Running head: EFFECTS OF CHORNIC ILLNESS ON ELDERLY

Effects of Chronic Illness on Elderly

Tessa Carson, Nicole Stolte, Rachel Stolte
Missouri State University
Jonna Laine
Satakunta University

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In accordance to WHOs definition, a complete state of physical, mental and social wellbeing, and not merely the absence of disease or infirmity, the members of this group constructed
one of similar interest with the addition of spiritual well being (Harkness, & DeMarco, 2016, p.
63). Health is living in a physical, mental, social and spiritual state of well being; which may or
may not include the absence of illnesses and disease. Although health impacts each age group
and population throughout the lifespan, this paper will focus on the effects of chronic illness in
the older adult. The older adults living with a chronic illness have individualized definitions of
health because they adapt to living with this condition every day, as opposed to overcoming an
acute condition. Chronic illness has the potential to negatively influence the health of the older
adult because it limits their quality of life (Erdtmann, 2015). It is important for the older adult, as
well as the healthcare provider, to be aware of this and the patients definition as it pertains to
health because it will influence the health care decisions made by the patient and interventions
provided by the nurse. Throughout this paper, the United States and Finland and are compared
and contrasted concerning chronic issues of the elderly in which attention will be brought to the
vulnerability group, rehabilitation, concerns for health promotion and disease prevention,
government structures and non-government organizations, and nursing theories applied.
Vulnerability Group
The elderly adult population is made up of individuals who are generally age 65 and
older. Due to the physiologic strains on the body throughout the years, wear and tear makes this
population more subjected to long-term illness or injury. Elderly living with chronic diseases will
need periodic contact and reevaluation of their capacity, resources and motivation to manage
their conditions, which falls in the hands of healthcare providers, the community, and political
aspects in which care takes place (Eliopoulos, 2014, p. 463).

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The development of elderly's health aims are: the conservation of ability, the prevention
of diseases, the prevention of abilities weakening, the support of independency, the maintenance
and increase of life quality, the reduction of the need for care, the prevention of inpatient, and the
delay of death (Source 1).
The elderly, or specifically the elderly with a chronic disease, may be living in an
environment or a society that affects their daily lives. Some older adults may feel isolated from
their communities because they are living independently. Most older adults embrace this
independence and want it to continue as long as possible, but this may mean that they are
removing themselves from the society. The older adults may also become more vulnerable if they
are living alone because they may have nobody close by to call in case of an emergency. The
elderly experience a decrease in their senses, so it is possible they are exposed to dangers that
they are not aware of. When an individual is suffering from an illness or disease, the body may
experience a variety of symptoms that can alter the physical, mental, social, and spiritual aspects
of their life. Chronic diseases are more prevalent in the elderly, which make up a larger than
expected percentage of the population (Eliopoulos, 2014).
In the United States, the total population is 308,745,538. Of this number, 40,267,984 are
over the age 65 and 5,493,433 are over the age 85. In Finland, the total population is 5,488,371.
Of this population, 790,000 are over the age 65 and 80,000 are over the age 85. To compare these
two countries, the United States has 13% of the population over age 65 and 1.7% of the
population over age 85. In Finland, 14% of the population is over age 65 and 1.5% of the
population is over age 85 (Census Population, n.d.). In comparison of percentages, the
populations are very similar in the number of elderly individuals apart of each population. Many
different risk factors affect the elderlys possibility of developing a chronic illness.

