conditions does your memo set against each other? Name them, and include the memo prompt and rubric. The draft that returns lays their demands side by side, cites published multimorbidity findings without borrowed numbers, and argues what should yield at the program level. The health department is invented. First free, turnaround 24 to 48 hours.
More HLTH 8815 papers and PhD in Public Health samples
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- HLTH 8815 Week 3: Older Adult Function Profile
- HLTH 8815 Week 5: Care Setting Comparison
- HLTH 8815 Week 6: Aging Framing Critique
- HLTH 8815 Week 7: Disability Measurement Memo
- HLTH 8815 Week 8: Hidden Caregiving Analysis
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- HLTH 8815 Week 10: Program Assumptions Peer Replies
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HLTH 8815 Week 4 questions, answered
Does the memo tell people with several conditions what to do?
No. It is addressed to a program committee and argues about how the department's classes are designed. Where two handouts collide on something clinical, such as fluid instructions, the memo recommends routing the question to the participant's own clinician rather than settling it. Keeping the argument at the program level is what makes it public health practice, and it keeps your memo inside the course's scope.
What did Boyd and colleagues show?
They applied the clinical practice guidelines for several common conditions to one hypothetical older woman and found that following all of them together would produce a demanding regimen, with some recommendations working against others. The sample cites that finding for its central point only. It does not reproduce their counts of medications or tasks, because a memo is stronger when every figure in it can be checked.
Why a table instead of paragraphs?
A committee needs to see collisions at a glance, and a table puts each program's demands in the same row so conflicts are visible without reading the argument. Paragraphs explain the table afterward. If your prompt specifies narrative only, the same comparison can be written program by program, although the shaded cells are usually the part a committee remembers after the meeting.
Where can I find a free HLTH 8815 Week 4 sample paper?
The full Week 4 multimorbidity memo is on this page, setting four disease-specific classes' handouts side by side, naming where they collide and proposing which instructions give way, with three references.
Which collision does the memo treat as most urgent?
Fluids. The diabetes and falls handouts encourage drinking, while the heart failure handout limits fluids to about two liters a day. The memo ranks the heart failure limit first for residents who have heart failure because it prevents acute danger.