Geriatrics-Chronic Diseases in Elders and the Healthcare Settings

According to the CDC, a chronic illness is a condition that is prolonged and does not get better spontaneously, or which usually cannot be cured completely. These types of disorders are more frequently observed in the elderly populations.  Some of the common disorders that occur in elders include arthritis, hypertension and other heart disorders, visual problems, strokes and diabetes mellitus.  About 70 % of elders in the US have more than one chronic disorder. About 40% of elders, who are not institutionalized, have a chronic health problem that limits their normal ability to function. Many chronic illnesses are associated with a serious morbidity (rate of disease incidence) and mortality (rate of death) rates.  Deaths from chronic illnesses may be as high as 70% of all deaths.  As the number of illnesses increase, the cost of treating an individual suffering from a chronic illness also increases.  The US spends more than 60% of its budget on healthcare.

Many elders still find it difficult to access the healthcare programs, in spite of the Government spending a quarter of the budget on their benefit. The healthcare system of the US is more suited to treat acute or sudden illnesses, and hospitalization, rather than chronic illnesses.  Healthcare providers spent less time on patients with chronic illnesses.  Medical insurance programs (such as Medicare and Medicaid), do not suit reimbursing for comprehensively managing or educating patients suffering from chronic illnesses or preventing such illnesses.  Educating patients with Diabetes mellitus has only recently become a reimbursable service.

Elders from a poor background, tend to depend entirely on the social security programs.  The Government has failed to meet the needs of the senior population who are not able to function properly.  Such individuals depend entirely on their families, friends, support groups, NGO’s, etc. Elders tend to be hospitalized more frequently, and the severity of the illness is much worse compared to younger individuals.  They require long-term care, which is they are often deprived of.  Old people usually end up being hospitalized because of improper care.  In some instances, the treatment is not sufficient or appropriate, leading to inability to function normally.

Elders usually do not desire to go to a hospital to treat an illness or may prefer a private room during hospitalization.  Some patients may delay seeking treatment until they find a good healthcare setting.  Many old people, who are unable to take care of themselves, may be sent to an institution meant for elders.  However, most of these institutions do not have proper facilities to manage the aged.

Management of patients with a chronic illness includes managing 3 components: the illness, the patient and the medical environment.  Managing the illness has been a practiced tradition since a very long time.  However, management of the needs of elders with chronic illness requires a lot of modifications in the present healthcare system.

Principles of Management of Chronic Illness

Traditionally, the clinician used to manage an illness by treating the cause.  However, this works well only for acute, solitary and uncomplicated illnesses.  It may not benefit those suffering from one or more than one chronic illnesses.  These usually have several associated causes, which may be difficult to identify and treat.  Chronic illnesses may produce several effects on the patient’s general health, family life, psychology and social interactions.  The clinician has to devise a broad package that includes several areas of the patient’s life (such as health, ability to function, finance, family and social issues).

 Some of the principles of managing chronic illnesses include:

• Start the therapy slowly as elders are more sensitive to the effects of medicines.
• Concentrate on improving the ability of the patient to function normally.
• Accept uncertainty as a clear cause of the symptoms is not available.
• Awareness of the program and course of the disease whilst deciding the diagnostic and therapeutic interventions.
• Avoid administering too many drugs as the chances of side-effects and unfavorable turnouts are greater.
• Presentation of an illness in elders

Certain factors influence this including:

• A false perception of what is normal and what is illness.
• Disease may be considered to be normal in old age.
• Development of certain symptoms (such as tiredness and memory loss) may be considered to be normal in old age.
• Elders may not always want to seek medical care.
• Clinicians need to monitor the psychological well-being of the patient.
• Healthcare providers usually spent a lot of time and money searching for the cause in individuals with chronic illnesses.

Sophisticated diagnostic and therapeutic procedures are generally employed, but these are not successfully as chronic illnesses may be related to several causes.  Besides, the clinicians may not devote much time to deal with patients affected with chronic illnesses.  They may also not involve the patients much in planning or executing the treatment program.

Clinicians should encourage activities that would promote health (such as exercise, diet, relaxation and stopping tobacco usage).  He / she should develop a good relationship and rapport with the patient.  The clinician should enforce the treatment plan only after discussing it with the patient.  The functional abilities of elders should be thoroughly assessed in order to develop appropriate rehabilitation techniques.

The clinician should encourage the patient of developing ways to take care of their needs.  The patient has to be constantly educated through written materials, audio-visual aids and computer-based programs.  Their progress should be closely followed up.

The Government should be able to coordinate the healthcare programs meant for elders.  The retirement system should be improved so that the citizens could benefit all-round.  The healthcare financing system should also support long-term needs of the elders affected with several chronic diseases.  New programs should be initiated to include home services, educational and preventive services, day care of the old age, compensating families that support a senor member, and improving the relationship between elders and others.  Clinicians specializing in the field of geriatric medicine should be able to assist other healthcare staff to provide proper care to elders.  As provision of care for old people requires a multidimensional approach, healthcare workers from related fields should be trained in providing proper geriatric care.

References

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