Week 8 Chronic illness in the older adult

Acute illness

• occurs swiftly and suddenly often without warning

• accident-leading to a fracture, MI, Brain Attack, infection

Chronic illness

• ever present, may be on the “back burner”

• tend to be managed, NOT cured

Common Chronic disorders

• Hypertension/Hypotension

• coronary Heart Disease (CHD)

• Heart failure

• Peripheral Vascular Disease (PVD)

• Cardiovascular Disease

Chronic illness trajectory

• preventive/pre-trajectory phase

• trajectory onset

• crisis phase

• acute phase

• stable phase

• unstable phase

• downward phase

• dying phase

Key points for the Chronic illness trajectory framework

• majority of health problems occur later in life

• may be lifelong adaptations

• chronic illness and management affect not only the individual but also family members and significant others

• there is some degree of predictability and unpredictability

What is the focus of older care?

Maintenance of function, not cure of disease

What is the limiter of function?

disability from chronic disease

Prevention needs to occur early in life through

screening, lifestyle changes and/or use of medication

Do chronic illness go away?

No, they often lead to weaken function and reduce the quality of life

Nonfatal chronic illness examples

• Osteoarthritis

• hearing or vision problems

• contribute to increase HC costs & disabilities

Serious illness

• eventually fatal

• cancer, organ system failures, dementia & strokes

Frailty

person/body has little reserves left

Key strategy for improving health is

prevention

Biggest challenge to health-related suffering, disability and death in the US

chronic diseases

• also accounts for vast majority of health care expenditures

Eliminating what risk factors would decrease chronic illness

• tobacco use

• poor nutrition

• inactivity

• hypertension

Frailty syndrome

• multiple comorbidities

• age-related physiologic vulnerability

• includes both physical and mental decline

• leads to an increase risk for morbidity & mortality

• becoming more common in older-old population; greater in females compared to men

• also found in populations with lower income & less education

Wellness in chronic illness

• wellness is not given but rather a state of being

• must be worked for

• chronic illness is often viewed by nurses and nursing students negatively

• older adults beleived in hope & refusal to give in

Improving care for chronic condition

• patient-centered care

• partnering

• quality improvement

• information & communication technology

• public health perspective

Patient centered care

supporting self management, communicating effectively

Partnering

patients, providers & communities

Quality improvement

measuring outcomes, EBP, Implementing

Information & Communication technology

registries, EHR, communication

Public Health Perspective

population based, systems thinking

Our role

• listen

• provide education

• ongoing assessment

• relieve symptoms that interfere with function

• set realistic goals

• give support

• encourage communication

• provide support & grief counseling

• assist with quality of life

• maintain hope

• assist to die with dignity & comfort

• direct care giver

• resource person

• advisor

• teacher

• facilitator

Nurse as the facilitator

• create therapeutic environment

• educate

• empower

• reinforce/affirm and validate

• remove or modify barriers of self care and self awareness

• keep treatment plans simple

Challenges with caring for Older adults with chronic illnesses

• long term & uncertainty

• costly

• difficult coordination of care

• little preventative care

• lack of geriatric expertise and chronic care

• finding providers who listen

• need for advocate or coach

General principles for caring for older adults with chronic illnesses

• manage pain

• prevent injury

• promote independence