Caring for the Elderly Means Dealing with Multiple Chronic Conditions

Caring for the Elderly Means Dealing with Multiple Chronic Conditions

By Melissa Hagstrom, contributor

November 9, 2012 - Along with their decades of life experience, many elderly patients also carry with them more than one lingering health issue. From diabetes to hypertension, the prevalence of multiple chronic conditions (MCC)--especially among the older population--continues to be a pressing issue in the healthcare system. But nurses can play a key role in helping educate the patient and the caregiver on the conditions at hand, and provide resources and information on how to better manage their care and keep the conditions under control.

According to the U.S. Department of Health and Human Services Initiative on MCC, "Among Americans aged 65 years and older, as many as three out of four persons have MCC.¹ In addition, approximately two out of three Medicare beneficiaries have MCC.²"
Susan Reinhard, RN, PhD, senior vice president and director of the Public Policy Institute at AARP, and chief strategist of the Center to Champion Nursing in America, said that the ever-increasing occurrence of multiple chronic co-existing conditions is a result of several factors and affects a variety of patient populations.
"We have an aging population, we have many people who are not adhering to the most healthy lifestyle, and that is of all ages. In fact, half of people with chronic conditions are below the age of 50 so it is not just an aging condition," she said. "Obesity is certainly one of the contributing factors (of MCC), it certainly contributes to diabetes, hypertension, many different problems--but it's not the only issue."
Hypertension, cholesterol, heart disease, mental illness and diabetes top the list of the most prevalent chronic conditions in the 50+ U.S. population, according to the latest AARP fact sheet. The information is based on analysis of data from the Medical Expenditure Panel Survey Household Component (2009), a nationally representative longitudinal survey of the civilian, non-institutional population of the United States, which was co-sponsored by the Agency for Healthcare Research and Quality and the National Center for Health Statistics.
"As nurses, we are rarely caring for people who have one issue, especially in hospital or home-based care--they have multiple issues and they have issues that are not going to be cured while they are in the hospital or while they are getting this particular visit from the nurse; they are lifelong and something that the person and the family need to manage for many years," Reinhard said.
Caring for a patient with multiple co-existing conditions involves a significant amount of at-home care including medication management, complicated wound care, specialized diets and more, which means that nurses can play a major role in education and serving as a vital resource for the elderly patient and the family member or caregiver assisting the patient.
"Nurses need to help understand what is going on in people's everyday lives and how we can help both the person and the family understand how to manage this on their own," Reinhard said. "I think the nurse is the most important person in this picture."
"Nurses in the hospital setting are not going to be doing all of the teaching on what you would do with home dialysis, but they can offer reassurance, they can make sure there are appropriate referrals and they can make sure that the family caregiver and the patient are connected in the system that is going to continuously follow them over time."
Recent research in Connecticut demonstrated that a technique where nurses speak out loud as they are performing a task can help the patient and caregivers to better understand the care plan and also the role of a nurse.
"It brings more visibility to nursing science, to nursing techniques and the art and science of healing,” Reinhard commented. “It is very good for nurses to talk out loud through what they are doing which can simultaneously help the patient understand and the family caregiver understand what is happening. And, it doesn't take any more time."
Regardless of the condition, it will take a team effort to combat MCC and its effects on patients and the health care system. Working together to help patients manage their care, understand their conditions and get the caregiver involved will all help to curb the burdens caused by MCC.
"Nurses are the ones that are right there on the front line; in hospitals, in homes, in schools, and in all kinds of communities and outpatient settings, and the more they can explain to people what is going on, what is the health problem, what treatment they are getting and what is going to happen when they get home--the better off we will all be. The patient needs to have a clear understanding. That is our job."
¹ Anderson G. Chronic Care: Making the Case for Ongoing Care. Princeton, NJ: Robert Wood Johnson Foundation, 2010.
² Chronic Conditions among Medicare Beneficiaries, Chart Book, Baltimore, MD: Centers for Medicare & Medicaid Services, 2011.

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