Chronic Disease Management

Contextual background

Globally the older population is the fastest growing population and it is estimated that by 2050, there will be 2 billion people aged over 60 years1. The level of health and functional status a person experiences as they age is related to behaviour or lifestyle and exposure to health risks rather than communicable diseases1. There was an argument in the 1980’s; termed Compression of Morbidity, hypothesising that living longer would result in additional years of chronic debilitating illness2, that is older people are more likely to be living with multiple chronic diseases requiring health and social services and supports. In Australia, the 2011 Productivity Commission report indicated over one million older Australians were receiving aged care services, predominantly in their home3. Moreover, older Australians generally wish to remain at home or at least choose where they live, maintain connections with their community and/ or family and have choice over the care they receive3.

 

Chronic disease management

The incidence of various diseases can increase with age and as a result older people may have multiple chronic diseases/conditions. According to the National Council on Aging 73% of older adults have at least two chronic conditions4; such as diabetes, arthritis, asthma, cardiovascular disease. Some neurological disorders are also more prevalent in older people for example dementia and Parkinson’s disease. Supporting people living with chronic disease to engage in shared decision making in relation to disease self-management is associated with improved health outcomes5. Models of chronic disease management focus on empowering and activating the individual6. An important aspect of empowerment involves the health professional developing an equal partnership with the person so that they are actively in decisions about services they receive5.

Parkinson’s disease is a progressive degenerative neurological disorder, a chronic disease, affecting a person’s capacity to control their body movements. It is more prevalent in people over the age of 50 years and whilst treatment can minimise symptoms it does not halt the disease. Please click either of the following links to learn more about Parkinson’s disease and its impact on the individual.

• Parkinson’s Australia: Living with Parkinson’s.
• European Parkinson’s Disease Association: Guide to living with Parkinson’s disease.

 

Services to support older people

Services aimed at supporting older people need to ensure the older person in central in decision making to enable them to maintain their autonomy and quality of life. For example Australia has adopted the Consumer Directed Care approach, which is a way of delivering services to ensure that the person has control over their own lives and is allowed to choose the type of care and service they access. As shown in the film this approach requires the older person to determine their own goal/s with regards to their situation and determine and agree to actions. Having an agreed and written action plan is an effective communication tool for the older person and health professionals involved. The action plan generally includes:

• the older persons goal with regards to their situation;
• identification of supports/ services needed;
• identified actions to be taken and by whom, including the older person; and
• review timeline.

 

Reflection

Before viewing the next film reflect on this film clip and identify how you would approach working with Mr Rosa.

• Are there things you would have liked to explored in more depth with Mr Rosa and if so what would be your rationale for this?
• Do you think it would have been helpful to have Mr Rosa niece involved in developing the action plan?
• What might be the risks of having a family member present for such a meeting?
• What knowledge and skills do you feel you need to further develop to be able to provide consumer or client directed care?

 

 

 

 

 

References

1. World Health Organization. Health topics: Ageing. 2014 [cited 2014 Feb 17]; Available from: http://www.who.int/topics/ageing/en/
2. Fries JF, Bruce B, Chakravarty E. Compression of morbidity 1980-2011: A focused review of paradigms and progress. Journal of Aging Research. 2011 [cited 2014 Sept 22]; Article ID 261702. Available from: http://www.hindawi.com/journals/jar/2011/261702/
3. Productivity Commission. Caring for Older Australians: Overview, Report No. 53, Final Inquiry Report. Canberra. 2011 [cited 2014 Sept 22]; Available from http://www.pc.gov.au/__data/assets/pdf_file/0016/110932/aged-care-overview-booklet.pdf
4. National Council on Aging. Centre for Healthy Aging: Chronic Disease. [cited 2014 Sept 24]; Available from http://www.ncoa.org/improve-health/center-for-healthy-aging/chronic-disease/
5. Peek M, Drum M, Cooper LA. The association of patient chronic disease burden and self-management requirements with shared decision making in primary care visits. Health Services Research and Managerial Epidemiology. 2014 [cited 2014 23 Sept]. Available from http://hme.sagepub.com./content/1/2333392814538775
6. Lorig KR, Holman H. Self-management education: history, definition, outcomes, and mechanisms. Annals of Behavioural Medicine. 2003:6(1):1-7.