Chapter 22 Living with a Chronic Illness Chronic Illness Those that are persistent regardless of treatment Long Progress slowly Require ongoing treatment Late disease- may interfere with daily lifestyle **Identify early enough to prevent problems later on (Cholesterol, HTN) Late diagnosis may be found r/t “end organ damage” Late Diagnosis Goal is to Manage rather than Cure Minimize complications, delay associated mortality, optimize health-related quality of life while being holistic Common Chronic Diseases Worldwide Cardiovascular/cerebrovascular Cancer Respiratory disease Diabetes Represent 63% of all deaths, killing 36 million a year 6 million attributed to smoking ALONE Common Chronic Disease US Hypertension Osteoarthritis Heart disease Older adults; 92% have at lease one 77% have at least two A chronic illness added onto aging increases the likelihood of needing assistance Developing frailty increases over time Exam Prep by Gatlet The most common chronic diseases in the United States are heart disease, stroke, cancer, diabetes, obesity osteoarthritis. Exam prep by Gatlet In a younger adult, the early signs of a pending chronic disease may be identified early enough to prevent later problems (e.g., controlling blood pressure to prevent heart disease). However, In older adults, a chronic disease may not be diagnosed until some amount of “end organ damage” has already occurred. For example, irreversible diabetic retinopathy may be found during an annual eye examination indicating that the diabetes has been present for some time. Although there are many age-related changes in the older adult, it is still possible to identify chronic illness. Chronic illness is common in younger adults, although it is more common in older adults. Chronic Disease Rehabilitation phase Home or at facility Acute exacerbation rehab stabilize and full function Informal help Formal help **Chronic disease are not normal parts of aging Many can be eliminated through preventive strategies- starting at a young age Tobacco use, unhealthy diet, physical activity, alcohol abuse (taking medications as prescribed) Exam Prep By Gatlet A number of risk factors are within control of the individual and, if eliminated, a significant amount of disease could be prevented. We know now that many chronic diseases could be eliminated through preventive strategies, especially when started at a young age. Major Risk Factors for the Development of Chronic Disease that can be eliminated via lifestyles are: Tobacco use and exposure to secondhand smoke or pollutants Poor nutrition Physical inactivity Excessive alcohol use Obesity Trajectory Model A life course perspective- a health and wellness continuum Individualized- even with same disease The pre-trajectory phase is characterized by the absence of signs or symptoms of the illness. The trajectory onset includes the diagnostic period. The downward phase is characterized by a progressive decline in physical/mental status, characterized by increasing disability/symptoms. The comeback phase is characterized as a period of temporary remission from the crisis Pre-trajectory: before illness, preventive stage Trajectory onset: signs and symptoms, diagnostic period Often a chronic disease is found while monitoring another Stable: controlled illness course/ symptoms Maintain high quality of life, secondary prevention Unstable: illness course/ symptoms not controlled by regimen but no hospitalization Strengths are stressed, avoid delayed treatment frail can down spiral quickly Exam Prep by Gatlet Role of a nurses during stable phase includes secondary prevention, including the receipt of high-quality medical care provided by nurse practitioners high-quality nursing from the gerontological nurse and staff. For those with more complex chronic diseases, achieving the highest outcome possible requires coordination between members of the health care team, often with the nurse coordinating this care Acute: active illness complications, requires hospitalization Crisis: Life threatening Discussion of code status Downward: Progressive decline in physical/mental status, increasing disabilities/symptoms Could be triggered by event (acute MI, fall, fracture) Comeback: temporary remission from the crisis- not likely in very frail Every effort to stop escalating symptoms, keep patient comfortable Ends in death, provide comfort, receives highest quality of care Dying: immediate weeks, days, hours preceding death Frailty Age itself nor presence of chronic disease is a predictor of who will become frail Incidence of frailty increase with age Formal diagnosis: presence of at least 3- unintentional weight loss, self-reported exhaustion, weak grip strength, slow walking speed, low activity level Highly associated with falls, hospitalization, death Primary frailty Secondary frailty Downward progression of specific chronic disease Poor prognosis Exam prep By Gatlet Frailty is defined as evidence of three or more of the following: unexplained weight loss, self-reported exhaustion, Weak grip strength, slow walking speed, and low activity One of the most common chronic conditions noted in the United States is: a. heart disease. b. malnutrition. c. pneumonia. d. kidney failure. Which is a sign of frailty? a. Unintentional weight gain b. Hyperactivity c. Weak grip strength d. All of the above
