Chronic Disease, Chronic Pain, and Disability

diabetes

29.1 million people in the United States had ________ Only 21 million had been diagnosed. (CDC, 2013) Total (direct and indirect) cost of $245 billion (2012). Much of the cost is associated with secondary complications, such as: heart disease, stroke, kidney disease, blindness, lower extremity amputation (not associated with injury).

chronic disease

A long-lasting condition that can be controlled but not cured. Affects the population worldwide. Leading cause of death and disability in the United States.

diabetes

Age-adjusted death rate in the US was 21.2 per 100,000 for ________in 2013. By state, age-adjusted death rates per 100,000 for __________ ranged from 14.1 (Massachusetts) to 34.1 (West Virginia) in 2010. Mississippi age-adjusted death rate, 32.9

interruptions

An acute problem Remains only a small and temporary part of a person's life. This works only for minor illnesses or mild disability

strokes

Approximately 72% of _______ occur in persons over 65. Estimated cost (direct and indirect) of ______ in the US for 2007 was $62.7 billion.

65

Arthritis is not just an old person's disease. Nearly two-thirds of people with arthritis are younger than ____. Comorbidities - obesity (1/3 of obese have arthritis)

interruption intrusion immersed

Chronic illness or disability can be experienced as an ____________, an ____________, or something in which the person is ___________.

$81 billion.

Each year, arthritis accounts for 36 million ambulatory care visits, 750,000 hospitalizations - estimated health care expenditures of ______ Arthritis costs the U.S. economy $128 billion per year in medical care and lost productivity (2003).

Patient education Simplifying regimens Behavioral strategies to remind patients to take their medications

Estimated that more than one of every two elderly have hypertension. Many older adults (>60 years) are uncontrolled (undiagnosed?) Role for pharmacists?

stroke (cerebrovascular disease)

Fifth leading cause of death in the United States. ______ kills more than 137,000 people a year (~ 1 in every 18 U.S. deaths) About every 4 minutes someone dies from ________ (AHA.org). Each year 700,000 Americans experience a new or recurrent ______. _______ is the number one cause of serious, long-term disability in adult Americans. 3 million Americans are currently disabled because of_______. 1/3 mild, 1/3 moderate, 1/3 severe

≥140mm Hg, systolic or ≥ 90 mm Hg, diastolic

Historically, an elevated blood pressure (_______________). Today, 120/80 is considered normal

immersion

If illness progresses further, it reaches the stage of ________. Patients must structure their lives around the demands of their bodies. Social relationships are at risk - withdrawal can be the consequence. Dealing with the body and illness can take most of a person's day Assistance is often required.

disability

Includes some persons with chronic diseases Others: Persons born deaf, paralyzed from an accident, experience chronic pain that limits functional ability

Heart Disease Cancer Cerebrovascular Disease (Stroke) Chronic Obstructive Pulmonary Disease (COPD) Diabetes Arthritis

List some common chronic diseases

*C*hange in bowel or bladder habits *A*sore that does not heal *U*nusual bleeding or discharge *T*hickening or lump in the breast, testicles, or elsewhere *I*ndigestion or difficulty swallowing *O*bvious change in the size, color, shape, or thickness of a wart, mole, or mouth sore *N*agging cough or hoarseness CAUTION

List some specific symptoms that should be looked out for (pharmacists role)

Medications Acupuncture Electrical stimulation Nerve blocks Surgery Less invasive psychotherapy Relaxation therapies Biofeedback Behavior modification Complementary or alternative medicine (CAM) approaches

List some ways that chronic pain can be treated

Heart disease: 614,348 Cancer: 591,699 Chronic lower respiratory diseases: 147,101 Accidents (unintentional injuries): 136,053 Stroke (cerebrovascular diseases): 133,103 Alzheimer's disease: 93,541 Diabetes: 76,488

List the leading causes of death (2015)

lower extremity blindness sight

More than 60% of __________amputations are from diabetes. 85% of these amputations could be avoided with proper management. Leading cause of new cases of ________ in people ages 20-74. Each year, from 12,000 to 24,000 people lose their _____ because of diabetes. It is believed that 90% of these cases of blindness could be avoided

Osteoarthritis (OA) Rheumatoid arthritis (RA) Fibromyalgia Gout

Most prevalent forms of arthritis

high blood pressure (hypertension)

One in 3 U.S. adults has ______________ (CDC, 2012). 70.0 percent were aware of their condition, 61.4 percent were under current treatment, 35.1 percent had it under control Estimated cost of ________ in the United States was $131 billion (2012).

cancer

Over 1,300 types of _______. In 2010, it was projected that more than 569,560 people would die of cancer in this country (Cancer statistics, 2010 report). That same year, more than 1,529,560 people were estimated to be diagnosed with cancer in the United States. Incidence of cancer is on the rise (even age- adjusted).

subjective sharp or dull constant or on-and-off burning or aching

Pain is a very personal and _____ experience. There is not test that can measure and locate pain w/precision. List defining pain "descriptions"

chronic pain

Pain that persists for more than 12 weeks may arise from an initial injury, or there may be an ongoing cause, such as illness. However, there may also be no clear cause.

self-management of chronic pain

Patient becomes an active participant in his or her pain treatment—engaging in problem-solving, pacing, decision-making, and taking actions to manage their pain. Person living with pain need help learning to think, feel, and do better, despite the persistence of pain. Through NIH-supported research, successful self-management programs have aided in the reduction of many barriers to effective pain management. Individuals who participate in these programs have significantly increased their ability to cope with pain. Improve ability to be active, healthy, and involved members of their communities. Best self-management programs teach people different ways of thinking about and responding to pain.

