NCM 114 – Geriatrics PATTERNS OF ILLNESS
Module 4: Chronic Illnesses Among Older Adults
WHAT IS CHRONIC DISEASE?
 It is a condition viewed from a pathophysiologic
model à physical dysfunction of the body
WHAT IS CHRONIC ILLNESS?
 It reflects the human experience of the
symptoms & suffering & how the disease is
perceived, lived with and managed. (Lubkin &
Larsen, 2002)
OLDER ADULTS AND CHRONIC ILLNESS
Experiences of older adults:
1. Powerlessness
 inability to control an illness or disability
 can be a result of normal aging changes, an
altered body image, or numerous losses.
 results to loss of hope and dependence
2. Stigma
 mark of shame or discredit
 older adult may feel ashamed of their
disability, disease or physical condition à
social isolation
3. Hopelessness
 feeling of futility and passive abandonment
of oneself to fate
4. Sensory deprivation
 As the person ages, sensory systems
gradually start to decline.
 sensory loss for older adults puts them at
risk for sensory deprivation.
 Severe sensory impairments may result to
increased disorientation and confusion.
5. Sleeplessness
PROBLEMS ASSOCIATED WITH CHRONIC
ILLNESS:
1. Patients become homebound
 à social isolation
2. Patients perceive themselves as burden
3. Family experiences caregiver stress
4. Expensive – disease is usually long term
RISK FACTORS ASSOCIATED WITH CHRONIC
ILLNESS
1. Malnutrition (undernourished/ obesity)
2. Lack of exercise / physical activity
 diminished functional reserves
3. Cumulative effects of lifestyle habits such as
 eating salty & fatty foods
 alcohol use
 smoking
 psychosocial stress
 Certain commonly seen conditions are liable to be
disregarded by the individual, relatives or by the
doctor as they develop slowly.
 Recovery from illness is often slower, owing to
inter-current infections or to the debilitating nature
of the condition.
 It is useful to identify underlying mechanisms that
lead to true age-related changes, as opposed to
age-related disease.
 Awareness of different pathological processes and
of normal age-related physiological changes will
assist the assessment and management of older
people.
GENERAL GOALS OF CARE FOR THE
CHRONICALLY ILL PATIENTS
1. Promoting the highest possible quality of life à
establishing or maintaining client’s sense of
personal control
2. Delaying deterioration and decline of health.
3. Increasing capacity for self-care.
4. Providing support in dying with comfort and
dignity à client coping with long term discomfort
or pain
TAKE NOTE!!! In caring for the chronically-ill older
person, you need to focus on his/ her overall functional
state, rather than on the state of disability.
Quality of life – an individual’s perceptions of well-being
that stem from satisfaction or dissatisfaction with
dimensions of life that are important to the individual
 Most elderly people want to keep their
independence for as long as they can.
 They feel so good if they are still useful.
 Hobbies or volunteer work or even another career
keep them going on for many years.
 Staying close to friends and relatives after
retirement.
DIMENSIONS OF HEALTH-RELATED QUALITY
OF LIFE
 Absence of distressing physical symptoms (eg,
pain, dyspnea, nausea, constipation)
 Emotional well-being (eg, happiness, absence of
anxiety)
 Functional status (eg, capacity to do activities of
daily living and higher-order functions, such as
pleasurable activities)
 Quality of close interpersonal relationships (eg,
with family members)
 Participation in and enjoyment of social
activities
 Satisfaction with medical and financial aspects
of treatments
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  Sexuality, body image, and intimacy

SELECTED CHRONIC ILLNESSES AFFECTING  Modifiable risk factors

OLDER PERSONS RISK FACTORS PREVENTION
 Heart Disease 1. Smoking Don’t smoke
 Hypertension 2. Hypertension Regular check-up and
 Stroke/ CVA control of blood
 Diabetes pressure
 COPD 3. High Cholesterol Avoid fatty food, more
 Cancer exercise and cholesterol
 Dementia lowering drugs.
