204
Unit 3
Applying concepts from the nursing process
restriction in performing an activity in a normal manner) is
usually present in severe or advanced chronic illness. However,
not all disabilities are a result of chronic illness, and not all
chronic illnesses cause disability. In this chapter, chronic
illness is discussed, followed by a discussion of disability, rehab
ilitation and the implications for nursing practice.
The psychological and emotional reactions of older indi
viduals to acute and chronic conditions and changes in their
health status are described in detail in Chapter 3. Symptoms
associated with chronic illnesses are often unpredictable, and
some are perceived as crisis events by individuals and their
families, who must contend with both the uncertainty of
chronic illness and the changes it brings to their lives. These
possible effects of chronic conditions can guide nursing assess
ment and interventions for the patient who has a chronic
illness.
Prevalence and causes of chronic
conditions
The prevalence of chronic conditions and illness is evident in
the mortality, morbidity, and disability statistics of industri
alised Western societies. These conditions have become the
major cause of health-related problems in developed countries
such as Australia and New Zealand (Australian Institute of
Health and Welfare [AIHW], 2008), as well as in develop
ing countries that are trying to cope with new and emerging
infectious illnesses such as malaria, tuberculosis and HIV
(human immunodeficiency virus), which also become chronic
health problems. In almost all countries, chronic illnesses are
currently the major cause of death among adults. More than
36 million people died of chronic illness worldwide in 2010. In
contrast to common belief, the total number of people dying
from chronic illness is twice that of patients dying from infec
tions (including HIV infection), maternal and perinatal con
ditions and nutritional deficiencies combined (World Health
Organisation [WHO], 2010). Chronic illness accounts for 80%
of the total burden of illness in Australia, and mental problems
and injury are the leading causes of disability in the community
(Australian Bureau of Statistics [ABS], 2010a).
Although chronic illnesses are common, people have many
myths or misunderstandings about them (Table 10-1). Causes
of the increasing number of people reported with chronic con
ditions include the following:
•
A decrease in mortality from infectious illness
(e.g. smallpox, diphtheria, acquired immunodeficiency
syndrome [AIDS]–related infections) and from acute
conditions because of prompt and aggressive management
of acute conditions (e.g. myocardial infarction, stroke,
trauma).
•
Lifestyle factors, such as smoking, chronic stress and a
sedentary lifestyle, which increase the risk of chronic
health problems such as respiratory illness, hypertension,
cardiovascular illness and obesity. Although signs and
symptoms of chronic illness often first appear during
older age, risks may begin earlier, even during fetal
development.
•
Longer lifespan because of advances in technology
and pharmacology, improved nutrition, safer working
conditions and greater access (for some people) to
healthcare.
•
Improved screening and diagnostic procedures, enabling
early detection and treatment of illness, resulting in
improved outcomes of management of cancer and other
disorders (Wenham & Russell, 2011).
Table 10-1 Myths and Truths about Chronic Disease
Common misconceptions about chronic disease
The reality about chronic disease
1. Everyone has to die of something.
Chronic illnesses typically do not result in sudden death but often result in
progressive illness and disability. People with chronic disease often die slowly,
painfully and prematurely.
2. People can live to old age even if they lead unhealthy
Although there are exceptions (some people who live unhealthy lives live to old age
lives (smoke, are obese).
and some people who live healthy lives develop chronic illnesses), the majority
of chronic illnesses can be traced to common risk factors and can be prevented by
eliminating these risks.
3. Solutions for chronic disease prevention and control
A full range of chronic disease interventions are very cost-effective for all regions of
are too expensive to be feasible for low-income and
the world, including the poorest. Many of these interventions are inexpensive to
middle-income countries.
implement.
4. There is nothing that can be done anyway; chronic
The major causes of chronic diseases are known, and if these risk factors were
diseases cannot be prevented.
eliminated, over 80% of heart disease, stroke and type 2 diabetes would be prevented;
and over 40% of cancer would be prevented.
5. If individuals develop chronic disease as a result of
Individual responsibility can have its full effect only if individuals have equal access
unhealthy ‘lifestyles’, they have no one to blame but
to a healthy life and are supported to make healthy choices. Poor people often
themselves.
have limited choices about the food they eat, their living conditions, and access to
education and healthcare.
6. Certain chronic diseases, especially heart disease,
Chronic diseases, including heart disease, affect women and men almost equally.
primarily affect men.
Almost half of all deaths due to chronic illness occur in women.
7. Chronic diseases primarily affect the elderly.
Almost half of chronic disease deaths occur prematurely, in people under 70 years of
age.
8. Chronic diseases mainly affect people who are rich
People who are poor are much more likely than the wealthy to develop chronic
(affluent).
diseases and are more likely to die as a result. Chronic diseases cause substantial
financial burden and can push people and families into poverty.
9. The priority of low-income and middle-income
Although infectious diseases are an issue, low-income and middle-income countries
countries should be on control of infectious diseases.
are experiencing a rapid increase in chronic disease risk factors and deaths, especially
in urban settings.
10. Chronic diseases affect mostly high-income countries.
Eighty per cent of deaths due to chronic disease are in low-income and middle-
income countries.
Based on World Health Organization. (2005). Widespread misunderstandings about chronic disease—and the reality. Facing the facts #2. Viewed April 2013 at
/
chp/chronic_disease_report/media/Factsheet2.pdf.
