Chapter 30 Major Health Issues and Chronic Disease Management of Adults Across the Life Span

1. Chapter 30Major Health Issues and Chronic Disease Management of Adults Across the Life Span

2. Objectives Define terms commonly used in the care of adults. Describe historical and current perspectives of adult health and health policy. Discuss sources of population-based public health data and health status indicators about adults to be used to align community resources to support adults with chronic illnesses.

3. Objectives, Cont’d Use appropriate assessment tools and development strategies to care for adults across the life span. Discuss the concepts of self-management and the implementation of the Chronic Care Model to support adults with chronic illness. Explain the dynamic forces that contribute to shared and gender specific diseases, health disparities, cultural diversity, and culturally competent care of adults in their communities.

4. Objectives, Cont’d Appraise the role of cultural, social, and behavioral factors in accessibility, availability, acceptability, and delivery of community-based models of care for adults. Examine role opportunities for nurses in providing care in the community.

5. Historical Perspectives Gender inequalities Predominantly men working, including in medicine and research Health researchers focused on issues predominantly oriented toward men Early 1900s: Women’s health focused on reproduction and women’s roles as mothers 1920s: Women’s health expanded to address family planning and reproductive health (beginning of birth control movement) 1980s: USPHS Task Force on Women’s Health Issues 1990: Society for Women’s Research founded

6. Health Policy and Legislation Older Americans Act of 1965 Americans with Disabilities Act of 1990 Family Medical Leave Act of 1993 Personal Responsibility and Work Opportunity Reconciliation Act of 1996 “Welfare reform”

7. Ethical and Legal Issues, and Legislation for Older Adults Abuse Neglect Financial exploitation Patient Self-Determination Act of 1991 Advanced medical directives Living will Durable medical power of attorney Do-no-resuscitate (DNR) order

8. Environmental Impact Men and women are often exposed to different environmental factors because of upbringing, employment, cultural or tradition variations. Men and women may respond differently to environmental factors. CDC’s Environmental Hazards and Effects (EHHE) Program

9. Health Status Indicators Mortality Life expectancy Mortality rates Morbidity Increasing prevalence of chronic diseases and other conditions associated with aging High prevalence of adults with risk factors

10. Adult Health Concerns Chronic Disease Cardiovascular Disease Hypertension Stroke Diabetes Cancer STDs/HIV/AIDS Weight Control

11. Chronic Disease Most common: Heart disease Diabetes Stroke Cancer Arthritis Chronic disease is leading cause of preventable deaths, disability, and decreased quality of life Wagner’s Chronic Care Model (CCM)

12. Cardiovascular Disease (CVD) An estimated 81,100,000 adults have one or more types of CVD. Leading cause of death for African Americans, American Indians or Alaska Natives, Hispanics, and Caucasians in the United States Twenty-three Healthy People 2020 objectives focus on CVD. Gaps in knowledge and awareness for heart disease Particularly in women

13. Hypertension (HTN) One in 3 adults in the United States have HTN. Uncontrolled HTN leads to heart attack, stroke, kidney damage, and a host of other complications. 22.4% of people with HTN are not aware they have it Racial, ethnic, and socioeconomic differences

14. Stroke Has decreased in the United States since the 1950s 2006: Estimated prevalence was 6,400,000 (down from 7 million in 2002) Responsible for 1 in 18 deaths Women more likely to die from stroke than men (because they live longer and strokes increase with age) Community-based programs and policy regarding stroke care (AHA)

15. Diabetes (DM) 23.6 million people with DM One in 12 to 13 adults has DM Costs the United States $174 billion each year Many complications associated with DM Eighteen Healthy People 2020 goals related to DM

16. Cancer Second leading cause of death in the United States Overall costs of cancer in 2008: $228.1 billion Needed to reduce the burden of cancer: Early screening and detection Promotion of healthy lifestyles Expanding access to services Improving cancer treatments

17. STDs/HIV/AIDS 19 million new STD infections each year Almost half occur in people 15 to 24 years of age Many cases go undiagnosed In 2007, 42,655 new cases of HIV/AIDS African Americans: 51% Caucasians: 29% Hispanics: 18% Healthy People 2020: Promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STDs and their complications

18. Weight Control Overweight and Obesity United States health care cost: $147 billion BMI 2008 Physical Activity Guidelines Anorexia Bulimia

19. Women’s Health Concerns Reproductive health Preconceptual counseling Gestational diabetes Menopause Breast cancer Osteoporosis

20. Men’s Health Concerns Lack of health screenings Dangerous employment Cancers unique to men Prostate cancer Testicular cancer Depression Erectile dysfunction

21. Health Disparities Adults of color Incarcerated adults Lesbian/gay adults Adults with physical and mental disabilities Impoverished and uninsured adults Frail elderly Importance of cultural competency

22. Community-Based Models for Care of Adults Nursing roles Community care settings Senior centers Adult day health Home health and hospice Assisted living Long-term care and rehabilitation