Lesson 7: Understanding Chronic Illness

CHRONIC ILLNESS
• Occur in people of every age, socioeconomic level, and culture.
• Medical conditions or health problems with associated symptoms that require long-term
(3 months or longer) management.
• Conditions that do not resolve or for which complete cures are rare.
• Management means that people must learn to live with the symptoms or disabilities, and
carry out lifestyle changes or treatment regimens.
• A chronic illness isn't the name of just one illness.
• It's a word used to describe a group of health conditions that last a long time.
• The root word of chronic is "chronos," which refers to time.
• The literature does not support a single uniform definition for chronic disease, but the
concept of chronicity includes the knowledge that patients experience persistent and
recurring health problems.
• Definitions of chronic disease also reflect the pathophysiology of disease and, more
importantly, consider the meaning of chronic illness and the experience of the patient,
family, and provider as they struggle to cope with the range of mildly complicated to
extreme challenges.
• Curtin and Lubkin (1995, pp. 6–7) defined chronic illness as “the irreversible presence,
accumulation, or latency of disease states or impairments that involve the total human
environment for supportive-care and self-care, maintenance of function, and prevention of
further disability.”
• Anderson and Horvath (2004) defined chronic conditions as conditions lasting 1 year or
more and requiring ongoing medical attention and/or the limiting of activities of daily living
(ADLs).
• Chronic disease or a chronic condition is also defined as any condition that requires
ongoing adjustments by the affected person and requires periodic interaction with the
health-care system (Improving Chronic Illness Care, 2016).

DEMOGRAPHIC OF CHRONIC ILLNESS

• Increased life expectancy and health-care advances are the main reasons for the
overwhelming increase in numbers of patients with chronic illness.
• The population of individuals age 65 years and older is now 46.2 million or 14.5% of the
population. That number is projected to increase to 21.7% of the population in 2040
(Administration on Aging [AOA], Administration for Community Living [ACL], U.S.
Department for Health and Human Services [USDHHS], 2016).
• As of 2012, about half of adults, or 117 million people, had one or more chronic health
conditions. The most common chronic diseases in the population age 65 years and older
include hypertension (60%), dyslipidemia (41%), arthritis (28%), cardiac disease (25%),
and eye disease (23%) (Robert Wood Johnson Foundation [RWJF], 2010).
• Seven of every 10 deaths in the United States are caused by chronic conditions. Heart
disease, cancer, chronic obstructive pulmonary disease (COPD), and stroke are the
leading causes of death, with heart disease as the number one cause of death among
both men and women. Other major diseases that contribute to the 70% death rate from
chronic disease include diabetes and Alzheimer ’ s disease (Centers for Disease Control
and Prevention [CDC], 2016). Heart disease and cancer together accounted for nearly
48% of all deaths (CDC, 2016).
CHRONIC CONDITIONS
 Chronic Conditions are now the leading cause of illness, disability, and death . Affects
people of all ages , the majority are the very old.
 Accounts for 7 of the 10 leading causes of death in the U.S.
 Cause of 1.7 million deaths per year (7 out of 10 deaths)
 Affects the quality of life of 100 million Americans
 90% of the elderly have at least one chronic illness
 Approximately 77% have at least two illnesses
 25% have 4 or more chronic illnesses

TERMINOLOGIES RELATED TO CHRONIC ILLNESS

 Chronic conditions - a general term that includes chronic illnesses and impairment.

 Chronic Illness – the presence of a long term( i.e. 3 or more months) disease or symptoms
. Example: arthritis, diabetes, cancer or heart ailment.

 Secondary condition - conditions related to the main illness or impairment that further
diminish the person’s quality of life, threaten his health or increase vulnerability to further
disability. Example: pain, depression and pressure illness.

LIFE WITH CHRONIC ILLNESS

 The diagnosis of chronic illness has a significant impact on the patient and their caregivers.
 People who have low incomes are more likely to report poor health.
 Factors such as poverty and inadequate health insurance decrease the likelihood that
people with chronic illness receive health care and health screening measures such as
mammography, cholesterol testing, and routine check ups.
 Few persons are prepared to live with chronic illness.
 Chronic illness involves suffering.
1. Suffering is one of the most profound and disturbing of human experiences
2. Suffering does not refer to just maladies, and pains, with which we can and should
cope. (Stan van Hooft, Hastings Center Report, 28, # 5, 1998)
 Suffering involves crisis and threats that constitute a degradation or alienation of our
being. (Eric J. Cassell, The Nature of Suffering and the Goals of Medicine, 2nd ed.,2003)

The Impact of Chronic Illness – The Individual

 Initial Impact
1. Shock
2. Denial
3. Loss and grief
4. Anxiety and depression (20-25% experience psychological symptoms)
 If these reactions last too long, they can have a negative effect on the illness
 Must adjust to:
1. Symptoms of the disease
2. Stress of Treatment
3. Feelings of vulnerability
4. Loss of Control
5. Threat to self-esteem
6. Financial Concerns
7. Changes in family structure
The Impact of Chronic Illness – The Family
 Must adjust to:
1. Increased stress
2. Change in the nature of the relationship
3. Change in family structure/roles
4. Lost income all have impact
 Different issues for different relationships
1. Adult children of ill parents
2. Spouse of ill person
3. Parents of ill children

 Chronic illness affects the person on many levels and can bring suffering on all of these
levels
 Psychologically- Some patient’s say:
They may feel unsafe by themselves.
1. Loss of independence
2. Fear
They have a change in self perception/self image
1. Feelings of loss
2. Grief
 Socially
Due to changing self perception the person may limit social interactions
1. “I don’t like being seen with oxygen on.”
Fear of exposure to “germs” may lead to decreased social interactions.
1. “I am afraid that if I get another infection I’ll die, so I don’t go to parties anymore.”
 Physically
We cannot rely exclusively on physiologic outcomes for evaluating and assessing a
patient’s “well being.” Or evaluating and assessing your own “well being.”
When people with activity limitations are unable to meet their needs for health care and
personal services:
1. they may be unable to carry out their therapeutic regimens or have their
prescriptions filled on time
2. may miss appointments and office visits with their health care provider
3. may be unable to carry out their ADL
 Spiritually
Feelings of Isolation
Why me?/ Why me, God?
Feelings of abandonment that can lead to spiritual alienation

3 REASONS FOR THE RAPID INCREASE OF CHRONICALLY ILL PERSONS

 Aging of the population
 Success of medical science
1. good medical care actually increases the amount of chronic illness
2. illness diagnosed earlier
3. many patients who may have died survive
 Worsening Obesity
1. obesity will soon surpass smoking cigarettes as the # 1preventable cause of morbidity
& mortality.