CHRONIC ILLNESS AND AGING

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CHRONIC ILLNESS AND AGING
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CHRONIC ILLNESS

• A long-lasting illness (in contrast to ACUTE
  illness, which is temporary)
• Most common in older adults
• Heart disease
• Cancer
• Cerebrovascular disease (stroke)

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HEART DISEASE

• Principal cause of death among o.a.s
• Accounts for significant morbidity, disablement
  inactivity among o.a.s
• Dominant factor--atherosclerosis (build-up of
  fatty deposits within arterial walls)

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Mechanism

• Atherosclerotic buildup------gt
• Narrowing of arteries supplying blood to the
  heart-----gt
• ISCHEMIA (denial of adequate blood supply)

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• Ischemic heart disease also known as
• coronary heart disease (CHD)
• coronary artery disease
• A common form myocardial infarction (heart
  attack)
• persistence of deficient blood supply, tissue
  dies. Dead area an infarct

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Heart attack may also result from

• Cardiac arrest-- some interruption of normal
  pattern of cardiac contraction
• Coronary thrombosis--sudden blockage of coronary
  artery with a blood clot
• Strenuous exercise resulting in suddenly
  increased need for O2

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Mortality associated with MI

• Over 70--2x that under age 70
• Symptoms of MI may differ in older people than in
  younger ones

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• while complete absence of chest pain is very
  rare in acute myocardial infarction up to middle
  age, it is a mundane occurrence in old people
• only about 1/3 of elderly patients present with
  a classical prolonged episode of chest pain.
  (Kart Kinney, p. 111)

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Heart Disease Modifiable Risk Factors

• Cigarette smokers 2x MI rate of non-smokers
• High BP
• High serum cholesterol levels
• Diabetes
• Obesity
• Sedentary lifestyle

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Healthy People 2000 goals

• 1. Increase prop. Of people whose high BP is
  under control
• 2. Reduce mean-serum cholesterol levels
• 3. Reduce dietary fat intake average
  unsaturated fat intake
• 4. Reduce prevalence rates of obese/oveweight
  adults

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• 5. Increase proportion of children adults
  engaging in regular, daily physical activity at
  least 30 min/day
• 6. Reduce cigarette smoking among people age 20
  and older
• http//www.health.gov/healthypeople

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CANCER

• 2nd leading cause of death in U.S.
• Incidence increases with age--Why?
• Most forms of cancer have a long latent period
  initiating factors start during youth
• increasing age and accompanying physiological
  changes make one more susceptible to actions of
  carcinogens

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CA, contd

• onset and management of many cancers do not vary
  greatly in the old and young. Prevention is
  still the order of the day regarding cancer. p.
  113.
• This includes

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• 1. Avoiding unnecessary exposure to ionizing
  ultraviolet radiation
• 2. Implementing hygienic measures in occupations
  involving exposure to CA-producing chemicals
  dusts
• 3. Avoiding exposure to tobacco cigarette smoke
• 4. Have periodic preventive medical exams.

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CEREBROVASCULAR DISEASE

• Results from
• changes in blood vessels that serve the brain
  tissue
• cerebral infarction
• cerebral hemorrhage

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• When a portion of the brain is completely denied
  blood, a cerebrovascular accident (CVA), or
  stroke results
• Severity is determined by location and total
  amount of brain tissue involved

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• After diseases of the heart, malignant neoplasms,
  accidents, cerebrovascular disease is the
  fourth-leading cause of death in the U.S.

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Cerbral Thrombosis

• Main cause of stroke in o.a.s
• Occurs when a formed clot becomes lodges in an
  already narrowed artery.

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• Stroke in evolution
• May develop over hours or even days
• Symptoms can appear within minutes or hours after
  onset

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Transient ischemic attacks (TIAS)--mini-strokes

• Warning signs of an impending stroke
• Transitory symptoms
• sudden motor weakness
• speech dysfunction
• dizziness
• sudden changes in vision (especially in one eye)
• sudden falls

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Cerbral Embolism Another cause of strokes

• Thrombus forms elsewhere in the body and travels
  to obstruct a vessel supplying the brain
• The onset of the stroke and its damage is
  immediate

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Damage from Strokes

• One-sided weakness or paralysis
• Sensory disturbances
• Aphasia (speech disorders)
• Mental symptoms
• Rehab should begin immediately

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APHASIA

• Impaired ability to comprehend or express verbal
  language
• Receptive aphasia
• difficulty in processing external stimuli
• may not understand others speech or what is read
• familiar objects may become unrecognizable

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• Expressive aphasia
• A person understands what is said but cannot form
  the words or gestures to respond to stimuli
• May be incorrectly associated with mental
  deterioration