9.1 Chronic Disease and Illness (Prevalence and Etiology)

Chronic diseases and illnesses affect more than half of the population and are the leading cause of death and disability in the United States.
Chronic disease is defined as a medical or health problem that lasts at least 1 year and requires ongoing medical attention or limits ADLs, whereas chronic illness refers to the human experience of living with a chronic disease.
Age, gender, and culture are three demographic factors that can significantly impact how an individual copes with a chronic medical condition.
It is imperative that nurses provide patient-centered care that considers the specific preferences and needs of the patient diagnosed with a chronic disease.

9.2 Comorbid Chronic Diseases

More than one-fourth of individuals with chronic illness are diagnosed with comorbidity, or the presence of two or more chronic conditions simultaneously.
Having chronic comorbidities increases disease burden and affects many aspects of health care including finances and health insurance coverage.
Polypharmacy often occurs because of comorbid chronic conditions and can result in negative outcomes, including adverse medication reactions and overdoses.

Disabilities, or limitations in function or performance of everyday activities, occur often because of chronic illness.
Wellness exists on a continuum, so even with a chronic disease, individuals may still fall somewhere on the high end of the wellness continuum if they ensure they are improving other aspects of health beyond just physical health.
There are many barriers—including physical, emotional, mental, social, and financial—that negatively affect the health of individuals with disabilities.
The Americans with Disabilities Act (ADA) is aimed to prevent discrimination against individuals with disabilities and mandates that “reasonable accommodations” must be provided in the workplace and on public transportation to allow individuals with disabilities to have equal access to services and opportunities.

There are many barriers that may limit health care access for individuals with disabilities, including social and financial factors, such as employment status, as well as access to transportation and geographic location.
Although some people are not able to work because of their disabilities, others who have severe, debilitating disabilities may not be able to leave their homes; they may require home nursing care.
Patients with chronic illness and disability who are admitted to the inpatient setting for care require an evaluation before discharge to determine the appropriate level of care and a safe discharge to home after leaving the hospital.

Though some chronic diseases occur regardless of lifestyle choices, many are preventable or may be limited, at least, in severity with the implementation of healthy lifestyle changes.
Primary prevention strategies aim to prevent a disease from occurring in healthy individuals and include interventions such as immunizations, exercise, and healthy lifestyle modifications.
Secondary prevention strategies are aimed at the early detection of disease and include regular physical examinations and screenings for specific medical conditions.
Tertiary prevention strategies are implemented after an individual has been diagnosed with a chronic disease. These strategies aim to limit the negative effects of the condition and allow the person to have the best quality of life possible despite their chronic illness.

The Chronic Care Model was developed to guide the prevention, management, and treatment of chronic disease. It consists of two main components: the organization of health care and the resources and policies of the community.
Within the organization of health care, one component is self-management support. This identifies the required services an individual requires to cope with their chronic disease.
Within the organization of health care, another component is delivery system design. This encompasses the partnership with the health care team and the individual with the chronic disease, as well as the importance of follow-ups.
Within the organization of health care, the third component is decision support. This is defined by the evidence-based interventions in managing chronic diseases.
Within the organization of health care, the final component is clinical information systems. These aid in understanding the health or chronic disease of an individual or aggregate.
The overarching goals of the Chronic Care Model include improving patient outcomes, enhancing patient self-management, increasing health care access, promoting care coordination, optimizing use of health care resources, fostering patient-centered care, and improving population health.

Nursing care of a patient with a chronic illness is like that of any other patient, but with more focus on the specific chronic condition itself.
The nurse must provide care that is patient-centered and focuses on management and treatment strategies specific to the patient’s needs and preferences.
Collaboration between members of the interdisciplinary health care team improves outcomes for patients with chronic conditions and ensures the patient receives thorough, high-quality care.