Module 11 Study Questions
Chronic Illness in Later Life 

STUDY ACTIVITY 11.1: How would a person attempting to deal with chronic pain from an injury or illness be treated by health professionals whose goals include treatment plans for a curative outcome? What if the treatment was massage or physical therapy for arthritis and no gains were made, but maintenance provided enough pain relief for the person to cope with the activities of their life? These treatment plans are usually guided by insurance reimbursement policy that does not cover treatment for "maintenance". In discussing the sick role the F & F text states that "elders should attempt to do the most they can despite their illness and go on with life as best as possible" (pg. 116). Discuss the issue that elders may need maintenance therapy to cope with chronic illness vs. the lack of health care reimbursement for maintenance therapy.

An example is an 82-year-old widowed female with post-stroke left sided paralysis of the arm and leg. Physical therapy over a six month period had good results and was terminated upon reaching "maintenance". Six months post therapy she was back to the level of paralysis when she had started physical therapy. Assistive services that were not needed during the physical therapy period, now became essential. Assistance was now necessary with bathing, grooming, dressing, meal preparation, shopping, laundry and housekeeping. This woman had not left her house in three years and was managing to walk with a walker using her right arm to get around her house. Evaluate which you think has a higher cost: routine physical therapy for maintenance or the provision of the services listed above?

STUDY ACTIVITY 11.2: Incontinence was discussed in the previous unit on acute illness. Describe why urinary incontinence could be placed in both categories. What other, if any, conditions could also be labeled as both acute and chronic, and elaborate.

STUDY ACTIVITY 11.3: Smits and Kee (1992) found through research that among a group of independent elders self-concept is significantly related to self-care and therefore suggest that focusing on psychosocial needs as well as physical interventions will promote self-care behaviors.

Lee (1993) compared a group of older women with osteoarthritis living in different population areas - urban, rural, and frontier. Consistent with other studies were findings that the rural group has poorer health than the urban group and yet the rural group had higher perceived ability to function. In addition she reported the more rural participants had fewer visits to health care providers and spent fewer days in the hospital than urban participants. The chronic illnesses reported for all participants were hypertension, heart problems, diabetes, vision problems, cancer, and osteoporosis. The author questions the possibility that the individuals living in the more rural areas may be "potentially normalizing a treatable functional disability" (pg. 36).

The results of Lee's study suggest that the attitudes of independence and self-reliance interfere with appropriate care that might prevent debilitating or disabling effects of chronic illness. The possibilities for low use of health care services may be from lack of need, lack of knowledge, or limited access. How could you address these areas keeping in mind the attitudes of independence and self-reliance in order to promote health and health prevention in the more rural areas? How could you integrate the results of Smits and Kee's research?