4. Diabetes Mellitus Treatment of Diabetes
HEART DISEASE 5. Obesity Avoid overeating, keep
 General term used to refer to problems that healthy weight
affect one or more components of the human 6. Lack of Exercise More exercise
heart. 7. Stress Relaxation
 Each year, 170,000 Filipinos die from
cardiovascular diseases, up from 85,000 more HYPERTENSION
than 20 years ago, according to a 2009 study by  Cardiovascular disease develops slowly and
the Department of Health. takes years to develop
 The most common cause of heart disease is the  Hypertension – major risk factor for other CV
narrowing or blockage of the arteries of the conditions.
arteries of the heart (Coronary Artery Disease)  “21% of Filipino adults are hypertensive” Dr.
which leads to a heart attack. Dante Morales (President of the Philippine
 Coronary Artery Disease – a process in which Society of Hypertension) , May 2012
the coronary artery vasculature is partially to  The recent Philippine National Nutrition Survey
totally occluded by atherosclerotic plaque, showed that High Blood Pressure prevalence has
resulting in disruption of blood flow to the heart significantly increased from 22.5 to 25.3
muscle. between 2003 and 2008.
 Non-modifiable risk factors include:  In the Philippines, hypertension is the leading
 Age - increased age related to length of cause of heart attacks, strokes and kidney
exposure to other risk factor failure.
 Family history  According to the latest WHO data published in
 Gender (men) May 2014 - Hypertension Deaths in
 Normal changes of aging that may lead to Philippines reached 20,986 or 4.03% of total
CAD deaths.
1. Muscles of the aged heart relax less  HPN is the single most important risk factor for
completely between beats à the pumping stroke causes about 50 per cent of ischemic
chambers (ventricles) become stiffer and strokes and also increases the risk of
may work less efficiently haemorrhagic stroke
2. Heart may not pump as vigorously or as  HPN does not show any obvious symptoms for a
effectively à becomes less responsive to long time.
adrenaline and cannot increase the strength  It is often diagnosed only when considerable
or rate of its contractions even during damage has already happened to the body’s
exercise blood vessels.
3. Heart does not get enough blood out to the  Changes of Aging and Hypertension
muscles to supply them with adequate  Blood pressure increases as arterial
oxygen resistance increases.
4. Walls of the arteries lose their elasticity and  Coronary arteries may become dilated,
stiffen. twisted and calcified. Circulation decreases
5. Veins thicken by 35% in most adults after age 60.
 Associated with is the presence of fatty
deposits in the inner walls of the arteries.
 There is lessened elasticity of the artery
walls.
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 Decline in the ability of the kidneys to
excrete salt loads.
 To ascertain if older adult has hypertension:
 Elderly must rest for at least 5 mins before
taking the BP
 Take the BP in a seated or lying position.
 Ask client to stand for 2 mins, then take the
second BP.
 Pseudohypertension
 BP cuff may not readily compress the
calcified and thickened arteries.
STROKE / CVA
 Infarction of a part of the brain due to
insufficient blood supply or rupture of a blood
vessel.
 The blood vessel affected determines the area
and the extent of damage.
 Neurologic dysfunction is long-lasting & often
permanent
 Prevalence of stroke in the 60–79 year old
group is 2% for men and 6.9% for women,
 Incidence of stroke in 80+ years age group is
9% for males and 13.8% of females (Go et al.,
2013)
 According to the latest WHO data published in
May 2014, Stroke deaths in Philippines reached
63,261 or 12.14% of total deaths.
 Hypertension is said to be a principal risk factor
for stroke
 Signs of Stroke
 Sudden numbness or weakness of the face,
arm or leg, especially on one side of the
body
 Sudden confusion, trouble speaking or
understanding
 Sudden trouble seeing or blurred vision in
one or both eyes
 Sudden trouble walking, dizziness, loss of
balance or coordination
 Sudden severe headache with no known
cause
DIABETES MELLITUS
 A chronic disorder characterized by insufficient
production of insulin in the pancreas or when the
body cannot effectively use the insulin it
produces.
