Lesson 9: Health Education in Chronic Illness

Heath Risk Behavior

 According to the CDC, four health risk behaviors are responsible for the majority of chronic
disease and death, including lack of physical activity, poor nutrition, tobacco use, and
excessive use of alcohol.
 The prevalence of cigarette smoking is still close to 20% of adults (USDHHS, 2014). The
American Heart Association tells us that there is a sharp increase in CVD risk with even
low levels of exposure to cigarette smoke, including secondhand smoke.
 On average, male smokers die 13.2 years earlier than male nonsmokers, and female
smokers die 14.5 years earlier than female nonsmokers (Go et al., 2013). Binge or heavy
drinking can lead to high risk sexual behavior, unintentional injuries (e.g., motor vehicle
crashes), falls, violence, and suicide.
 Excessive alcohol consumption can also lead to development of high blood pressure,
liver disease, some cancers, dementia, and alcohol dependence (Chowdhury et al., 2016).
The age-adjusted prevalence of obesity in 2013 to 2014 was 35.0% among men and
40.4% among women (Flegel, Kruszon-Moran, Carroll, Fryar & Ogden, 2016). Individuals
who are obese can suffer serious health problems, face discrimination, and have a
reduced life expectancy.
 The greater the body mass index (BMI) (and waist circumference), the greater the risk of
CVD, including hypertension, coronary artery disease, and stroke.
 In addition, obese individuals have an increased incidence of type 2 diabetes, sleep
apnea, osteoarthritis, gallbladder disease, respiratory problems, some types of cancer,
and depression (Jenson et al., 2014).
 It is known that 85.2% of people with type 2 diabetes are overweight or obese (American
Diabetes Association, 2015).
 There is strong evidence that modest weight loss (5% to 15%) can greatly reduce the risk
of these conditions. An expert panel (Jensen et al., 2014) also recommends intensive
management of CVD risk factors (hypertension, dyslipidemia, prediabetes, diabetes, and
sleep apnea) in addition to weight loss measures.