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As a greater number of people are reaching old age, the incidence rate of chronic disease
is more prevalent and incidence rates continue to climb. According to Charlotte Eliopoulos in
Gerontological Nursing, more than 80% of older adults have at least one chronic illness, most of
which significantly affect activities of daily living as well as the quality of day to day life
(Eliopoulos, 2014). Risk factors and determinants of the health status of the elderly are
developed and built upon over their lifespan. Common trends that cause a reduction in health in
association with chronic illness can include diet, exercise, past medical history, exposure to
environmental pollutants and toxins, access to health care, and having the funds to support health
care to name a few.
Certain infectious diseases are also easily contracted depending on the geographical
background and living environments one is associated with. The four most infectious diseases
are the following; aids, malaria, tuberculosis and respiratory tracts. These diseases are most
dangerous to poor people. The old leader of WHO, Hiroshi Nakajima, has said that poverty is the
deadliest disease in the world. Poverty and bad health have a high connection. If one is ill, then
the risk of being poor rises as one is unable to work. And vice versa: if one is poor the risk of
getting a chronic illness gets bigger as one does not have the money for treatments. It is valuable
to the individual to be aware of how their environment and socioeconomic status may hinder
their health and well-being (Source 2).
The United States and Finland measure the health of older adults by their quality of life.
In both countries, the elderlys independence is viewed as sacred. The elderly wish to live in their
own homes as long as possible. To be able to do this, they need the autonomy to perform daily
activities and care for themselves. Chronic illnesses can make performing these activities and

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autonomy difficult, especially when the chronic illnesses have no known cure or adaptability
(Ollongvist, Aaltonen, Karppi, Hinkka, & Pntinen, 2008).
Nurses are more available in the US health care setting than the doctors, therefore, it is up
to the nurses to build therapeutic relationships with elderly clients to empower them to treat and
handle their chronic illnesses so that they can have autonomy and a higher quality of life
(Henriques, Costa, & Cabrita, 2012). However, in Finland, the doctor is as much available as the
nurse which shows a relatively big difference where the responsibility of the well being of the
patient is on shared manners. Older adults need to adapt to their changes in health status to make
the appropriate adjustments to maintain a high quality of life.
Chronic Illnesses Amongst the Elderly
In this chapter the leading diseases are introduced from both countries.
US - Ten Leading Chronic Conditions Affecting Populations 65 and Older
1.

Arthritis

2.

High blood pressure

3.

Hearing impairments

4.

Heart conditions

5.

Visual impairments

6.

Deformities or orthopedic impairments

7.

Diabetes Mellitus

8.

Chronic sinusitis

9.

Hay fever and allergic rhinitis (without asthma)

10.

Varicose veins

Finland

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In Finland the chronic diseases amongst public include heart diseases, hypertension,
diabetes, asthma and allergies, chronic lung disease, cancer, memory disorders, support- and
physical organisms and lastly, mental health problems.
The most common heart- and blood vessel diseases include coronary artery disease, heart
operation failure and cerebrovascular disorders. Coronary artery disease is mostly impacted of
lifestyle, such as smoking, but also by the fat percentage in nutrition and blood pressure.
The Coronary Artery Disease
Occurs for example in heart muscle gangrene, heart failure and in angina pectoris. The
disease may also occur in sudden death, on first time, to clinically healthy people.
With heart operation failure is meant that the heart's pumping action deteriorates. The most
common causes are coronary artery disease and hypertension. The rarer causes include inborn
heart problems, acquired valvular heart disease and heart muscle diseases.
Cerebrovascular accident means that the cerebral arterial blood is flowing temporarily or
sudden deterioration. These lead to brain dysfunction such as deterioration of conciousness or
paralysis. (Terveyden- ja hyvinvointilaitokset www-sivut 2014)
Memory Disorders
Memory diseases are public diseases. Every third, over 65 year old, reports of memory
problems. In Finland there are yet 120 000 people, whose cognitive actions have slightly
diminished, and moreover 35 000 slightly and 85 000 at least moderate symptoms of dementia.
The most common progressive memory disorder is Alzheimer disease. Other progressive
memory disorders are, for example, the memory disorder caused by cerebrovascular, dementia
with Lewy Bodies and memory disorder caused by Parkinson's. Especially in the elderly age
groups it is normal that in memory disorder one can meet the symptoms and features of

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Alzheimer and cerebrovascular disease.(Kyp hoito www-sivut 2015).

