bs_bs_banner

Nursing and Health Sciences (2014), 16, 413–414

Editorial

Era of person-centered care for people with chronic illnesses We have entered an era of providing person-centered health care to the increasing population with chronic illnesses. Chronic illnesses are physical, mental, or cognitive conditions that last a year or more, require ongoing medical attention, and/or limit activities of daily living. In 2012, approximately 117 million Americans, half of all adults, had one or more chronic conditions, and this number will amount to 171 million by 2030. The main reasons for the increasing prevalence of chronic illnesses are the growing older adult population, increasing life expectancy, and advanced medical care on the macro level (Robert Wood Johnson Foundation, 2010). Health risk behaviors that cause chronic illnesses at the micro level include lack of physical activity and fruits and vegetables in diet; smoking; excessive alcohol consumption; and risk factors for heart disease and stroke, such as uncontrolled high blood pressure (Centers for Disease Control and Prevention, 2013). The prevalence and nature of chronic illnesses varies by gender, setting, and age. Women are disproportionally affected as the number of concurrent chronic illnesses increases. For example, the prevalence of one chronic illness is 23% for men and 22% for women; however, 13% of women have two chronic illnesses versus 11% of men, and 6% of women have five or more chronic illnesses versus 4% of men (Robert Wood Johnson Foundation, 2010). The presence of two or more concurrent chronic conditions is known as multimorbidity (Ward et al., 2014). Multimorbidity affects one in 20 children, two in three people 65 years of age and older, and 73% of individuals aged 80 years and older. The leading chronic conditions among older adults are hypertension, arthritis, heart disease, and eye disorders. The leading chronic conditions among people aged 18–64 years of age are hypertension, respiratory illnesses, arthritis, and chronic mental conditions. Respiratory illnesses and asthma are the most common chronic conditions in children (Robert Wood Johnson Foundation, 2010; Centers for Disease Control and Prevention, 2013; Ward et al., 2014). At least 25% of individuals with chronic illnesses have functional limitations in activities of daily living (Centers for Disease Control and Prevention, 2013).The course of chronic illnesses is marked by ongoing functional decline, which is triggered by acute exacerbations. When a person recovers from an acute exacerbation of chronic illness, his/her functional level returns to a level that is lower than what was before the acute episode. (Robert Wood Johnson Foundation, 2010; Ward et al., 2014). Other consequences of chronic illnesses include higher rates of being hospitalized and using medications. Compared to the 3% in the general population, the hospitalization rate increases as the number of chronic illnesses increases, from 5% for individuals with one chronic © 2014 Wiley Publishing Asia Pty Ltd.

illness, but no functional limitations, to 18% for those with more than five chronic illnesses. Individuals with one chronic illness are prescribed 7.3 medications on average, while those with five or more chronic illnesses have 57.4 drugs (Robert Wood Johnson Foundation, 2010). Multimorbidity is also associated with higher rates of death, disability, adverse events, institutionalization, and poor quality of life. A person-centered approach is the backbone for the effective management of chronic illnesses, especially multimorbidity. Although evidence-based clinical practice guidelines have been developed for the management of a single chronic illness, many research studies that form the evidence base might not have sufficiently included certain populations, such as older adults (Ward et al., 2014). Because older adults of the same age could vary drastically in their physical function and cognition, the evidence-based guideline needs to be modified to suit a given person’s specific condition, thus the idea of person-centeredness. It is even more challenging to manage individuals with multimorbidity when two or more chronic illnesses interactively and synergistically affect treatment responses in ways that are yet to be investigated. Because older adults with multimorbidity are often excluded or underrepresented in research studies, the clinical practice guidelines for a single chronic illness are impractical, irrelevant, or even harmful to use for people with multimorbidity. In 2012, the American Geriatrics Society put forward an expert consensus statement, offering five guiding principles and their rationales for the management of multimorbidity in older adults (American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity, 2012): • Patient preference: Providers need to recognize a preference-sensitive decision. After adequately informing patient (and families) of benefits and risks of different options, preference can be elicited. • Interpreting the evidence: When interpreting research findings, providers need to consider whether the patient population of interest was actually included in sufficient numbers in the studies. • Prognosis: Providers should ask the patient to undergo diagnostic work-up or receive treatments when the work-up or treatment will generate benefits in a time horizon that is within a person’s remaining life expectancy. • Clinical feasibility: Complex treatments are infeasible and burdensome to patients and families, resulting in higher risks for non-adherence, adverse reactions, poorer quality of life, greater economic burden, and greater strain and stress to caregivers. • Optimizing therapies and care plans: Older adults, particularly those with multimorbidity, are at increased risk for doi: 10.1111/nhs.12172

414

Editorial

polypharmacy, suboptimal treatments, and potential harms (American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity, 2012). In conclusion, chronic illnesses are increasingly prevalent and affect all ages and groups. Women, older adults, and individuals with multimorbidity are particularly vulnerable to chronic illnesses and their negative health outcomes. The course of chronic illnesses marks an ongoing functional decline over time, which is punctured by episodes of acute exacerbations. The management of chronic illnesses relies on a person-centered approach and the need to address patient preference, interpreting the evidence, prognosis, clinical feasibility, and optimizing therapies, and care plans for older adults with multimorbidity. Fang Yu Associate Professor, University of Minnesota School of Nursing, Minneapolis, Minnesota, USA

© 2014 Wiley Publishing Asia Pty Ltd.

REFERENCES American Geriatrics Society Expert Panel on the Care of Older Adults with Multimorbidity. Patient-centered care for older adults with multiple chronic conditions: a stepwise approach from the American geriatrics society: American geriatrics society expert panel on the care of older adults with multimorbidity. J. Am. Geriatr. Soc. 2012; 60: 1957–1968. Centers for Disease Control and Prevention. Death and Mortality. NCHS FastStats web site. [Cited 28 Aug 2014.] Available from URL: http://www.cdc.gov/nchs/fastats/deaths.htm. Robert Wood Johnson Foundation. Chronic Care: Making the Case for Ongoing Care. Princeton, NJ: Robert Wood Johnson Foundation, 2010. Ward BW, Schiller JS, Goodman RA. Multiple chronic conditions among US adults: a 2012 update. Prev. Chronic Dis. 2014; 11: 130389. http://dx.doi.org/10.5888/pcd11.130389.

Copyright of Nursing & Health Sciences is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.

Era of person-centered care for people with chronic illnesses.

Era of person-centered care for people with chronic illnesses. - PDF Download Free
136KB Sizes 3 Downloads 5 Views