SECTION 1: CHRONIC VS. ACUTE

In contrast to acute illness, chronic illness is a long-term result of a progressive medical disorder. Unlike acute illness, chronic illness is usually incurable, progressive, and lasts the balance of lifetime. The cause of chronic is illusive or the result of multiple problems.  Treatment is ongoing and aimed at symptom relief rather than cure; usually because of a prognosis of progressive deterioration. The immense financial burden of this long term care adds to the psychological impact of chronic illness. 

The major difference that affects quality of life is the impact of chronic illness on comfort and function. An episode of acute illness heals in a short time with return to comfort and function. Chronic illness may lead to disability and dependence. The most common chronic illnesses in the elder population are arthritis, high blood pressure, hearing impairment, and heart disease. An important factor to remember is that not attending to an acute illness appropriately could result in a chronic illness which impacts comfort and function needlessly.

Approximately 80% of all elders live with at least one chronic disease condition; the majority of those have symptoms of one or more additional chronic illnesses. Despite these high numbers, the majority of the population affected by chronic illness are able to function independently.

The most difficult problem in diagnosing a chronic disorder in elders is to identify the underlying condition. Many symptoms have varied sources of origin and may even be erroneously associated with age changes. One example is hypothyroidism; the symptoms are slowed thought process, constipation, weight gain, cold intolerance, and depression. These symptoms are often associated with aging; hence a medically treatable problem is overlooked.

The most difficult problem in treating a chronic illness in elders is the complexity and number of complications that need to be addressed; some of the complications are side-effects of treatments already in place. Usual medical treatment for chronic illness consists of addressing symptoms to prevent disease progression rather than attempting a cure.

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SECTION 2: MOBILITY/DISABILITY

Assessment tools are used to determine the total impact the chronic illness or injury has on the individual. The tool will assess for problems associated with thinking and memory as well as musculoskeletal strengths and weaknesses. An important element of assessment is the elder's social and psychological status.

One simple assessment tool is to give the person the following instructions: Take your shoes and socks off, put them back on again, walk across the room, return to the chair, and then remove and eat the package of saltine crackers. Observing this action will give you information about the following: arthritic changes, skin conditions of toes and feet, flexibility, strength, endurance, balance, weight shift, presence of contractures, mobility, oral function, eye-hand coordination, visual acuity, ability to sequence and follow instructions, cognitive capability, and hearing.

A rehabilitative treatment program will address appropriate assistive devices (wheelchair, walkers, canes, commodes, etc.), exercise, nutrition, speech therapy, and occupational therapy (therapy to enhance one's ability to build or construct things related to work or hobby). Rehabilitation also needs to address the issues of preventing social isolation and sensory deprivation. These can easily occur when people are confined to a specific environment without any interaction.

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SECTION 3: PAIN, ACUTE VS. CHRONIC

Pain is usually considered a negative sensation, feared by many and associated with advancing age. We need to remember that although the pain sensation may be uncomfortable, it serves as a protective mechanism. Similar to hunger, thirst, and fatigue, pain serves to inform us of information about our internal environment and the need to take some action to prevent injury or illness. Pain signals us when some body function has become impaired or some body part has been injured. Some examples are the pain of kidney stones or a broken bone.

Despite advances in the research of pain and its management, information and strategies relate to children and the adult population. Research addressing the topic of pain in elders is lacking. This is most likely due to the misconception that pain is an inevitable outcome related to aging. This limitation of knowledge contributes to the multitude of myths and stereotypes about aging. Misconceptions about pain in elders and thus the fears of the younger generations become perpetuated.

In spite of the fact that pain is not an inevitable part of aging, elders are more likely to experience disorders that result in pain. Some examples include arthritis, heart disease, and cancer. Elders are also more likely to experience falls and fractures because of the impact of aging on proprioception and bone density.

Acute pain accompanies acute illness or injury, has a specific duration, and is curable. Chronic pain accompanies chronic illness or the resulting debilitation from an injury. While the level of intensity may fluctuate, chronic pain resulting from chronic illness or injury does not relent.

Pain Perception & Sensation

A common misconception is that the ability to perceive pain decreases with age. Needless suffering is the consequence of this misperception because of the undertreatment of pain and the underlying medical condition causing pain.

Failure to report pain or under-report pain in the elder population may also be related to other factors. One example is an elder who holds off reporting pain due to a fear that the pain represents some debilitating illness.

Available research in the area of the pain experience in elders is inconclusive. Therefore, accurate assessment of pain needs to incorporate other avenues of information gathering that adjust for the aging experience.

Other avenues include these aspects:

To enhance the assessment of pain in elders:

1. Request information from family or friends about changes in activities or performance of activities.

2. Request the person describe the experience in their own words.

3. Observe actual function looking for change in gait or guarding of body part.

4. Reduce fears by discussing risks involved and options available.

Pain Treatment

Three common misconceptions about the treatment of pain in elders exist:

1. The side effects of narcotic pain medications are too dangerous to use for elders.

2. If the elder is distracted or asleep, then he or she does not have much pain.

3. If an elder is depressed and the pain has no known cause, then the pain is a result of the depression and will subside when the depression is treated (McCaffery & Beebe, 1989).

Narcotics can be used safely in the elder population with frequent assessment and appropriate evaluation of the response to the medication. The lack of expression of pain must not be interpreted as a lack of pain. Again, such assumption leads to needless suffering and inappropriate care. While chronic pain can cause depression, rarely does depression cause pain. Depression can affect an elder's ability to cope with pain.

Pain needs to be addressed in older persons because of the impact pain has on movement and mobility. The pain from some chronic medical conditions such as arthritis can limit the number of activities and level of activities a person will perform. The level of limitation depends on the severity of pain and the person's behavioral characteristics. Individuals react to pain differently. Some succumb to pain and avoid activities. Others attempt to distract themselves from the pain through involvement in activities. From the information available about the hazards of immobility, we know that pain can negatively effect a multitude of body systems. Therefore, pain needs to be assessed and treated appropriately.

Pain can be treated through the use of medications. Depending upon the health care provider, the amount of pain, and the cause of the pain various types of medications are available. Some examples are narcotics, Non-Steroidal Anti-Inflammatory Drugs (NSAID), steroids, aspirin, and acetaminophen (Tylenol). Some alternative preparations for pain relief involve the use of homeopathy, herbs, vitamins, and minerals. Other effective treatments for pain include Transcutaneal Electric Nerve Stimulation (TENS) units, imagery and relaxation techniques, biofeedback therapy, hypnosis, yoga, and exercise. Exercise causes the production and release of endorphins, a natural chemical that relieves pain and depression.

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SECTION 4: FACTORS RELATED TO CHRONIC ILLNESS

Dependency/Control/Powerlessness

Depression and Fatigue

Elder Abuse Related to Health Care

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SECTION 5: IMPACT OF TREATMENT ON QUALITY OF LIFE

Touch

Medications

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