Groups more likely to report COPD

People aged 65-74 years. Non-Hispanic whites. Women. Individuals who were unemployed, retired, or unable to work. Individuals with less than a high school education. People with lower incomes. Individuals who were divorced, widowed, or separated. Current or former smokers . Those with a history of asthma.

ageing populations

Rates of disability are increasing in part due to _____________ and an increase in chronic health conditions.

(443,000 deaths per year, and an estimated 49,000 of these smoking-related deaths are the result of secondhand smoke exposure). Smoking costs the US ~$193 billion each year in healthcare costs and lost productivity.

Role of tobacco in COPD?

<200mg/dL

Target cholesterol (___________) 2009-2012 average - 196 (20 yrs+) - has been on the decrease since 1960 (222). 13.4 percent of population has high cholesterol (>240mg/dL), (2009-2012) During 1999-2002, only 63% of those with high levels were aware of it. A 10% decrease in total blood cholesterol levels may reduce the incidence of coronary heart disease by as much as 30%

health care costs

The nature of health care in the US has changed dramatically over the past century. Increased need for treatment of ongoing illnesses and long-term care services. ______________for chronic disease treatment account for over 75% of national health expenditures.

women

The percentage of adults with arthritis ranges from 20% in California to 36% in Kentucky. Nearly two-thirds of people with arthritis are _______. Additionally,_______ tend to report more limitations in activity. A recent study estimated that 1 in 250 children (<18) has some form of arthritis or related condition.

COPD (chronic obstructive pulmonary disease)

Third leading cause of death (142,943 in 2010) 12.1 million people in the U.S. 18 years of age or older were estimated to have_______. ~ 24 million U.S. adults have evidence of impaired lung function, indicating an under diagnosis of _______(American Lung Association).

Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being."

WHO definition of disability

Family history of diabetes overweight Sedentary/do not excersie regularly Certain racial and ethnic groups e.g. African Americans, Hispanics and Native Americans

Who is at GREATER RISK for Type 2 Diabetes (non-insulin dependent)?

40% 88% 70%

_____%of the population has, at least, one chronic disease. ____%of older adults have, at least, one chronic disease. Accounts for ___% of all deaths in the US.

21 million

_______ Americans (9% of all adults) reported activity limitation because of their arthritis.

prevalence men

_______ of heart disease (hypertension) increases as age increases. (men or women) have a higher incidence?

100 million older headache, low back pain, cancer pain, arthritis pain, and neurogenic pain.

_________ Americans suffer from chronic pain (IOM, 2011) 1.5 billion persons suffer worldwide (Global Industry Analysts Report, 2011) Annual total cost of health care due to pain ranges from $560 billion to $635 billion (2010) in the US Many chronic pain conditions affect ______ adults. Common chronic pain complaints include __________,_________,__________,________, and ________

age-adjusted death rate

________________in the US was 167.0 per 100,000 for diseases of the heart in 2014. By state, _______________ per 100,000 for diseases of the heart ranged from 116.5 (Minnesota) to 240.0 (Mississippi) in 2014.

1. american indian/alaska native 2. non-hispanic white 3. multiracial/other 4. non-hispanic black 5. hispanic 6. asian/pacific islander

arthritis is most prevalent among which races? (list in order of most prevalent to least)

chronic diseases

diseases are among the most common, costly, and preventable of all health problems.

Tobacco use Lack of physical activity Poor nutrition Excessive weight

heart disease is largely linked to what risk behaviors?

intrusion

illness or disability that progresses, can become an _________. Demanding time accommodation, and attention and requiring that the person live "day-to-day".

heart disease

leading cause of death ( in men and women) in the US over the past 75 years. 25% of deaths in 2015

-long latency -protracted clinical course is permanent or long-term -uncertain etiology -no definitive "cure"

list characteristics/attributes of chronic diseases

Fatigue sleep disturbance decreased appetite mood changes mobility limitations lead to disability/despair

list chronic pain symptoms

American Chronic Pain Association (ACPA) U.S. Pain Foundation Agency for Healthcare Research and Quality (AHRQ) Sports Injury Rehab Resources National Association of Drug Diversion Investigators (NADDI)

list some organizations dedicated to helping people with pain

prostate breast cancer (female) lung/bronchus colon/rectum corpus/uterus, NOS

list top 5 cancers in all races

Chronic pain

may occur in a variety of locations in the body and for many different reasons Patients and their health professionals need to work together to identify the causes and symptoms of that pain and how it can be relieved. The person with pain and their family must be actively involved in the treatment.

arthritis

the most common cause of disability among americans

*Causes* *External* (chemicals, radiation, viruses) *Internal* (hormones, immune conditions, inherited traits) *Costs* - estimated by the NIH to be $216.6 billion (overall) in 2009.

what are the causes and costs of cancer

reduce pain and improve function Patients and their healthcare providers have a number of options for the treatment of pain. Important to remember that chronic pain usually cannot be cured, but it can be managed.

what are the goals of treatment of chronic pain