Disability in America Toward a National Agenda for Prevention (1991) / Chapter Skim
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6 Prevention of Disability Associated with Chronic Diseases and Aging
6 Prevention of Disability Associated with Chronic Diseases and Aging
Pages 184-213
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From page 184... ...
This first revolution has had at least two consequences: the age structure of modern society shifted as a result of increased average life expectancy, and acute disease was joined by chronic disease as a focus of public health attention. Chronic disease and its related disabling conditions, however, have not been responsive to the traditional public health interventions that were so successful in the first revolution.
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From page 185... ...
Department of Health and Human Services, 1990) employs the life course approach in setting objectives, including goals to increase average life expectancy to 78 years, to reduce disability caused by chronic conditions to a prevalence of no more than 6 percent of all people, and to increase years of healthy life to at least 65 years.
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From page 186... ...
Because some chronic diseases occur before age 65, and because a life course perspective is important for considering chronic disease, aging, and disability, the data presented are not limited to the elderly. Prevalence of Chronic Conditions Although the prevalence of chronic illness increases with age and is a major cause of disabling conditions, many elderly persons are healthy and function independently.
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From page 187... ...
187 oo oo Cat ¢ Cal o .
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From page 188... ...
188 Do oo o w U
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From page 189... ...
Chronic Conditions Causing Disability The higher-ranking prevalent chronic health conditions are not necessarily those that cause the most disability (defined here in terms of activity limitations)
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From page 190... ...
C 0D e D ~ ~ Cat ~ 0 0 C O (~) >% |
From page 191... ...
Many people, especially the elderly, have multiple chronic and potentially disabling conditions. Data from the NHIS for the three-year period from 1979 to 1981 indicate that multiple chronic conditions causing limitation of activity increase with age.
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From page 192... ...
For those 60 years of age and older who had no chronic conditions, only 2.1 percent of men and 2.3 percent of women required assistance in performing one or more activities of daily living (ADLs)
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From page 193... ...
LIFE COURSE PERSPECTIVE ON DISABILITY AND ITS PREVENTION The life course provides a useful framework for considering disabling conditions and their prevention. For persons 60 years of age and older, 8 out of 10 have one or more chronic diseases or impairments (Guralnik et al., 1989b)
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From page 194... ...
Older adults constitute, in sum, an interesting case of the modifiability of disablement from chronic diseases and impairment over the entire life course through risk factor reduction. A related question to be pursued in future research is the effect of not sustaining previously developed healthy lifestyles in later years.
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From page 195... ...
The interventions should be determined by the needs of each individual rather than by rigid definitions of disabilities. Collaborative projects involving primary care providers, public health agencies, voluntary associations, and the community should be developed to coordinate disability prevention programs that implement interventions centered on individual needs with a goal of improving an individual's physical, mental, and social well-being over the life course.
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From page 196... ...
Thus, although much is known about the prevention of certain chronic diseases and associated disabling conditions, sometimes the preventive and rehabilitative interventions that are used are not underlain by sufficient understanding, and their effectiveness has not been thoroughly evaluated. Moreover, prevention efforts are hampered by limited understanding of the natural histories of many chronic diseases, of the aging process, and of the relationships among chronic disease, aging, and functional outcomes.
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From page 197... ...
Existing approaches to reducing disabling conditions and premature mortality caused by diabetes rely on secondary and tertiary prevention of complications. Cardiovascular disease is a leading cause of mortality among people with diabetes, accounting for half of all diabetes-related deaths.
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From page 198... ...
As the committee's model of the disabling process suggests, there are numerous opportunities for intervening and modifying the risk factors that predispose people with chronic diseases to disability. Obviously, the goals of preventing, or at least delaying, the onset of disability and of minimizing the severity of its consequences become more challenging as the age of the target population increases and as the risks of chronic disease, comorbidity, and functional limitation also increase.
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From page 199... ...
