The Phenomenon of Chronicity
Although each chronic condition has its own specific physiologic characteristics, chronic conditions do share common qualities. Many chronic conditions, for example, have pain and fatigue as associated symptoms. Some degree of disability is usually present in severe or advanced chronic illness, limiting the patient’s par-ticipation in activities (Collins, 1997). Many chronic conditions require therapeutic regimens to keep them under control. Unlike the term “acute,” which implies a curable and relatively short dis-ease course,chronic describes a long disease course and conditions that may be incurable. It is this characteristic of duration that often makes managing chronic conditions so difficult for those who must live with them.
Psychological and emotional reactions of patients to acute and chronic conditions and changes in their health status. People who develop chronic conditions may react with shock, disbelief, depression, anger, resentment, or a number of other emotions. How people react and cope with chronic conditions is usually similar to how they react to other events in their lives, depending, in part, on their understanding of the condition and their perceptions of its po-tential impact on their own and their family’s lives. Adjustment to chronic illness is affected by various factors:
• Personality before the illness
• Unresolved anger or grief from the past
• Suddenness, extent, and duration of lifestyle changes ne-cessitated by the illness
• Family and individual resources for dealing with stress
• Stages of individual/family life cycle
• Previous experience with illness and crises
• Codependency in family systems (Lewis, 1998)
Psychological, emotional, and cognitive reactions to chronic conditions are likely to occur at the initial onset, but they may also recur if symptoms worsen or recur after a period of remis-sion. Symptoms associated with chronic illnesses are often un-predictable, and some are perceived as crisis events by patients and their families, who must contend with both the uncertainty of chronic illness and the changes it brings to their lives.
“Chronic conditions” are defined as medical conditions or health problems with associated symptoms or disabilities that require long-term (3 months or longer) management (Robert Wood Johnson Foundation, 1996). The condition may be due to ill-ness, genetic factors, or injury. Management of such conditions includes learning to live with symptoms and/or disabilities and coming to terms with identity changes brought about by having a chronic condition. It also consists of carrying out the lifestyle changes and regimens that are designed to keep symptoms under control and to prevent complications. Although some people take on what might be called a “sick role” identity, most people with chronic conditions do not consider themselves to be sick or ill and try to live as normal a life as is possible. Only when complications develop or when symptoms become severe enough to interfere with performance of daily life activities do most people who are chroni-cally ill think of themselves as being sick or disabled (Nijhof, 1998).
Chronic conditions occur in people of every age group, socio-economic level, and culture. In 1995, an estimated 99 million peo-ple in the United States had chronic conditions, and it has been projected that by the year 2030 about 150 million people will be affected (Robert Wood Johnson Foundation, 1996). Table 10-1 shows the projected increase in rates of people with chronic con-ditions by year, along with an estimate of the costs to be incurred in managing those conditions.
Not every chronic condition is disabling; some cause only minor inconveniences. Many, however, are severe enough to cause major activity limitations. Figures 10-1 and 10-2 present overviews of the projected number of people in millions with activity limitations and the five most disabling chronic conditions.
Activity limitations are not limited to adults: an estimated 6.5% of all U.S. children experience some degree of disability. The most common disabling conditions in children are respiratory diseases and mental impairment (Newacheck & Halfon, 1998). People with activity limitations need assistance with their activi-ties of daily living. Figure 10-3 indicates what happens to people with activity limitations whose needs for health care and personal services are not met for various reasons. They may be unable to carry out their therapeutic regimens as prescribed or have their prescriptions filled on time; they may miss physicians’ appoint-ments and office visits; and they may be unable to carry out the activities of daily living (Robert Wood Johnson Foundation,1996). These figures provide an overview of the scope of the problem and are useful in planning health promotion and edu-cation programs as well as in allocating resources and services.
Chronic conditions have become the major cause of health-related problems in developed countries, and even developing countries are experiencing an increase in chronic conditions, giving these countries the dual burden of trying to eradicate in-fectious diseases while learning to manage chronic conditions (Kickbusch, 1997). Some of the reasons that so many people are afflicted with chronic conditions include the following:
· A decrease in mortality from infectious diseases, such as smallpox, diphtheria, and other serious conditions
· Longer life spans because of advances in technology and pharmacology, improved nutrition, safer working condi-tions, and greater access (for some people) to health care
· Improved screening and diagnostic procedures, enabling early detection and treatment of diseases
· Prompt and aggressive management of acute conditions, such as myocardial infarction and AIDS-related infections
· The tendency to develop single or multiple chronic illnesses with advancing age
· Modern lifestyle factors, such as smoking, chronic stress, and obesity, that increase the risk for chronic illnesses, such as pulmonary disease, hypertension, and cardiovascular disease
A major problem of chronic conditions is that physiologic changes in the body commonly occur before symptomatic man-ifestations of disease, as in the case of hypertension (Sadowski & Redeker, 1996). Greater emphasis has recently been placed on the adoption of healthy lifestyles, beginning in childhood. De-spite the media attention on the benefits of maintaining healthy lifestyles, many Americans are overweight, smoke, and lead sedentary lives. Consequences of unhealthy lifestyles include an alarming increase in the incidence of diabetes, hypertension, obe-sity, and cardiac and chronic respiratory disorders (Juarbe, 1998; Wing, Goldstein, Acton et al., 2001).
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