 This leads to an increased concentration of
glucose in the bloodstream (hyperglycemia).
 Diabetes affects 18% of people over the age of
65, and approximately 625,000 new cases of
diabetes are diagnosed annually in the general
population.
 2014 - 3.2 million cases of diabetes in the
Philippines
 Risk Factors:
 Family History
 Unhealthy Eating
 Lack of Exercise
 Overweight
 Conditions or situations known to exacerbate
glucose/insulin imbalance
1. Previously undiagnosed or newly diagnosed
type 1 diabetes
2. Food intake in excess of available insulin
3. Adolescence and puberty
4. Exercise in uncontrolled diabetes
5. Stress associated with illness, infection,
trauma, or emotional distress
CHRONIC OBSTRUCTIVE PULMONARY
DISEASE
 It is a progressive disease that makes it hard to
breathe.
 Term used for 2 closely related diseases of the
respiratory system: chronic bronchitis &
emphysema (often occur together in older
patients)
 COPD affects millions of elderly people
worldwide, and this is more dangerous because
the older people might suffer from weak
immune system or other chronic health
conditions that may aggravate COPD.
 Chronic Obstructive Pulmonary Disease
(COPD) and asthma are 2 of the leading causes
of deaths in the Philippines and the world.
 (World Health Organization) - 600 million
people worldwide suffer from COPD while 12%
of Philippine population of 90 million have
asthma.
 Changes of Aging & COPD
 Lungs become stiffer and expand and
contract less easily.
 Muscles that support breathing become
weaker, making it harder to stretch the chest
in order to breathe.
 Breathing becomes more shallowly to
compensate
 Cough, it may not be very effective so that
clearing the mucus from the lungs is
difficult.
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 ALZHEIMER’S DISEASE
CANCER
 Group of diseases characterized by uncontrolled
cellular growth with local tissue invasion and
systemic metastasis.
 More than 100 types of malignant tumor are
represented by the term “cancer”.
 Lung and breast cancer - commonly affects the
elderly
 Philippines, - 75% of all cancers occur after age
50 years, and only about 3% occur at age 14
years and below.
 It is estimated that for every 1800 Filipinos, one
will develop cancer annually (if the current low
cancer prevention consciousness persists)
 Geriatric patients with lung cancer are clearly at
greater risk for toxicity due to chemotherapy and
other interventions, particularly if they are frail
or have serious comorbidity.
 Lung cancer remains the leading type of cancer
among Filipino men.
 Philippine Cancer Society - expressed concern
over the rise in lung cancer incidences among
Filipino women.
 2010 - breast cancer became the most common
cancer in the country with 16% of a total of
50,000 cases resulting in death.
 Why do older people get cancer?
 Some cancers can be inherited, and others
are caused by long term exposure to cancer-
causing substances (tobacco smoke).
 The body works to repair and control this
damage, but when cells continue to grow
and divide and don’t die when they should,
cancer may develop.
 Most symptoms of aging have nothing to do
with cancer, but older folks who don’t report
unusual changes to their doctor risk missing
an early cancer that could be treated
successfully
DEMENTIA
 Incidence of dementia rises with age.
 65-74 years old – 3% experience dementia
 75-84 years old – 19%
 85 years old or older - 50%
 Dementia occurs due to degradation of the
nerves endings that send impulses to the brain
 Dementia is associated with higher mortality:
2.3 cases/100 person.
 Dementia is a major cause of functional
dependence.
 the most common form of dementia.
 It is a progressive, irreversible, degenerative
disease attacking the brain & resulting in
impaired thinking, behavior, movement
coordination and memory.
 first described in 1906 by a neurologist (Dr.
Alois Alzheimer) who observed neurofibrillary
tangles & neuritic plaques in an autopsy of the
brain.
 Risk factors associated with Alzheimer’s
disease (AD)
1. lack of education
2. smoking
3. lack of physical activity
4. depression
5. high BP @ midlife
6. diabetes
7. obesity
 ETIOLOGY : Unknown, but it is believed that
reduced level of certain brain chemicals cause
degeneration of nerve cells in the part of the
brain responsible for memory & other thought
processes.
