As our population gets older there will be increasing numbers suffering from chronic illness and disease. This focus and aim of this assignment is to discuss the challenges of this for both the health service and the individual. Perhaps the best place to begin is to consider how chronic illness has been defined.
There are many definitions of chronic illness some more expanse than others. It is characterised as a condition that requires ongoing adjustments by the affected person and interactions with the health system. The Centre for Disease Control’s National Centre for Chronic Disease Prevention and Health Promotion (2000) broadly defines chronic disease as illnesses that are prolonged, do not resolve spontaneously and are rarely cured completely. Chronic illness may get slowly worse over time. It may cause permanent body changes to the body and it certaintly affects the persons quality of life (Locker 2003, cited by Scambler 2003).
Advances in public health, medical treatment and technology enable people to live longer lives. The longer one lives the more likely one is to develop a chronic condition. Premature infants who would have once died at birth now live. People injured in car accidents now survive, when once they would have died. The increasing presence of people with disabilities in society and the increasing proportion of elderly people in society is a testament to the success of modern science.
The demographic profile of Western Europe is changing such that an increasing proportion of the population is living into old age. In 1990 the average life expectancy at birth was 47 years, by 1995, the estimated life expectancy reached 75.8 years (Field, Cassel 1997). According to Minino and Smith (2001) at present life expectancy for and individual at age 85 years is 6.3 years. The number of people aged 65 years and older is projected to double by 2030. This demographic shift has resulted in increased life expectancy, but has also greatly transformed the illness experience. The experience of serious illness, and subsequently death and dying has been transformed from one that was early in life, rapid and largely unanticipated, into an ongoing series of events that are chronic and progressive (Centre for Disease Control 2000).
Garavan, Winder, Mc Gee (2001) state that although the death rate from cardiovascular disease – the largest single cause of morbidity – are falling, the prevalence of chronic illness and co – morbidity more generally in increasing. This ageing population has significant implications for healthcare planning and delivery.
The prevalence of chronic illness is rising. The 2002 Census of population indicated that there were 323,207 people, some 8% of the population, with chronic illnesses in Ireland. According to Beaglenole and Horton (2005) there were 60 million deaths worldwide in 2005. 113 million people, or almost half of all Americans live with a chronic condition (Holman and Lorig 2000). That number is projected to increase by more than one per cent by 2030, resulting in an estimated chronically ill population of 171 million. Approximately 35 million (65% of the total) was due to chronic disease of adults, principally heart disease, stroke, cancer and diabetes.
Long term chronic illness does not merely have an impact on people’s physical health; it affects their emotional well – being, their careers, relationships and social existence. These social, psychological and emotional challenges can destroy lives.
In time the acute nature of the illness may abate. But total recovery does not occur, and the illness persists. There is much uncertainty about the future that the person may not be able to sleep at night and may seem restless and agitated during the day (Alexander, Fawcett 2006). This lack of an expectable future constitutes a major assault on one’s self – image.
According to Huurre and Aro (2002) depression is one of the main complications of chronic illness. It is estimated that up to one third of individuals with a serious medical condition experience symptoms of depression. Depression and illness may occur together because the physical changes associated with the illness trigger the depression or the individual has a psychological reaction to the hardships posed by the illness.
People with different chronic conditions face common problems including extensive and ongoing medical costs that are often not covered by insurance, leading to enormous bills that can mean bankruptcy for some families. Also, because of these costs people are often forced to adopt strategies to ‘make ends meet’ and these are often detrimental to their health. For example they are likely to restrict their expenditure on energy costs, transport and telephone services in order to afford medications.
Complicating the financial issues confronting the ill person and their family is the difficulty in keeping a job or even working at all. Many people feel obliged to give up their jobs or feel severely constrained in the jobs they can take. They often need employers to be flexible, but many companies struggle, or are unwilling, to provide that support.
One member’s chronic illness influences the lives of everyone in the family, because the limitations of the ill member and the demands of treatment may require that others be more available. Some families panic at the prospect of providing round the clock care without training or financial support. According to Jamshidi et al (2004) families expend a wide range of emotional energy.