Needs and Opportunities Although the past 25 years have seen considerable progress in health promotion and the prevention of chronic disease, the need remains for further development and critical evaluation of primary, secondary, and tertiary prevention efforts. Health promotion and other primary prevention efforts that begin at the earliest stages of life are among the most effective and are applicable not only to those who are free of disease or impairment but also to those with disease and disabling conditions.
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From page 200... ...
Greatly needed is longitudinal epidemiological research that tracks the progression to disability and identifies the contributing risk factors. Longitudinal studies are needed to help define the dynamic nature of pathology, impairment, functional limitation, and disability, arid to describe the natural history of chronic diseases arid aging in terms of these conditions.
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From page 201... ...
tial targets for disability prevention. For example, inappropriate prescribing of medications by physicians and improper use of drugs among the elderly pose serious risks to physical and mental health.
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From page 202... ...
Systolic/diastolic hypertension and isolated systolic hypertension are important risk factors in persons 50 years of age and older. The older the patient, the less a physician can predict optimal dose based on lab tests and clinical judgment.
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From page 203... ...
significantly retard bone loss; but once lost, before ERT, bone mass is irretrievable. Sensory loss Approximately one-third of Association between sensory the elderly population loss and physical limitation to suffers hearing or vision determine risk factors for those loss of varied etiology.
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From page 204... ...
Nutrition Poor nutrition is a risk factor Clarification of the associations for many common chronic between nutritional require diseases coronary artery meets and function. heart disease, hypertension, Optimal activity rate for those stroke, and certain cancers.
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From page 205... ...
Cessation of smoking de creases risk of all these chronic diseases, particu larly coronary heart dis ease, even after age 50. Past age 50, smoking continues to diminish life expectancy and increase morbidity, and remains a good predictor of lung and other cancers.
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From page 206... ...
Poor functioning attributed solely to depressive symptoms was comparable to the level of functioning associated with cancer, cardiovascular disease, and six other major chronic conditions. Given that the likelihood of depression is high among elderly people who have a physical illness, these findings underscore the potential health benefits that are likely to result from the provision of appropriate mental health services.
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From page 207... ...
. Patients with chronic schizophrenic symptoms are commonly neglected, which may exacerbate their symptoms and lead to a variety of secondary conditions, including sometimes violent acting-out behavior, social isolation, withdrawal from everyday activities, malnutrition, substance abuse, imprisonment, and homelessness.
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From page 208... ...
Both standardized protocols for the management of chronic diseases and mental disorders, and guidelines for preventive services need to be developed and widely disseminated with the goal of preventing disability. The increased life expectancy for persons with developmental disabilities, chronic diseases, or injury-related conditions, for example, mandates an emphasis on their inclusion in the national disabilities prevention program.
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From page 209... ...
provided unpaid assistance to 1.6 million elderly people who required help with one or more basic life activities. The average age of the informal caregiver is 57; a quarter of these caregivers are between the ages of 65 and 74, and 10 percent are older than 75.
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From page 210... ...
. These predicted trends and the mismatch between today's health and social service system and the needs of the elderly and of younger adults with chronic disease and disabling conditions should compel policymakers and service planners and providers to rethink current approaches to care.
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From page 211... ...
In the area of disability prevention, however, clinging to outdated service delivery models and to disproved notions about the chronically ill and the elderly makes the prospects for progress quite poor. New thinking is required, and this can be achieved only through public and professional education.
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From page 212... ...
As a consequence, high-technology medicine tends to be favored even when low-tech services are likely to be more beneficial, and providers of health care and social services operate in isolation rather than as multidisciplinary teams. The potential exists for modifying the quality of life associated with aging and chronic disease processes through individual lifestyle change and through social policies that ensure adequate income, educational opportunities, and social support across a person's life course.
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From page 213... ...
If this information were compiled in easy-to-use data bases, adoption of these consensus guidelines and protocols by health care professionals would be accelerated.
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