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Illness Behavior in the Elderly

Illness Behavior in the Elderly. C. Eberle, M.D . University of Nebraska Medical Center. Healthy Aging. Paul Tatum, 76 y/o Competing in cross country cycling event. Illness Behavior in the Elderly Objectives. Describe ways a person may respond to illness.

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Illness Behavior in the Elderly

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  1. Illness Behavior in the Elderly C. Eberle, M.D. University of Nebraska Medical Center

  2. Healthy Aging • Paul Tatum, 76 y/o • Competing in cross country cycling event.

  3. Illness Behavior in the ElderlyObjectives • Describe ways a person may respond to illness. • Identify reasons an older person may not report symptoms. • Explain how a person’s response to his/her illness impacts his/her health. • Discuss the role of disability in elders’ illness.

  4. Illness Behavior in the Elderly • What is the impact of this behavior? • Is it really any different than yours or mine? • How does this affect my interaction?

  5. Illness Behavior in the Elderly • Any behavior that occurs due to the illness: • Symptom reporting • Compliance/ Adherence • Medications • Lifestyle (diet, exercise, habits, etc)

  6. Response to illness This frequently occurs without conscious thought. If done reflexively, how is it learned/ taught ? • Trial & error • Feedback • Repetition

  7. Responses to Illness • Minimize . . .‘Just a cold.’ • Deny . . . Don’t come in. • Withdrawal . . . Isolates self. • Fight . . . ‘…beat it.’ • Over-react . . . Lose control. • Embrace the sick role .Dependent • Matter of fact . . . Deal/Cope w it.

  8. Different Patterns of IllnessJAMA 262(7):907-913, 1989

  9. Healthy Aging Lenny Aikins, 83 y/o Parachutes 6 times / week

  10. Age / Aging • AGE Distance from birth • Chronologic measure • AGING Encompasses whole person • Ubiquitous process • Not a disease ! • Timeline v Puddle

  11. Aging Retire Married ? Children ? Work College School Birth Puddle Timeline

  12. Illness Behavior in the ElderlyTruth v Myth • Old people are somatic or hypochondriacal. • Old people are noncompliant. • Old people are set in their ways. - “Can’t teach an old dog new tricks.”

  13. Illness Behavior in the ElderlyHypochondriacal ? Self Rated Health

  14. Symptom Shortness of Breath Chest Pain “Feeling Blue” Coughing a lot Difficulty with urine Reported : Not Reported 57 43 % 69 31 42 58 62 38 60 40 Illness Behavior in the ElderlyHypochondriacal ?

  15. Illness Behavior in the ElderlyHypochondriacal ? • “Normal” aging • Ignored or minimized previously • Physician already knows • Fear of consequences Why Symptoms Aren’t Reported

  16. Illness Behavior in the ElderlyHypochondriacal ? Kaplan, ...Jl Gerontol 43(4):s114-120,1988

  17. Illness Behavior in the ElderlyTruth v Myth • Old people are somatic or hypochondriacal. • Old people are noncompliant. EVERYONE is non-adherent. Learned early in our experience with antibiotic therapy • Old people are set in their ways. - “Can’t teach an old dog new tricks.”

  18. Medication Adherence • Daily. . . . . 95% • Twice daily. . . . 76% • Three times daily. . . 75% • Four times daily. . . 58% Cockburn, BMJ, 1987

  19. Illness Behavior in the Elderly“Set in their ways” Habit 18 y/o + 65 y/o + U.S. NCHS, NHIS, 1985, unpublished

  20. Illness Behavior in the ElderlyTruth v Myth • Old people are somatic or hypochondriacal. • Old people are noncompliant. • Old people are set in their ways. “Can’t teach an old dog new tricks.”

  21. Illness Behavior in the Elderly Is it Different ? NO • Denial • Nonadherence YES • Attribute signs/symptoms to age • Fear

  22. Illness Behavior in the ElderlyReason for Differences • Different types of illnesses Acute v Chronic • Atypical presentation of illness • Aging: Decreased reserve • Age: Variable loss of reserve

  23. Illness in the Elderly • Main health problem is: • CHRONIC DISEASE • Frequently results in: • Physical impairment and • Functional disability • Perhaps dependence on others.

  24. ACUTE Sudden Short, limited Return to normal limited sick role Identify & cure. CHRONIC Sudden-Gradual Long-unknown ? If able to return to Normal sick role, dependent Can’t cure … Why me?, what did I do? Acute vs Chronic Illness ONSET DURATION EXPECTED OUTCOME ROLES ETIOLOGY

  25. Prevalence of Disability in Older Persons IADLS

  26. Prevalence of Disability in Older Persons ADL U.S. Dept. of Health & Human Services, 1986.

  27. Prevalence of Disability in Older Persons (Hospital) Study Cognition Mobility Continence

  28. Health and Disabilty

  29. Cascade to Disability and Handicaps Hoenig H. JAGS, 1997 & GRS.

  30. Patient Care NeedsRule of Thumb Based on ADL and IADL abilities:

  31. Illness Behavior in the ElderlySummary • Response to illness is very similar between young and old • Denial, Fear, Isolation, Fight, Sick Role • There are differences • Older individuals frequently fail to report symptoms, attributing them to ‘normal’ aging and may be more fearful of illness.

  32. Illness Behavior in the ElderlySummary • Failure to recognize and report symptoms leads to delay in diagnosis and treatment, and poorer outcomes. • Disability is an important element of chronic disease/illness that requires intervention in our management.

  33. Healthy Aging Earl Shaffer, 79 y/o Through-walked the Appalachian Trail, 98 (The 3rd time)

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