Guidelines for effectively teaching older adults

 Vision – large easy-to-read typeface; emphasize black & white; avoid blues & greens;
use non-glare paper, write short simple paragraphs, make sure glasses are clean & in
place.
 Hearing – speak slowly; enunciate clearly; lower pitch of your voice, eliminate
background noise; face the learner; use nonverbal cues; have hearing aid in place &
working correctly
 Energy level / attention – use short teaching sessions, offer liquid refreshments &
bathroom breaks, promote comfort
 Information processing/memory – present most important info first, clarify information w
use of examples; motor skills – teach one step at a time {have written easy to understand
instructions}; be concrete & specific, eliminate distractions; correct wrong answers/
reinforce correct answers; offer praise & encouragement
Teaching Older Adults About Individual Responsibility and Assertiveness for Maintaining
Wellness
 Learn to do some of the simple health checks yourself:
1. Pulse
2. Blood pressure
3. Breast exam - Ask your physician or nurse to teach you how.
  Stop smoking
 Keep active, both mentally and physically. Reduce stress
 Take a few medicines as possible, but do not stop taking any without discussing it with
your physician. Discuss the possible need for vitamin, mineral and calcium supplements
with your physician.
 Ask your physician about the benefits and risk of specific medicines, treatments and
surgeries. Ask for clear information in writing.
 Prepare for all physician’s office visits by writing down all of your questions and concerns
a few days before the visit and do not leave until you get answers to your questions from
the physician and/or nurse.
 Keep your own written record of the dates of physician visits, immunizations and BP
readings.
 Select physicians and hospitals that have the special services, staff and equipment to give
quality care to older adults.
 Be assertive in seeking quality health care for yourself and your family.
 Take responsibility for your own health and that of your family and insist on quality care.
 Do not change your health insurance unless you can obtain better benefits at the same or
lowest cost. Be sure to understand exactly what the benefits are. Ask questions.
 Do not sign anything that you do not completely understand
Behavioral Management in Chronic Illness
 Behavioral and Personal Factors
1. Good “copers” have hardy or resilient personalities – can remain positive
2. Men have more difficulty adjusting to chronic illness
3. Timing during the lifespan affects reactions
4. Personal health belief issues
Physical and Social Environmental Factors
1. Hospital environments can be depressive
2. Home/hospital environments may not foster self-sufficiency
3. Social support enhances coping
4. Network members may act as bad examples
The Tasks and Skills of Coping
1. Cope with symptoms or disabilities
2. Adjust to hospital or procedures
3. Develop and maintain good relationships with practitioners
Psychosocial Functioning Tasks
1. Control negative feelings and remain positive
2. Maintain satisfactory self-image
3. Preserve good relationships
4. Prepare for uncertain future
Coping Skills
1. Denying or minimizing
2. Seeking information
3. Learning to provide one’s own medical care
4. Setting concrete, limited goals
5. Recruiting support
6. Considering possible future events
7. Gaining a manageable perspective
People with chronic illness must work harder at well being
 Well-being is more complex than just having good health
 It involves: Mind, Body and Spirit
 It involves the whole person
Issues and Trends in Chronic Care
• Costly chronic care needs are growing and exerting considerable demand on health
systems.
• Chronic diseases and conditions are on the rise worldwide.
• An ageing population and changes in societal behaviour are contributing to a steady
increase in these common and costly long-term health problems.
• The middle class is growing; and with urbanisation accelerating, people are adopting a
more sedentary lifestyle.
• This is pushing obesity rates and cases of diseases such as diabetes upward.
• According to the World Health Organization, chronic disease prevalence is expected to
rise by 57% by the year 2020.
• Emerging markets will be hardest hit, as population growth is anticipated be most
significant in developing nations. Increased demand on healthcare systems due to
chronic disease has become a major concern.
• Another rising health concern is global pandemics. The pandemics of the past decade
have clearly demonstrated the speed at which infections spread across the globe. Ebola,
SARS, MERS, and H1N1—to name but a few—demand coordinated and agile
healthcare responses.
• Pandemics will likely exert periodic and significant disruptive pressure on health
systems.
• Healthcare organisations across the globe need to be ready to work together to contain
outbreaks quickly when they occur.
• ECONOMIC BURDEN OF CHRONIC DISEASE
• Eighty-six percent of all health care spending in 2010 was for people with one or more
chronic medical conditions (CDC, 2016).
• The latest economic reports of chronic disease indicate that the cost burden associated
with five of the most common chronic diseases was $28 billion greater than had been
predicted.
• This unexpected increase relates to the prevalence of chronic, preventable conditions
among people in the United States, largely due to the effects of obesity.
• In all diseases other than CVD, the numbers of patients with chronic disease rose above
projections, and actual treatment costs and productivity losses exceeded estimates. Total
overall treatment costs and lost productivity in the United States presently amounts to $1.3
trillion (Chatterjee, Kubendran, King, & Devol, 2014).
• A few of the more common chronic diseases have substantial cost estimates. The
estimated total cost of diagnosed diabetes in 2012 was $245 billion, a 41% increase from
the previous estimate of $174 billion (American Diabetes Association, 2013).
• Total payments in 2016 for individuals with Alzheimer ’ s disease and other dementias are
estimated at $236 billion, with Medicare and Medicaid payments of $160 billion, or 68%,
and out-of-pocket spending expected to be $46 billion, or 19% of total payments
(Alzheimer ’ s Association, 2016, p. 45).
• The total costs of heart disease and stroke in 2010 were estimated to be $315.4 billion
with $193.4 billion, respectively, for direct medical costs, excluding costs of nursing home
care (CDC, 2016).
• Additional costs of chronic disease relate to the multiple acute care hospitalizations
experienced by the seriously chronically ill population. In a 2004 classic study, almost one-
 fifth of Medicare patients had unplanned rehospitalizations within 30 days of release, with
a cost of $17.4 billion (Jencks, Williams, & Coleman, 2009).
• Cost and complexity of care are greater for individuals with multiple chronic diseases, who
account for 75% of overall health-care spending (Thorpe, Ogden, & Galactionova, 2010).