Cancer
On top of age and genetics cancer risks are highly influenced by lifestyle and
environment. The biggest lifestyle risks for cancer are smoking, unhealthy diet, excessive use of
alcohol, slight sports, heavy amount of sunlight, skin burn and overweight. (Terveyden- ja
hyvinvoinnin laitoksen www-sivut 2014)
Support Member- and Musculoskeletal Diseases
Almost everyone gets osteoarthritis with ageing but with many people there are only a
few problems with it. Therefore when a person has interfering symptoms one can call it a
disease. The older the more osteoarthritis is usually found when examined. However the eldest
that have symptoms do not anymore feel the pain but the physical condition weakens and so fort
affects the life. Obesity, heavy work and genetics increase the risks to get it. On the other hand,
fragile and osteoporotic bones seem to protect from it.(Reumaliiton www-sivut 2005)
Bone Diseases
The amount of bone one has is the biggest when being 30 years old. After that the bones
start to lessen from all humans. For the elderly the bone can be so thin that it cracks when falling.
The cracks caused by osteoporosis are a very big and expensive health problem. The importance
of that will increase in the future when there are more elderly in the society. For adults the lack
of D-vitamin is very common. The elderly who eat unilaterally and do not spend time outdoors
are mainly under danger. (Reumaliiton www-sivut 2005)
Mental Health Problems
Depression is the most common mental health problem amongst elderly. For them it is
often in connection with anxiety. Loss and crisises, mourn the mat and social network declining

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as well as loneliness may all cause anxiety and therefore let off depression. It is not often easy to
recognize depression in the elderly. It can occur only on physical symptoms such as loss of
appetite, loss of weight, odd pains and digestion problems. Irritability and excessive use of
alcohol may hide the mood change symptoms. When the physical symptoms are over taking it
may mislead the health care professionals.
Delusional disorder which includes pronounced suspiciousness or paranoia , is a typical
mental problem for elderly who live alone. It occurs for women more often than men. Memory
loss and sensory function's weak functioning may predispose to developing paranoia.
Therefore, when it comes to illnesses we can conclude that the same types of illnesses
occur in both countries however it remains unknown how the diseases are seen in US due to lack
of information. Despite the lacking information we can conclude in the next part similarities in
the relationship between the nurse and the elder patients. (Furman 1993, 120).
Older Adults Relationship with Nurses, Applicable for Both Countries
Older adults wish to age with autonomy, and a high quality of life. Because chronic
illness can get in the way of aging with this independence and dignity, medications are
prescribed to help the older adult manage the symptoms of the chronic illness. The elderly
reported that the relationships with healthcare professionals are crucial to their management of
their medications and the information given by the nurse during consultation is very important
(Henriques, Costa, & Cabrita, 2012, p. 3096).
The elderly feel safe around nurses and are empowered to ask them questions if they are
confused about their medication regimen. Effective communication between the patient and
nurse leads to better medication adherence. This study could also be applied to different areas of
health care in that nurses offer professional help that the elderly can trust.

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Nurse Relationship, not Applicable in Finland

Because nurses are more available in the US health care setting than the doctors, it is up
to the nurses to build therapeutic relationships with elderly clients to empower them to treat and
handle their chronic illnesses so that they can have autonomy and a higher quality of life
(Henriques, Costa, & Cabrita, 2012). However, in Finland the doctor is as much available as the
nurse which shows a relatively big difference where the responsibility of the well being of the
patient is on shared manners.
Rehabilitation
Older adults living with chronic illness face many hardships during their daily lives.
Chronic conditions such as arthritis, hypertension, visual and hearing impairments, diabetes, and
heart diseases can make life difficult. Older adults typically have one, if not more chronic
diseases. If they have more than one, it is termed comorbidity (Eliopoulos, 2014). The chronic
conditions can result in frustration, fatigue, pain, and isolation (Chronic Disease SelfManagement Program, n.d.). In both the United States and Finland, rehabilitation programs are
put in place to help the elderly suffering from chronic illness to adapt to the illness and still
maintain a high quality of life. Rehabilitation can be defined as, an active, process; that is
deliberate, planned, skilled, and continuous. While the focus may be on functional abilities,
restoring wellbeing and maintain social roles to enhance the quality of life of the older person,
who remains central, is paramount (Clay & Wade, 2003, p. 26).
In the United States and Finland, the elderly aspire to continue their independence and
quality of life (Ollongvist, Aaltonen, Karppi, Hinkka, & Pntinen, 2008). The elderly from both
countries wish to live in their own homes as long as possible. When an elderly individual has a
chronic condition, it can make activities of daily living or instrumental activities of daily living

