Chapter 30 Major Health Issues and Chronic Disease Management of Adults Across the Life Span

1Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc.

Chapter 30

Major Health Issues and Chronic Disease Management of Adults

Across the Life Span


Objectives

1. Define terms commonly used in the care of adults.

2. Describe historical and current perspectives of adult health and health policy.

3. Discuss sources of population-based public health data and health status indicators about adults to be used to align community resources to support adults with chronic illnesses.


Objectives, Cont’d

4. Use appropriate assessment tools and development strategies to care for adults across the life span.

5. Discuss the concepts of self-management and the implementation of the Chronic Care Model to support adults with chronic illness.

6. Explain the dynamic forces that contribute to shared and gender specific diseases, health disparities, cultural diversity, and culturally competent care of adults in their communities.


Objectives, Cont’d

7. Appraise the role of cultural, social, and behavioral factors in accessibility, availability, acceptability, and delivery of community-based models of care for adults.

8. Examine role opportunities for nurses in providing care in the community.


Historical Perspectives

Gender inequalities Predominantly men working, including in medicine and

research Health researchers focused on issues predominantly

oriented toward men Early 1900s: Women’s health focused on reproduction and

women’s roles as mothers 1920s: Women’s health expanded to address family

planning and reproductive health (beginning of birth control movement)

1980s: USPHS Task Force on Women’s Health Issues 1990: Society for Women’s Research founded


Health Policy and Legislation

Older Americans Act of 1965 Americans with Disabilities Act of 1990 Family Medical Leave Act of 1993 Personal Responsibility and Work

Opportunity Reconciliation Act of 1996 “Welfare reform”


Ethical and Legal Issues, and Legislation for Older Adults

Abuse Neglect Financial exploitation Patient Self-Determination Act of 1991

Advanced medical directives Living will Durable medical power of attorney Do-no-resuscitate (DNR) order


Environmental Impact

Men and women are often exposed to different environmental factors because of upbringing, employment, cultural or tradition variations. Men and women may respond differently to

environmental factors. CDC’s Environmental Hazards and Effects

(EHHE) Program


Health Status Indicators

Mortality Life expectancy Mortality rates

Morbidity Increasing prevalence of chronic diseases and

other conditions associated with aging High prevalence of adults with risk factors


Adult Health Concerns

Chronic DiseaseCardiovascular Disease

HypertensionStroke

DiabetesCancer

STDs/HIV/AIDSWeight Control


Chronic Disease

Most common: Heart disease Diabetes Stroke Cancer Arthritis

Chronic disease is leading cause of preventable deaths, disability, and decreased quality of life

Wagner’s Chronic Care Model (CCM)


Cardiovascular Disease (CVD)

An estimated 81,100,000 adults have one or more types of CVD.

Leading cause of death for African Americans, American Indians or Alaska Natives, Hispanics, and Caucasians in the United States

Twenty-three Healthy People 2020 objectives focus on CVD.

Gaps in knowledge and awareness for heart disease Particularly in women


Hypertension (HTN)

One in 3 adults in the United States have HTN.

Uncontrolled HTN leads to heart attack, stroke, kidney damage, and a host of other complications. 22.4% of people with HTN are not aware they

have it Racial, ethnic, and socioeconomic differences


Stroke

Has decreased in the United States since the 1950s 2006: Estimated prevalence was 6,400,000 (down

from 7 million in 2002) Responsible for 1 in 18 deaths Women more likely to die from stroke than

men (because they live longer and strokes increase with age)

Community-based programs and policy regarding stroke care (AHA)


Diabetes (DM)

23.6 million people with DM One in 12 to 13 adults has DM

Costs the United States $174 billion each year

Many complications associated with DM Eighteen Healthy People 2020 goals related

to DM


Cancer

Second leading cause of death in the United States

Overall costs of cancer in 2008: $228.1 billion Needed to reduce the burden of cancer:

Early screening and detection Promotion of healthy lifestyles Expanding access to services Improving cancer treatments


STDs/HIV/AIDS

19 million new STD infections each year Almost half occur in people 15 to 24 years of age Many cases go undiagnosed

In 2007, 42,655 new cases of HIV/AIDS African Americans: 51% Caucasians: 29% Hispanics: 18%

Healthy People 2020: Promote responsible sexual behaviors, strengthen

community capacity, and increase access to quality services to prevent STDs and their complications


Weight Control

Overweight and Obesity United States health care cost: $147 billion

BMI 2008 Physical Activity Guidelines Anorexia Bulimia


Women’s Health Concerns

Reproductive health Preconceptual counseling

Gestational diabetes Menopause Breast cancer Osteoporosis


Men’s Health Concerns

Lack of health screenings Dangerous employment Cancers unique to men

Prostate cancer Testicular cancer

Depression Erectile dysfunction


Health Disparities

Adults of color Incarcerated adults Lesbian/gay adults Adults with physical and mental disabilities Impoverished and uninsured adults Frail elderly Importance of cultural competency


Community-Based Models for Care of Adults

Nursing roles Community care settings

Senior centers Adult day health Home health and hospice Assisted living Long-term care and rehabilitation

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Chapter 30 Major Health Issues and Chronic Disease Management of Adults Across the Life Span

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