Chronic Illness and Older Adults

KEY POINTS

CHRONIC ILLNESS
Chronic illnesses are those that are prolonged, do not resolve spontaneously, and
are rarely cured completely.
Most chronic conditions may be viewed as a trajectory with overlapping phases,
in which an individual moves from a level of optimum functioning, with the illness in
good control, to a period of instability in which they may need assistance.
Corbin and Strauss identified seven tasks of those who are chronically ill. These
include managing and preventing crises, controlling symptoms, following the treatment
regimen, reordering time, adjusting to disease changes, preventing social isolation, and
attempting to normalize interactions with others.
Preventive health behaviors are those voluntary actions taken by an individual or
group to decrease the potential threat of illness.
Primary prevention refers to measures that prevent the occurrence of a
specific disease.
Secondary prevention refers to actions aimed at early detection of disease
that can lead to interventions to prevent disease progression.
Tertiary prevention refers to activities (e.g., rehabilitation) that limit
disease progression or return the patient to optimal functioning.

NURSING ASSESSMENT AND MANAGEMENT: CHRONIC ILLNESS

Nurses play a critical role in the assessment and management of chronic
conditions: comprehensive assessment, planning of care, teaching the patient, family, and
caregiver, implementing strategies, and evaluating patient and family outcomes.
Self-management is an individuals ability to manage his or her symptoms,
treatment, physical and psychosocial consequences, and lifestyle changes in response to
living with a chronic disorder.

OLDER ADULTS
Demographics of Aging
The U.S. population of older adults is rapidly growing, becoming older and more
ethnically diverse.
Factors contributing to a growing aging population include improved treatment of
disease through drug therapy, earlier detection of illness, and a greater emphasis on health
promotion and disease prevention.

Attitudes Toward Aging

A number of myths and stereotypes about aging exist and are often supported by
the media. These can lead to errors in the assessment and care of older adults.
 Ageism, a negative attitude based on age, can lead to discrimination and
disparities in health care provided to older adults.

Biologic Aging
Aging reflects the changes that occur over time.
Biologic aging is a balance of positive (e.g., healthy diet, exercise, social support)
and negative (e.g., smoking, obesity) factors.

Age-Related Physiologic Changes

Age-related changes affect every body system; the age at which changes occur
varies from person to person.
It is important for you to assess for age-related changes in all individuals.

SPECIAL OLDER ADULT POPULATIONS

Most older adults live with at least one chronic condition, such as hypertension,
heart disease, heart failure, cancer, diabetes, or arthritis.
Other vulnerable groups of older adults who may experience limited health care
services include those in certain geographic locations, the homeless, the poor, or those
affected by ethnic or cultural biases.
The frail older adult is one who is usually over age 75 years and experiences
changes in physical function, energy, gait speed, and strength that interfere with function.

SOCIAL SUPPORT AND OLDER ADULT

Elder mistreatment describes intentional acts by a caregiver or trusted other that
cause harm or serious risk of harm to a vulnerable older adult and/or neglect meeting the
basic needs of a vulnerable older adult. Such acts can include physical and/or mental
abuse, sexual abuse, medical abuse, financial exploitation, neglect, and abandonment.
Family members are perpetrators in approximately 90% of domestic elder abuse,
neglect, and exploitation.
Low social support is a risk factor for both self-neglect and mistreatment of
vulnerable older adults by trusted others.
Self-neglect is when an individual is unable to meet their basic needs (e.g., food,
water, hygiene) and refuses help. The individual who self-neglects often has multiple
untreated medical or psychiatric conditions.

SOCIAL SERVICES FOR OLDER ADULTS

Most older adults are beneficiaries of at least one social or government program.
Social support may involve family, the community, religious organizations, social
welfare agencies, health facilities, and government support (Medicaid and Medicare).

MEDICARE AND MEDICAID

Medicare is composed of four parts: A, B, C, and D. Part A covers inpatient
hospital care and limited skilled nursing facility care; Part B covers outpatient treatment
and physicians and primary care providers services; Medicare Advantage Plans, referred
 to as Part C, are offered by private companies approved by Medicare; and Part D covers
prescription drugs.
Home health care services require physician recommendation and skilled nursing
care for Medicare Part A reimbursement.
Medicaid is a state-administered program that assists eligible low-income persons.
Since it is state administered, eligibility and coverage vary by state.

CARE ALTERNATIVES FOR OLDER ADULTS

Many older adults remain in their residence and, if needed, are assisted through
community support, religious organizations, living adaptations, and housing assistance.
Older adults with special care needs include people who are in need of assistance
with ADLs, cognitively impaired, homebound, and no longer able to live at home and/or
the homeless. The older adult may be served by adult day care, adult day health care,
home health care, respite care, long-term care, and programs for all-inclusive care of the
elderly (PACE).
Continuing care retirement communities, congregate housing, and assisted living
facilities are housing options for older adults.

LEGAL AND ETHICAL ISSUES

Legal concerns regarding advance directives, end-of-life care, estate planning,
taxation, and appeals are a concern for many older adults.
Ethical issues surrounding care of the older adult include evaluating the patients
ability to make decisions, initiating resuscitation, treating infections, and providing
nutrition and hydration in addition to financial and material exploitation by others.
The nurse plays a role in acknowledging when these issues are present and
advocates for an institutional ethics committee.

NURSING MANAGEMENT: OLDER ADULTS

As a nurse caring for the older adult, you can advocate for accurate and
comprehensive assessments in which health and disease states are accurately diagnosed
and actively teach health promotion and disease prevention strategies.
The focus of a comprehensive geriatric assessment is to determine appropriate
interventions to maintain and enhance functional abilities of the older adult. It includes a
thorough history, mood assessment, mental status evaluation, ADL and instrumental ADL
(IADL) evaluation, social-environmental assessment, and physical assessment.
For the hospitalized older adult there are special concerns related to high surgical
risk, acute confusional state known as delirium, health careassociated infection (HAI),
and premature discharge with an unstable condition.
ADLs, including bathing, dressing, eating, toileting, and transferring, are
important for you to assess in the older patient living with chronic condition(s).
Reducing disability through geriatric rehabilitation is important for quality of life
of older adults.
Age-related changes in pharmacodynamics and pharmacokinetics of drugs as well
as polypharmacy put older adults at risk for adverse drug reactions.
 Depression is the most common mood disorder in older adults.