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more difficult than before their chronic condition. A condition that could cause a decline in the
ability to feed oneself, bathe oneself, or prepare meals is arthritis. Arthritis is the first leading
chronic condition affecting populations aged 65 and older in the United States (Eliopoulos,
2014). When arthritis is in the wrist or fingers, it causes stiffening and pain. If severe enough, the
older adult is unable to use the joint the arthritis affects, causing them to have a functional
decline of self care abilities. It is important to consider that for both countries, the United States
and Finland, older adults with chronic conditions wish for informal care or home health services
to come into their home to help with their activities of daily living rather than be forced to live in
an institution or assisted living facility. These informal caregivers consist of family, friends, and
neighbors. Formal caregivers are individuals hired from a home health service. The help from
these caregivers fulfill the wishes of the elderly is in hopes to keep them out of a formal
institution, such as a nursing home or assisted living community. Keeping older adults in their
home also promotes their independence, for them to be in charge of their own health and
participate in activities that will keep them active. These activities could be exercising, following
a health diet, and educating him or her about their chronic condition and how to live with it. In
Finland, an example of formal services is a well-organized bathing service (Ollonqvist et al,
2008, p. 116). Home services, informal or formal, provided to the elderly are important in both
countries because when elderly persons receive appropriate support according to their needs,
the time they are able to live at home may be prolonged (Ollonqvist et al, 2008, p. 122).
There are many challenges older adults face in order to receive rehabilitation care. If an
older adult is isolated, does not have any family or friends, having an informal caregiver would
be near impossible. If the older adult is poor or lives in poverty, finding a formal caregiver would
be very costly without insurance or funding from the government. Older adults in these

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situations, would not benefit from the rehabilitation service of home health, and is more likely to
have a decline in their self-care abilities related to their chronic condition. Nurses can advocate
for these patients by referring them to social workers or different institutions in hopes of finding
the proper funding for these programs. Another challenge is when older adults have multiple
caretakers providing rehabilitation care in an interdisciplinary fashion. Members from different
professions might work on addressing their goals for the patient separately, and not take into
account the other members of the multidisciplinary team. An example of this could be a nurse
and the occupational therapist. The nurse could educate the client about proper nutrition and
what to eat at each meal. If the nurse does not teach the client how to open jars or cans and relies
on the occupational therapist to teach the client the task, the client will not be able to open the
jars or cans to eat the nutritious meal. It is important for the interdisciplinary team to have open
lines of communication and work toward the same goals (Clay & Wade, 2003).
In the United States and Finland, many rehabilitation programs are put in place to help
the older adult suffering from a chronic condition. In Finland, researchers suggest the need for
intermediate care. Intermediate care is defined as the services that do not require the resources
of an acute general hospital, but are beyond the scope of the traditional primary care team (Clay
& Wade, 2003, p. 26). In the United States, one example of rehabilitation care is referring the
patient to occupational and physical therapists to help with mobility issues. Many different
rehabilitation programs exist depending on the chronic illness of the elderly.
According to the US Department of Health, rehabilitation should be part of every
nurses role (Clay & Wade, 2003, p. 26). Finland also agrees with this same statement. The
nurse should motivate the older adult to perform self-care, provide information for the older
adult to make informed decisions, teach skills that maintain optimum functioning that prevent