Many of the challenges faced by people with chronic disorders are unavoidably social in nature. A study funded by the Equality Authority and National Disability Authority found that people with a chronic disease or disability face many barriers to full participation in Irish society. People with a chronic illness are constantly trying to make themselves acceptable and their stigmatising condition often assumes primacy in establishing the social identity and relations with others (Alexander, Fawcett 2006). The inward focus that chronic illness encourages can serve to greatly deprive the chronically ill person of the social interaction that could be so beneficial for them (Petrie and Revenson 2005).
Management of chronic illness is one of the main challenges facing our health care system (Beaglenole, Horton 2005). According to Ford (2006) the services that our health care system makes readily available were designed to cope with short – term threats such as accidental injuries and heart attacks. Unfortunately the nations health care system has not yet adapted to meet the changing needs of our population. It is having to contend with a new upsurge of chronic conditions, brought about by demographic, environmental and life style factors Wakefield 2002).
Chronic disease is now the main reason why people seek health care in the developed world (Ham, Robert 2003). They need to make repeated contact with health care facilities to monitor the effectiveness of their condition, to be treated in times of a crisis and to attend rehabilitation programmes. Most health care costs are focused in treating chronic conditions such as diabetes, cardiovascular disease and asthma. The costs of treating these chronic health conditions are enormous because of the difficulty and duration of the treatment. Holeman and Lorig (2000) state that in the USA, it now consumes 70% of health care spending. Also in the UK the acute care of primary conditions is a primary factor in the continued dominance of hospital spending in the NSH budget (60% in 2003) (British Medical Association 2002).
There is a need to refocus the health care system for the 65 and over population to one with a chronic disease emphasis (Wagner et all 1996). As mentioned previously the health care system focuses on providing acute care. The health care needs of this group will eventually represent a significant burden for the health care system, which could be better managed through a chronic management approach. Figures on hospital usage provide one part of the picture of the impact of chronic illness or conditions on the population. There is little doubt that the highest users of hospital services are the 65 and over age group. Making better facilities in the community such as advanced practice nurse would better serve the needs of the chronically ill person. As according to Burgener and Moore (2002) the Advanced Practice Nurse is an ideal provider of primary care and prevention in the face of prevalent chronic illness.
According to Kumar and Grimmer – Somers (2007) best practice for many elderly people suffering from complex chronic illnesses is community health services and self – management. They also stated that this practice minimises the costly hospital resources. Primary care is provided in the community and its main priority is prevention. Most health care costs are spent on treating chronic conditions and not enough on spent on prevention (Kumar, Grimmer – Somers 2007).
Chronic illness may be inherited, but many lifestyle and environmental factors, such as smoking inappropriate diet, inactivity and heavy alcohol consumption are known to significantly increase risks. These factors are to some extent within the control of a wee – informed person. Besides early diagnosis and management a very important aspect of primary care is aimed at prevention and healthy behaviour.
There is a wide range of chronic disease prevention strategies to modify the risk factors mentioned above. Information, provided both personally and through the media, is the key to prevention (Jacobs et al 2006). Primary preventative measures include; counselling, screening and immunisation. According to Takahashi et al (2004) immunisation of elderly people, including the healthy ageing population, and those with a chronic illness will prevent suffering and save lives.
Self-management refers to the individual’s ability to manage the symptoms, treatment, physical and psychosocial consequences and lifestyle changes inherent in living with a chronic condition (Barlow et al 2002). Basically it is how a person lives with their illness on a day-to-day basis. Education is needed to promote self – management. Bodenheimer et al (2002) believes that self – management education goes beyond traditional patient education in supporting people to live the best possible life with their illness.
Whereas traditional education teaches technical skill and offers information, self – management education includes processes that develop patient solving skills and improve self – efficacy. Self – efficacy is central to the process of self – management (Krein et al 2007). Krein et al (2007) believe that promoting self – efficacy is a promising strategy to improve their ability to follow self – management and reach a desired goal.
In conclusion, as life expectancy increases so does the likelihood that people will become susceptible to chronic illness. Chronic illness is at the heart of societies high cost, high stress health care crisis. Whether it be asthma, diabetes, stroke, Alzheimer’s or another disease, the problems facing people suffering from long-term chronic conditions are similar – too little care, too little support, too high a cost and too much struggle with a health care system not designed to meet their needs. Increasingly what’s needed from the health care system is the steady but simple care that helps people with chronic illness stay out the hospital and live independent, productive lives.