CHRONIC ILLNESS AND
AGING
CHRONIC ILLNESS:
• A long-lasting illness (in contrast to
ACUTE illness, which is temporary)
• Most common in older adults
Heart disease
– Cancer
– Cerebrovascular disease (stroke)
–
HEART DISEASE:
• Principal cause of death among o.a.’s
• Accounts for significant morbidity,
disablement & inactivity among o.a.’s
• Dominant factor--atherosclerosis
(build-up of fatty deposits within
arterial walls)
Mechanism:
• Atherosclerotic buildup------>
• Narrowing of arteries supplying blood
to the heart----->
• ISCHEMIA (denial of adequate blood
supply)
• Ischemic heart disease also known as:
coronary heart disease (CHD)
– coronary artery disease
–
A common form: myocardial infarction
(heart attack)
– persistence of deficient blood supply,
tissue dies. Dead area: an infarct
–
Heart attack may also result
from:
• Cardiac arrest-- some interruption of
normal pattern of cardiac contraction
• Coronary thrombosis--sudden
blockage of coronary artery with a
blood clot
• Strenuous exercise resulting in
suddenly increased need for O2
Mortality associated with MI:
• Over 70--2x that under age 70
• Symptoms of MI may differ in older
people than in younger ones
• “…while complete absence of chest
pain is very rare in acute myocardial
infarction up to middle age, it is a
‘mundane occurrence’ in old people”
• “…only about 1/3 of elderly patients
present with a classical prolonged
episode of chest pain”. (Kart & Kinney,
p. 111)
Heart Disease: Modifiable Risk
Factors:
• Cigarette smokers 2x MI rate of nonsmokers
• High BP
• High serum cholesterol levels
• Diabetes
• Obesity
• Sedentary lifestyle
Healthy People 2000 goals:
• 1. Increase prop. Of people whose
high BP is under control
• 2. Reduce mean-serum cholesterol
levels
• 3. Reduce dietary fat intake &
average unsaturated fat intake
• 4. Reduce prevalence rates of
obese/oveweight adults
• 5. Increase proportion of children &
adults engaging in regular, daily
physical activity at least 30 min/day
• 6. Reduce cigarette smoking among
people age 20 and older
• http://www.health.gov/healthypeople
CANCER
• 2nd leading cause of death in U.S.
• Incidence increases with age--Why?
Most forms of cancer have a long latent
period; initiating factors start during
youth
– increasing age and accompanying
physiological changes make one more
susceptible to actions of carcinogens
–
CA, cont’d
• …onset and management of many
cancers do not vary greatly in the old
and young. Prevention is still the
order of the day regarding cancer.” p.
113.
• This includes:
• 1. Avoiding unnecessary exposure to
ionizing & ultraviolet radiation
• 2. Implementing hygienic measures in
occupations involving exposure to CAproducing chemicals & dusts
• 3. Avoiding exposure to tobacco &
cigarette smoke
• 4. Have periodic preventive medical
exams.
CEREBROVASCULAR DISEASE
• Results from:
changes in blood vessels that serve the
brain tissue
– cerebral infarction
– cerebral hemorrhage
–
• When a portion of the brain is
completely denied blood, a
cerebrovascular accident (CVA), or
stroke results
• Severity is determined by location
and total amount of brain tissue
involved
• After diseases of the heart,
malignant neoplasms, & accidents,
cerebrovascular disease is the
fourth-leading cause of death in the
U.S.
Cerbral Thrombosis
• Main cause of stroke in o.a.’s
• Occurs when a formed clot becomes
lodges in an already narrowed artery.
• Stroke in evolution:
May develop over hours or even days
– Symptoms can appear within minutes or
hours after onset
–
Transient ischemic attacks
(TIA’S)--”mini-strokes”
• Warning signs of an impending stroke
• Transitory symptoms:
–
–
–
–
–
sudden motor weakness
speech dysfunction
dizziness
sudden changes in vision (especially in
one eye)
sudden falls
Cerbral Embolism: Another
cause of strokes
• Thrombus forms elsewhere in the
body and travels to obstruct a vessel
supplying the brain
• The onset of the stroke and its
damage is immediate
Damage from Strokes
•
•
•
•
One-sided weakness or paralysis
Sensory disturbances
Aphasia (speech disorders)
Mental symptoms
• Rehab should begin immediately
APHASIA
• Impaired ability to comprehend or
express verbal language
• Receptive aphasia:
difficulty in processing external stimuli;
– may not understand other’s speech or
what is read
– familiar objects may become
unrecognizable
–
• Expressive aphasia
–
A person understands what is said but
cannot form the words or gestures to
respond to stimuli
–
May be incorrectly associated with
mental deterioration