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deterioration and enhance quality of life, listen to the older adult to evaluate the success of the
rehabilitation services provided. The prevention efforts are aimed towards decreasing physical,
psychological, and economic costs of chronic illness in the elderly (Harkness & DeMarco, 2016).
Concerns for Health Promotion and Disease Prevention
Some of the main leading causes of death in both Finland and the United States are
cardiovascular diseases. Cardiovascular diseases affect adults, especially the elderly, because the
main risk factor for this disease is based on lifestyle factors. Little regulation in the past, lack of
knowledge, changing policies, social isolation, lack of mobility, and many other factors affect the
older adults access to information on reducing the risk of cardiovascular diseases. An example
of how both countries implemented a health policy was to declare some public areas smoke free.
This policy helps to reduce individuals to secondhand smoke and will maybe help influence
those who do smoke to quit. Both of these countries also enforce a high tax on tobacco products.
In the United States, a national program called My Plate educates the public and is a resource
tool to live a healthy lifestyle. My Plate suggests heart healthy foods to eat and includes an
exercise plan as part of the daily diet to promote health and wellness. A program that is specific
to Finland is the Keys to Health national TV broadcasts that aim to educate the public about high
cholesterol and what a heart healthy diet should consist of. The goal of this TV program is to
motivate individuals to make the changes themselves. In the addition to policies put in place to
eliminate smoking and programs such as My Plate, there are a multitude of efforts to initiate
health improvements (Stahl,Wismar, Ollila, Lahtinen, & Leppo, 200).
In the United States, Healthy People 2020 is a set of goals that is guided by the
Department of Health and Human Services. It is a national plan that identifies focal areas for
health improvement for the general public. The two goals of Healthy People 2020 are to

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increase the quality and years of healthy life and to eliminate any barriers to accessing care,
specifically through health disparities (Harkness & DeMarco, 2016, p. 86). What is unique
about Healthy People 2020 is that is contains measurable objectives. Change is not possible
without realistic solutions; availability, cost, and benefits are considered when making the
Healthy People 2020 objectives. Over the years, the objectives have expanded to include
genomics, global health, healthcare-associated infections, LGBT (lesbian, gay, bisexual, and
transgender) health, preparedness, and social determinants of health (Harkness & DeMarco,
2016, p. 86).
In Finland, the North Karelia initiative put in place a community based program that has
a goal of having an equal access of information and healthcare for all. To accomplish health
promotion in this country, the government, NGOs, and the private sectors collaborate with each
other in order to bring access to health to individuals regardless of their socioeconomic status.
This project was the worlds first community based program and set high standards for other
countries to follow. The public health law states that instead of focusing on tertiary services, or
curative services, that health care should be focused on primary services, or preventive care
(Stahl et al, 2006).
The Ottawa Charter, which is the was a product from the First International Conference
on Health Promotion, created five goals for health promotion. These goals include build a
healthy public policy, create supportive environments, strengthen community actions, develop
personal skills, and reorient health services (Stahl et al, 2006, p. 8). This group encourages
individuals to diminish the inequalities of health and to expand the determinants of health to
create a better access to information (Stahl et al, 2006).

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For both countries, the nurses should be concerned with the elderlys accessibility to
health care and health care information. If the individual does not have access to appropriate
transportation, is socially isolated, or has a physical disability it may be difficult to travel to a
health care provider or to other resources. Nurses should also be concerned about the education
materials and how the information is presented to the older adult. Older adults are capable of
learning new information, but it may take them a little longer to learn this information. The older
adult may also have poorer eyesight or be hard of hearing, so its important that the learning
environment is appropriate for the client to be presented with new information. Many different
programs are set in place to provide health promotion and disease prevention for the elderly with
chronic illness.
Government Structures & NGOs
Health care is a dynamic process that is continuously up for reevaluation and
readjustments in order to provide the best quality of care for the nation. The public health
delivery system in the United States supports health concerns on a federal, state and local
governing level.
The federal government creates policy, financing and regulatory enforcement when a
service is identified that could benefit citizens (Harkness & DeMarko, 2016, p. 27). In addition
to the role in regulation of public health entities through the Department of Health and Human
Services (DHHS), the federal government allocates tax funds to state governments to support
certain public health programs (Harkness & DeMarko, 2016). Entitlement programs such as
Medicare, Medicaid and Tricare are created to support low-income family needs, which are
federally governed, however Medicare does not solely apply to low-income needs.