 This degeneration is attributable to :
1. INTRINSIC cause
 People with Alzheimer’s have a
common history of viruses or infections
such as herpes simplex, measles &
polio.
 Genetics
2. EXTRINSIC cause
 Exposure to metals.
 It was found out that people with
Alzheimer’s have high aluminum
content in their blood.
 CLINICAL MANIFESTATIONS of AD
1. Significant forgetfulness
 Problems with long & short term
memory.
 Inability to remember details of one’s
personal life (e.g. birthplace, name of
children ).
2. Impaired cognitive functioning.
 Persons with MCI (Mild Cognitive
Impairment) have complaints and
objective evidence of memory problems.
 they do not have deficits in ADL & do
not meet the criteria for dementia
3. Difficulty in performing familiar tasks ;
misplacing objects constantly.
4. Decline in social functions.
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 Stages of Alzheimer’s disease:
 Stage I - Normal
o Common manifestations:
 No objective nor subjective
evidence of cognitive impairment.
 No objective evidence of
impairment but subjective concern
about memory loss.
 Stage 2 – Forgetfulness
o Common manifestation:
 Can do familiar tasks in familiar
settings.
 Stage 3 – Early confusional
o Clinical manifestations :
 Decreased ability to perform in
demanding employment and social
interactions.
 Deficit in memory and ability to
concentrate
 Stage 4 – Late confusional
o Clinical manifestations :
 Increasing difficulty in performing
complex tasks of daily life including
money management.
 Can bathe, dress, & travel in
familiar settings.
 Trouble speaking may begin.
 Stage 5 – Early dementia
o Clinical manifestations :
 No assistance required with eating
or toileting.
 Can recall own name and name of
spouse & children.
 Unable to recall phone number.
 Difficulty choosing proper clothing.
 May require coaxing to bathe.
 Difficulty subtracting 3’s from 20.
 Stage 6 – Mid dementia
o Clinical manifestations :
 More deliberate gait, smaller steps.
 Progressive deficits in independent
dressing, bathing, & toileting.
 Eventual urinary and fecal
incontinence.
 Stage 7 – Late dementia
o Clinical manifestation :
 Progressive loss of speech,
locomotion, & consciousness.
 Medications for Alzheimer’s Disease
1. Cholinesterase inhibitor
2. Antioxidants (Vit. E)
3. Conjugated estrogen (estradiol)
4. NSAIDs
5. Ginkgo Biloba
 Cholinesterase Inhibitor
 Increases the amount of acethylcholine
which slows the mental decline in people
with AD.
 Does not prevent the disease from getting
worse but may slow the progression of
symptoms.
 Antioxidants (Vitamin E)
 Helps prevent free radical damage (to the
brain can produce oxidative stress
contributes to devel’t of AD)
 Conjugated Estrogen ( Estradiol)
 Increases cerebral blood flow
 Has anti-inflammatory action
 Has antioxidant properties
 Promotes the nonamyloidogenic metabolism
of the amyloid precursor protein
 CARING FOR CLIENTS WITH
ALZHEIMER’S DISEASE
 Promote functional independence and self-
care as long as possible.
 Provide a structured, predictable daily
routine.
 Institute safety measures.
 Protect client from sources of infection.
 Guard against learned helplessness
NURSING DIAGNOSIS RELATED TO CHRONIC
ILLNESS
 PHYSICAL
 Impaired Physical Mobility r/t intolerance to
activity/ decreased strength & endurance;
pain/ discomfort; perceptual/cognitive
impairment
 Activity intolerance r/t bedrest/ immobility;
generalized weakness; sedentary lifestyle
 Self-care deficit r/t decreased strength and
endurance; physical, perceptual or cognitive
impairment
 PSYCHOSOCIAL
 Social Isolation r/t absence of supportive
SO; alterations in physical appearance
 Risk for loneliness
 Ineffective Role Performance
 Impaired Home Management
 Acute Confusion