Saturday, January 14, 2006

chronic and acute conditions

Because one or more chronic health conditions (such as arthritis, high blood pressure, heart trouble, diabetes, poor hearing, and eyesight) affect nearly 90 percent of the older population, it is common to think that illness is normal for the old. Chronic illness, however, needs to be distinguished from specific episodes of acute illness (such as a heart attack, a bout with pneumonia, or a bone fracture). Individuals who have chronic conditions can usually manage things by themselves by modifying their diets and lifestyles, taking medications, or using devices such as hearing aids. Acute conditions, however, are usually much more serious, often requiring hospitalization and attention from physicians, nurses, physical therapists, or other trained health personnel.
Contrary to what one might expect, incidents of acute illness are three times more frequent among children under age 6 than for people over 45 because of the common childhood diseases. The figures on acute health problems for various age groups are reported by the U.S. Bureau of the Census as follows:

Two significant points with respect to chronic disease among the elderly relate, first, to the individual's feelings about his or her health, and, second, to restricted activity caused by chronic disease. As long as people continue to feel satisfied with their health, chronic illness does not interfere with their quality of life, and as long as they do not need assistance with activities of daily living (cooking, bathing, toileting, etc.) they do not require support from others nor do they incur personal or public expenses for assistance. An indication of the importance of the first point can be seen from data elicited in the General Social Survey. This shows that only about 52 percent of the population over 65 describes their health as "good" to "excellent," but that over 75 percent rate themselves as fairly satisfied or a great deal satisfied with their health. (The National Health Interview Survey carried out by the National Center for Health Statistics, incidentally, reports a more positive picture of self-assessed health than the GSS-it shows that over 70 percent of the population over 65 rates its health as good to excellent).
In regard to the problem of disability due to chronic conditions, the National Long- Term Care Survey showed that over 60 percent of the population over 65 had no disability, and that less than 20 percent had any limitation in a major activity of daily living (i.e., that they were unable to carry on one or more activities of daily living, such as dressing and eating). Statistics on chronic conditions show the greater frequency among people over 65 when compared with people aged 18-44. These figures also suggest that most activity limitation is due to heart conditions, high blood pressure, and arthritis.

Physician visits for chronic conditions are also more frequent among the elderly than among younger age groups. The annual rate of such visits per person is 4.7 at age 25- 44, and these then rise to 6.6 at 45-64, 8.1 at 65-74, and to 10.6 after age 75. The very young (under age 5) also have a fairly high rate of physician visits for chronic conditions-- 6.3 visits per person per year.
Problems of chronic illness are often controlled and even overcome by individuals acting by their own initiative and without help from others. Physical fitness and exercise- activities that should be maintained throughout life-are especially beneficial in late life when an affirmative effort is needed to keep healthy, and when individuals have more time for them than during working and childrearing years. People who have chronic health problems should not undertake physical activity and exercise without consulting a physician; nor does exercise need to be strenuous-walking, swimming, bicycling on a stationary bicycle, etc. will promote good health and also maintain muscle and joint conditioning even when done with moderation.
Other measures to control chronic illness include good nutrition to reduce blood pressure and cholesterol levels. Avoiding drugs (except when prescribed by a physician) and alcohol, controlling stress, and discontinuing smoking can all reduce sickness, ameliorate chronic poor health, and promote a long life of high quality. The major obstacle to adopting a sound health regimen often does not lie in the condition of one's health itself, but rather in developing the willpower and determination needed for self-control and for engaging in pursuit of fitness activities. When motivation is a problem, joining with others who are participating in activity programs, reading inspirational books, and seeking out training programs to overcome bad habits and promote good ones will frequently supply the willpower to begin an exercise regimen.
National Center for Health Statistics, Dawson, D. A., and P. F. Adams. Current Estimates from the National Health Interview Survey; United States, 1986. Vital and Health Statistics. DHHS Pub. No. (PHS) 87-1592. Series 10, No. 164. Public Health Service. Washington, D.C.: U.S. Government Printing Office, 1987.
Russell, C. H., and I. Megaard. The General Social Survey, 1972-1976: The State of the American People. New York: Springer-Verlag, 1988.
U.S. Bureau of the Census. Statistical Abstract of the United States: 1989, l09th ed. Washington, D.C., 1989.


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