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State governments also play a role in public health to regulate activity, program
responsibility and resource allocation, which leaves enforcement and implementation of public
health activities within the community at the local level of government (Harkness & DeMarko, p.
28). The state department overseas the local level, but the local level creates their own structure
based on the needs of the community.
The format of the United States health care regulations is very similar to the Bismarck
Model. Most of the population, who enters Medicare age, will wait to enroll and get Medicare
benefits because they are receiving employee stipends for their health care. After working for 10
years or more, the population is allowed to collect Social Security benefits, much like a welfare
system as discussed in the model. In contrast with this model, however, the United States health
insurance does not have universal health coverage, though with Patient Protection and
Affordable Care Act, there is more coverage than previous years (Health Care Systems - Four
Basic Models, n.d.).
When developing health care reforms and referendums, it is important to assess the health
needs of the nation, possible economic impact, and consider past successes and failures. Current
challenges facing the United States health system include a high population of uninsured
individuals, access to health insurance coverage, and specific public health problems identified in
Healthy People 2020 Initiatives such as obesity. Efforts to re-organize health care, such as
Patient Protection and Affordable Care Act (ACA), has been greatly demanded but not yet
proven a successful projection of the future in the five year period it has been in action (Bliss,
2013). The transition of the American health system will continue to change according to the
needs of its Nation.

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In contrast to the United States, Finland offers universal coverage for a range of health
services delivered mostly by publicly owned and operated providers who receive funding mostly
through general taxation (Vuorenkoski, 2008). This more so decentralized system runs on several
major components all of which are responsible for different aspects of health care such as the
municipal health care, private health care and occupational health. The national administration
defines general health policy guidelines and directs care at the state level; it does not organize
services itself. The Ministry of Social Affairs is similar to the US Congress and Center for
Medicaid Services (CMS) in that it directs policy guidance for social security, social welfare and
health services. The ministry, in close collaboration with policy decision makers, sets broad
developmental goals, prepares legislation and other key reforms, and oversees the
implementation. Health services for the residents fall under the responsibility of Municipalities.
To fund these services, municipalities levy taxes and receive state subsidies. This funding allows
hospitals to develop in varied districts along with specialized hospitals each of which are owned
and financially supported by the members in the municipality (Teperi, J., Porter, M.,
Vuorenkoski, L., & Baron, J. 2010).
In addition to Finlands public health system, Finns are eligible to partial reimbursement
to private health care services through the National Health Insurance (NHI) system
(Vuorenkoski, 2008). The NHI model includes elements of the Bismark Model, as mentioned
above, as well as the Beveridge Model. NHI uses private-sector providers, but payment comes
from a government-run insurance program that every citizen pays into (Health Care Systems Four Basic Models, n.d.). The dual payment system of the municipal funding, with the
exemption of outpatient drugs and transport costs, and the NHI funding creates challenges in

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the overall efficiency of service production where pharmaceutical care with dual financing
incurs cost shifting problems (Vuorenkoski, 2008, p. 147).
Similar to any nation, there are reforms created to improve the system of health care, in
the Finns case, the goal towards a more centralized system, promote cost containment with
pharmaceuticals, developing an electronic patient record program, introduction of shorter waiting
times, and increasing the number of physicians are a few up for discussion (Vuorenkoski, 2008).
Although there are variations in the health care systems between the United States and
Finland, similarities do exist. Socioeconomic differences are determinants in the use of health
care services for individuals. In the year 2000, Finland was among the highest OECD countries
pro-rich inequity in doctor visits along side of the United States meaning those who can afford
the best care, will generally seek private health services and specialty procedures or treatments
(Vuorenkoski, 2008, p. 146). In addition, white-collar workers are healthier than blue-collar
workers, employed people are healthier than the unemployed, and people with high income and
the highest educational level are healthier than low-income people with only a basic education
in Finland, which resembles related statistics to that of the United States (Vuorenkosky, 2008, p.
146).
To support the health care systems of the United States and Finland apart from
government funding and taxation, National Government Organizations (NGOs) are quite
resourceful. Beyond public and private control and ownership of healthcare services, NGOs are
helpful in aiding to the well being of individuals or groups through voluntary or philanthropic
organizations (Harkness & DeMarko, 2016). To direct this in the attention towards preventing
chronic illness among the elderly, the United States and Finland both have taken action with
NGOs separately as well as collaboratively to slow the effects and impacts of chronic illnesses

