HRONIC ILLNESS

Al Duane B. Ungab, RN, MAN

Living with chronic illness is like piloting a
small plane
 To get safely to their destination
pilots need:

1. Flight instruction 1. Self-Management

2. Preventive Maintenance
3. Safe Flight Plan
4. Air Traffic Control
Surveillance
Support
2. Effective Clinical
Management
3. Treatment Plan
4. Close Follow-up
Why is Learning How to Provide
Self-Management Support
Important to Nurses?
Usual care works well if your plane
is about to crash
Three Biggest Worries About Having A
Chronic Illness (Age 50 +)
 One of the greatest
challenges that will face
health systems globally in
the twenty-first century
will be the increasing
burden of chronic diseases
(WHO, 2002).
Chronic conditions are
defined by the World Health
Organization (WHO) as
requiring “on-going
management over a period
of years or decades”
Chronic conditions
frequently go untreated or
are poorly controlled until
more serious and acute
complications arise.

There is often a large gap

between evidence-based
treatment guidelines and
current practice.
 Case Study
Mr George is an 89-year-old man was
diagnosed with osteoathritis. George
has experienced increasing symptom
distress and gradual functional
deterioration. His wife can no longer
care for him at home and his prognosis
is fair.
On the scenario presented, as
a nurse how can you apply
effective self management
support? Use strategies to
help the patient live a normal
life despite of his condition.
1. Review the Pathophysiology of selected
chronic condition: (Diagram form, concise,
simple and easy to understand)
a)Heart Disease – Babanto, Villela
b)Hypertension – Caintic, Tabianan
c)COPD – Caulin, Suelto
d)Diabetes – Doronio, Soriano
e)Cancer – Egote, Roque
f)Dementia – Gonzales, Racho
g)Stroke – Loria, Petalcurin
h)Kidney Disease – Mahilum, Muyco
2. What are the specific assessment
focus and management?
3. Effective health education
strategies of the assigned
condition?
4. Is there any behavioural
management available in these
conditions?
5. New issues and trends/updates
1. Have this written assignment
submitted on August 23, 2017
2. Place it on Transparent Sliding
folder, A4, Arial, font size 11
Psychosocial Assessment of Older
Adults with Chronic Conditions
Comprehensive Assessments
Comprehensive geriatric assessment (CGA)
and geriatric evaluation and management
(GEMs) programs
 Geriatric Evaluation and
Management
 Geriatric Evaluation and Management (GEM) services provides care in
which the primary clinical purpose or treatment goal is improving the
functioning of a person with multidimensional needs. These needs are
associated with medical conditions related to aging. They include falls,
incontinence, reduced mobility, delirium and depression.
 The person may have complex psychosocial problems and is usually (but
not always) an older person. GEM is always managed by a clinician with
special expertise in GEM.
 GEM incorporates an individualised multidisciplinary management plan
that is documented in the person’s medical record. The plan includes
negotiated goals within indicative timeframes and documented
assessment of functional ability.
 Primary Component of CGA and
GEM programs
Interdisciplinary team
 Areas of assessment are overall
health status
 presence of pain
 nutritional status
 risk for falling
 Incontinence
 Sleep
 alcohol and drug use
 dental or oral health
 sensory perception, especially vision and hearing
 use and misuse of medications
Psychological well-being and
mental health
 Two distinct types of cognitive
changes:
First:
 gradual decline in memory
 selective attention
 information processing
 problem-solving ability
 Two distinct types of cognitive
changes:
Second:
 Progressive
 Irreversible
1.Alzheimer’s
2.Huntington’s
3.Parkinson’s
4.Vascular dementia, often caused by strokes or
tumors.
Ability to perform Various ADLs
People who are
confined to bed or
have severely
impaired mobility
are likely to
disengage from
social activities
Assessment of family caregivers
 66% of community-dwelling people
needs long-term care
 28% receive a combination of
informal and formal care
 assessing both objective and
subjective components of
caregivers’ strain is important for
gaining a better understanding of
their needs.
Theories of
Aging
 Physiological, Social, or
psychological reasons why people
die
 THEORIES
BIOLOGICAL
that the reason people age and die is
because of changes in the human body
 2 Categories
1. Feature Theory
 “Hayflick limit”
 States that cells will divide for a finite
number of times, and once they have
reached this limit, the cells shrink, disperse,
and eventually die, resulting in death of the
body.
 “programmed cell death”
 Theorists who support this theory believe
that how a person ages is genetically
predetermined.
 2 Categories
2. Defect Theory
Opposite of feature theory
the breakdown and losses that occur
with aging are accidents or mistakes
believe that the cause of death of older
adults generally results from a wearing
out of the body, or an accumulation of
mutations in DNA that can no longer be
withstood
 THEORIES
PSYCHOLOGICAL
support the idea that an older adult’s life ends
when they have reached all of their developmental
milestones
Within the final stage, ego integrity versus
despair, the older adult must successfully
master changes in health, loss of loved ones,
and resolution of role changes such as no
longer being a parent, employee, or friend
 THEORIES
MORAL/SPIRITUAL
support the idea that once an older individual
finds spiritual wholeness, this transcends the need
to inhabit a body, and they die.
 MORAL/SPIRITU
AL
Kohlberg’s stages of moral development
individual goes through a series of moral reasoning
activities that become progressively more
sophisticated throughout life
Sophisticated and final step is post-conventional
reasoning
person develops an understanding of themselves
within the world and accepts who they have become
 MORAL/SPIRITU
AL
Tornstam’s theory of gerotranscendence

resulting in greater maturity and improved

understanding of the world and the individual’s
position within it
often finds older adults with a decreased need to be
with others, as individuals become increasingly more
comfortable being alone
 THEORIES
SOCIOLOGICAL
THEORIES
explain that aging results as older adult’s
usefulness in roles and relationships changes or
declines
 SOCIOLOGICAL
THEORIES
Disengagement theory
states that as relationships change or end for older adults,
either through the process of retirement, disability, or death
gradual withdrawing of the older adult is evidenced

Activity theory
social activity is an essential component of successful aging
when social activity is halted because of death of loved ones,
changes in relationship, or illness and disabilities that affect
relationships, aging is accelerated and death becomes nearer
 SOCIOLOGICAL
THEORIES
Continuity Theory
one can look to past experiences of an older adult to predict how
they will encounter current and future stressors
For example, if an individual became greatly distressed after the
loss of a friend in their forties, it is likely that they will experience
similar distress to other losses in life
 Critical Thinking Case Study
A 64-year-old White male had been healthy for
most of his life. He was a teacher and an
upstanding father who was active in the church and
community. However, after experiencing signs of
Coronary Artery Disease (CAD), he underwent a
Coronary Artery Bypass Graft (CABG). What
should have been an unremarkable recovery was
tainted with many complications, and he required
permanent residence in a nursing home
approximately 1 hour away from his home, wife,
and grown children. Within 1 month of admission,
he died.
1. What theories of aging could be used to
help explain why this client died when he
did?
2. What factors may have contributed to
this man’s premature death?
3. Do you think any one theory explains the
aging process and the cause of death
among older adults, or do you feel a
combination of theories is more useful?
Why?