Grief

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Chapter 27

Chronic Illness and Rehabilitation

Chronic disease affects physical, psychologic, and social aspects of lives of individuals and families.

Many with chronic illness become homebound; decreased outside contact leads to social isolation.

Chronic disease is the leading cause of death and disability in the United States.

Chronic Disease

Disease refers to a condition viewed from a pathophysiologic model, such as an alteration in structure and function; it is a physical dysfunction of the body.

Illness is what the individual (and family) are experiencing, how the disease is perceived, lived with, and responded to by individuals and families.

Disease vs. Illness

Noncommunicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely (Bernall & Howard, 2016)

Nurses need to consider the illness related issues that the patient and family experiences.

Understanding the perception of and response to the disease will allow for a more individualized plan of care.

Chronic Disease Defined

Increase in chronic conditions is caused by: Lifesaving and life-extending technologies not previously available, increase in population of older adults, and increasing life expectancy

The health care system applies the “acute care model” to those individuals with chronic conditions, and as a result, the needs of older adults and what the system can provide do not match.

This results in fragmented care, inadequate or inappropriate care from the system, and dissatisfaction on the part of the patient.

Chronic Conditions

The State of Aging and Health in America (CDC, 2013) reports two out of three older Americans have multiple chronic diseases and account for 66% of the health care budget.

Nursing care needs to focus on increasing functional ability, preventing complications, promoting the highest quality of life, and, when the end stage of life occurs, providing comfort and dignity in dying.

Prevalence of Chronic Illness

Include hypertension, hyperlipidemia, heart disease, arthritis, diabetes, chronic kidney disease, ischemic heart disease, dementia, depression, and chronic obstructive pulmonary disease.

Repeated hospitalizations are common to treat exacerbations of heart disease, cancer, pneumonia, and stroke.

Women are hospitalized for injuries like hip fractures.

Most Frequently Occurring Chronic Diseases

Course of a chronic illness varies from one individual to another.

Variables that impact the disease include: socioeconomic factors, psychosocial factors, culture, and other contributing comorbid disease or illness

Older adults often view themselves as “well”; their disease is only one component of their life and not their identity.

Chronic Illness Experience

Concepts of health and illness are deeply rooted in culture, race, and ethnicity and influence an individual’s (and family’s) illness perceptions and health and illness behavior.

30% of the population is racially and ethnically diverse.

Nursing frameworks assist health care providers in providing culturally competent care.

Cultural Competency

Multiple definitions for quality of life exist most include physical, psychological, and social components; disease and treatment-related symptoms; and spirituality.

QOL is determined by the individual, not the health care provider.

Health-related quality of life (HRQOL) is a multi-dimensional concept used along with well-being to measure the impact of chronic illness, the treatments, and the corresponding related disabilities.

Quality of Life

Adherence is how well the patient manages the treatment plan.

Use of the five A’s to assist patients with the self-management aspects of their chronic disease: assess, advise, agree, assist, and arrange.

Also important to (1) advise the patient of the importance of the treatment plan, (2) establish agreement with the treatment plan, and (3) arrange adequate follow-up

Adherence in Chronic Illness

Understanding the relationship between the older adult’s social, psychologic, and physiologic needs is important for health care providers.

Adaptation to chronic illness: three frameworks for practice demonstrate the importance of controlling symptoms, managing the trajectory of the disease process, and engaging the patient in self-care

Discussed on next slides

Psychosocial Needs of Older Adults With Chronic Illness

Issues and concerns framework—examines the psychosocial needs of patients VS their physical needs

Trajectory framework—the illness trajectory is set in motion by the pathology of the patient, but the actions taken by the health care providers, patient, and family may modify the course.

Chronic Care Model—assists with the management of multiple chronic diseases and improve outcomes by providing a method of care coordination to improve patient self-care

Chronic Illness and Quality of Life

Powerlessness

Stigma

Social isolation

Chronic Illness Experience

Is educating and providing a treatment plan that allows the patient to be in charge of the management of the chronic illness and have open communication with health care providers

Nurse should guide, educate, and support older adults and their families in developing positive coping strategies.

The nurse serves as a resource for older adults and their families in solving care management problems.

The Chronic Care Model

Pain is a major issue.

Fatigue may be difficult to manage.

Immobility and activity intolerance predictor of ability to maintain or recover wellness

Sexual activity can be affected by many aspects of chronic illness.

Physiologic Needs of the Chronically Ill

Situational factors related to caring for adults with chronic illnesses contribute to caregiver stress.

Role strain—balancing the role as primary caregiver with other roles within the family network

Female caregivers experience a greater sense of burden and stress than male caregivers.

Caregivers’ Stress

Providing care not only to the patient but also to the caregiver

Get to know the caregiver

Provide information about the illness

Reassure the caregiver that feelings of frustration or helplessness are not unusual reactions

Referral to social worker

Respite services

Nursing Implications of Caregiver Stress

Rehabilitation: services and programs designed to assist individuals who have experienced trauma or illness that results in impairment that creates a loss of function, which can be physical, psychologic, social, or vocational

Gerontologic rehabilitation nursing is a specialty practice that focuses on restoring and maintaining optimal function while considering holistically the unique effects of aging on the person.

Rehabilitation

You are a nurse caring for a patient with several chronic illnesses and who lives with a daughter. Discuss some of the ways the nurse can assist the patient and daughter to adapt the their illness and improve their health outcomes.

Quick Quiz!

Answers will vary

Answer to Quick Quiz

Goal: maintain or improve function

Activities older adults enjoy can be incorporated into exercise and endurance training.

Helps with chronic illness and disease prevention

Endurance training, strength training, balance exercises, and flexibility exercises are important exercises for older adults.

Enhancement of Fitness and Function

Function is a useful measure in the diagnosis of illness and self-care deficits.

Functional independence measure (FIM) measures abilities in six areas: self-care, sphincter control, transfers, locomotion, communication, and social cognition.

Establishing a patient’s baseline level of functioning helps identify the patient’s strengths and rehabilitation potential.

Functional Assessment

First check mental status

Conduct specific assessments based on the degree of potential or actual disability

Ask what they can do VS cannot do

Safety screening for self-care limitations

Consider values and beliefs about quality of life

Completing a Functional Assessment

Within rehabilitation allows older adults to achieve a maximum level of functioning and increase longevity

In chronic illness involves behavioral change for positive lifestyle activities, accepting one’s condition and making the necessary adjustments, decreasing the risk of secondary disabilities, and preventing further disease, all while striving for optimal health

Health Promotion

A person with a chronic illness or disability finds taking health or ability for granted is no longer possible.

Older adults must reorganize their lives to enhance functional ability and rehabilitation.

The nurse may assist older adults with organization and maximize financial resources.

Life Issues

Nurses assist patients in setting and achieving goals that facilitate reintegration to former environments.

Improving range of motion

Improving endurance and tolerance for activity

Restoring functional ability to an acceptable level

Improving ambulation (if appropriate)

Maintaining safety

Goals must be the patient’s goals, not the health care provider’s goals of care.

Nursing Strategies