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such as arthritis, hypertension, visual and hearing impairments, diabetes, and heart conditions
just to name a few.
With the focus being on the high prevalence of cardiovascular disease in the US and
Finland, multilateral agencies, bilateral agencies and NGOs are formed with the goal to improve
health and wellbeing. Although a multilateral agency such as the Word Health Organization
(WHO) receives funding from both governmental and nongovernmental sources, the importance
of involvement and support from NGOs such as the World Heart Federation, Partnership to Fight
Chronic Disease, American Heart Association are all vital components in the prevention efforts.
Finland municipalities and hospital districts can purchase services form active NGOs and
foundations. These organizations can receive subsidies from the Finnish Slot Machine
Association which collections a sum from a monopoly in place on gambling. This is governed by
the state (Vuorenkoski, 2008). The most widely known involvement of NGOs in Finland which
spread internationally is the North Karelia Project, which coupled with WHO in attempts to
identify risk factors of cardiovascular disease and how implementing change with low resource,
community based intervention was possible in dramatically decreasing cardiovascular disease.
No matter what Nongovernmental voluntary organization exists, if it relates to health and social
welfare sectors, the Finnish Slot Machine Association is the main contributor with an annual
donation of 300 euros (Vuorenkoski, 2008). The NGOs then have a focus of these donations to
tend to the targeted groups such as old and disabled people, young families, people with chronic
disease, and substance abusers. The association is inclusive to only third-sector organizations, so
the municipal health services or private for-profit making providers must find another means of
funding if needed (Vuorenkoski, 2008).

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The United States NGOs are often run by altruistic, nonprofit organizations and help
keep people healthy through voluntary and philanthropic services (Harkness & DeMarko, 2016,
p. 32). In relation to overall health care, private community hospitals may be supported by
community NGO groups to ensure that the vulnerable populations have access to health care; this
may or may not be free. NGOs can also sponsor community health education programs and
prevention screening clinics that might be vital resources in the health of a new chronic illness
discovery or living with the diagnosis. Specifically in Green County, NGOs such as Area
Agencies on Aging can provide information on useful agencies that will be of assistance to the
individual. Partnership to Fight Chronic Disease as well as The American Heart Association is
among commonly known organizations in raising awareness and prevention for chronic illness.
Raising National awareness of cardiovascular disease and stroke has been made into fun
activities such as Jump Rope for Heart, sponsored by the American Heart Association. It is never
too early to start prevention and raise awareness on the effects of wear and tear in ones body as
they age.
To overcome obstacles such as lack of funding or support, it is imperative that
organizations such as WHO, World Bank as well as national support such as USDHHS work
together to find solutions for a healthier nation and world. Research being exchanged in the
OECD is good in determining which areas are implementing successful interventions as opposed
to countries that may be deteriorating in morbidity or mortality for example. In Finland and the
United States, a more cost effective long-term elderly care center and elderly home may decrease
the risk of chronic illness. In Finland, the expansion of private insurance made available for the
elderly could also contribute to a longer prosperous life. The United States continues to make
efforts directed to the elderly such as Medicare and Medicaid if it applies. Finlands municipality

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has also designed a contract for the next several years with a private NGO-based foundation to
provide primary health care and early care to its cohabitants (Vuorenkoski, 2008, p. 65). In
order for these reforms to be successful, the government along with the health care providers
must work in collaboration. It is important for nurses to be alert to physical, emotional and
economical changes that may influence the aging of the elderly adult. By being knowledgeable
about the population and their vulnerability such as chronic illness, suggestions and referrals can
be made to help assist the individual in improving their health and well being with the help of
governmental and nongovernmental organizations.
Nursing Theory
Different nursing theories can aid the elderly with chronic illness with interventions for
primary, secondary, and tertiary prevention. The nursing theories established are essential for
nurses to integrate into their practice because the care nurses provide can influence the quality of
life the elderly have during their last years of life suffering from a chronic illness.
Primary prevention, or maximizing health and wellness through education, can be
implemented in nursing practice by education about medication. Older adults wish to age with
autonomy, and a high quality of life. Because chronic illness can get in the way of aging with this
independence and dignity, medications are prescribed to help the older adult manage the
symptoms of the chronic illness. A large number of older adults do not adhere to their prescribed
medication regimen. Non-adherence could lead to therapy failure, complications of the disease,
increased mortality, and increased money spent on the disease. The elderly reported that the
relationships with healthcare professionals are crucial to the management of their medications
and the information given by the nurse during consultation is very important (Henriques,
Costa, & Cabrita, 2012, p. 3096). The elderly feel safe around nurses and are empowered to ask

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21

them questions if they are confused about their medication regimen. Effective communication
and establishment of interpersonal relationships between the patient and nurse leads to better
medication adherence. This study could also be applied to different areas of health care in that
nurses offer professional help that the elderly can trust. Because nurses are more available in the
healthcare setting than the doctors in the United States, it is up to the nurses to build therapeutic
relationships with elderly clients to empower them to treat and handle their chronic illnesses so
that they can have autonomy and a higher quality of life (Henriques, Costa, & Cabrita, 2012). In
Finland, doctors are more available to patients. Therefore, it is just as important for them to
develop the same type of therapeutic relationship with the patient. This study directly correlates
with Hildegard Peplaus Theory of Interpersonal Relationships. For primary prevention, it is
imperative that the nurse and patient first identify the problem, and then develop guidelines
about how to solve the problem. Through education, the nurse can take the role of a teacher,
resource, counselor, leader, and technical expert utilizing Peplaus theory. The nurse and patient
can work together to reach an outcome that will provide the patient with information about how
to handle their medication, and improve their quality of life living with the chronic illness
(George, 2011).
Secondary prevention is maximizing health and wellness through screening programs.
This is in hopes of disease being caught before onset or early enough so the disease can be
prevented and treated before symptoms arise. Secondary prevention can be met for chronic
illness in the elderly by using Virgina Hendersons Nursing Need Theory. In the theory, nurses
are to care for a patient when the patient cannot care for himself or herself. This requires
surveillance of the patients self-care abilities. When the patient cannot provide self care or
adhere to activities of daily living, interventions are required. There are 14 components based off

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22

human needs that nurses relate their interventions to. The components include breathing
normally, eating and drinking adequately, eliminating wastes, moving and maintaining desirable
postures, sleeping and rest, keeping temperature within normal range, protecting the skin,
avoiding dangers in the environment, communicating with others, worshiping ones own faith,
working for a sense of accomplishment, participating in recreation, using available facilities.
While the nurse is providing care to this patient, in the community, hospital, or another setting,
he or she is conducting assessments and screenings that relate to the patients abilities to be able
to meet the 14 listed components (George, 2011).
Tertiary prevention is maximizing health and wellness through treatment of a disease. For
chronic illnesses, it lasts throughout the lifetime and some cannot be cured. Especially for the
elderly, it is important to focus on comfort measures to treat the symptoms rather than treating
the disease to improve their quality of life when the chronic illness cannot be corrected. This is
why Katherine Kolcabas Comfort Theory should be utilized for tertiary prevention. There are
four contexts of the human experience of comfort. These include, physical comfort,
psychospiritual comfort, environmental comfort, and sociocultural comfort. The theory states
that physical comfort is the most agreed upon context of comfort (George, 2011, p. 649). The
elderly with chronic illness can have their comfort be obtained three ways: relief, ease, and
transcendence. Relief is the experience of a patient who has had the specific comfort need met
(George, 2011, p. 649). Ease is state of calm or contentment (George, 2011, p. 649).
Transcendence is a state in which one rises above problems or pain (George, 2011, p. 649).
The goal of providing tertiary interventions to the elderly with chronic illness is to enhance
comfort.

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23
Conclusion

The older adults with chronic illnesses are a vulnerable population that is on the rise in
both Finland and the United States. The decline in health is presumed to have a potential
negative impact on this population. In efforts to preserve the quality of life of each individual,
both countries have policies in place by the government on multiple levels as well as individual
health sectors that are readjusted and updated in order to meet the needs of this increasingly
vulnerable population. Due to the prevalence of this vulnerability group and their impact on the
population, it is imperative that healthcare providers, educators, and all members of society are
active in the awareness and improvements of the health status of the elderly with chronic
illnesses.

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