Chronic Disease

Original Editor - Lucinda Hampton Top Contributors - Olajumoke Ogunleye, Lucinda hampton and Kim Jackson

Introduction

Chronic diseases/Non-communicable diseases are currently the major cause of death among adults in almost all countries and the toll is projected to increase by a further 17% in the next 10 years[1]. Globally, approximately one in three of all adults suffer from multiple chronic conditions[2]. Six in ten adults in the US have a chronic disease and four in ten adults have two or more[3]. It has been calculated that, of the 58 million deaths in 2005, approximately 35 million will be as a result of chronic diseases[1]. Health damaging behaviours - particularly tobacco use, lack of physical activity, and poor eating habits, excessive alcohol use - are major contributors to the leading chronic diseases[3]. The leading chronic diseases in developed countries include (in alphabetical order) arthritis, cardiovascular disease eg.heart attacks and stroke, cancer eg breast and colon cancer, diabetes, epilepsy and seizures, obesity, and oral health problems. Each of these conditions plagues older adults. This rise in Chronic diseases (CDs) is a very serious situation, both for public health and for the societies and economies affected. Until recently, the impact and profile of chronic diseases have generally been insufficiently appreciated[1].

What are Chronic Diseases

One important element of effective communication is having a shared language or at least a shared understanding of the meaning of the central words used in a conversation. One term that is often used in discussions between patients and medical providers, in the academic literature, and policy discussions, is “chronic disease”[4]. There is a various definition for chronic disease with variation in the time a disease must be present for something to be referred to as chronic, therefore making it difficult to reach a consensus.

For example, MedicineNet describes a chronic disease as, one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear[5]. According to Wikipedia, a chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects or a disease that comes with time. The term chronic is often applied when the course of the disease lasts for more than three months[6].

The World Health Organization states that chronic diseases are not passed from person to person. They are of long duration and generally slow progression[7].

Bernell and Howard[4] suggested that rather than adhering to a specific list of diseases and a specified period, they advocate for a simpler approach. According to Merriam Webster, “chronic” is something that is “continuing or occurring again and again for a long time.” Using this simpler view, we would exclude something like a broken leg as a chronic condition but would include reoccurring lower back pain, or hormone-related migraine headaches, for example.

This video (less than 3 minutes) is good viewing.
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Characteristics of a Chronic Diseases

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Chronic illnesses are mostly characterised by:

  • Complex causes
  • Many risk factors
  • Long latency periods (time between the onset of the illness and feeling its effects)
  • A long illness
  • Functional impairment or disability.

Most chronic illnesses do not fix themselves and are generally not cured completely.

  • Some can be immediately life-threatening, such as heart disease and stroke.
  • Others linger over time and need intensive management, such as diabetes.
  • Most chronic illnesses persist throughout a person’s life but are not always the cause of death, such as arthritis[9].

Common Chronic Diseases

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While many illnesses can be considered chronic, 13 major chronic conditions that are a significant burden in terms of morbidity, mortality and healthcare are[9]:

Common stresses of Chronic Diseases

Chronic or long-term illness and its treatment pose special problems. People living with CD need to

  • Deal with the treatments
  • Make sure to understand the condition and management strategies
  • Maintain emotional balance to cope with negative feelings
  • Maintain confidence and a positive self-image[9].

Comorbidity of CDs

Comorbidity refers to the occurrence of two or more conditions or diseases in a person at one time. Chronic conditions often occur together.

In Australia, like many nations, the rate is higher for:

  • People aged 65 and over (60%) compared with people aged 0–44 (9.7%)
  • Females (25%) compared with males (21%)
  • People in the lowest socioeconomic areas (30%) compared with those in the highest socioeconomic areas (19%)
  • People living in Regional and Remote areas (28%) compared with those in Major cities (21%).

The most common combination—or comorbidity—is arthritis with cardiovascular disease (7.4%), followed by arthritis with back pain and problems (5.1%), and back pain and problems with cardiovascular disease (5.0%).

Some chronic diseases may act as a precursor or as a risk factor for other chronic diseases. eg diabetes is known to be a risk factor for developing cardiovascular disease; asthmatics are at greater risk of developing chronic obstructive pulmonary disease later in life[10].

Management / Interventions

Chronic Diseases(CDs) – including cardiovascular diseases, cancer, chronic respiratory diseases and diabetes – kill 41 million people every year. Prevention and investment in CDs are important.

  • Investing in better management of CDs is critical.
  • Management of CDs includes detecting, screening and treating these diseases and providing access to palliative care for people in need.
  • High impact essential CDs interventions can be delivered through a primary health care approach to strengthening early detection and timely treatment.
  • There is mounting evidence that nutrition plays an important role in the aetiology and management of CDs. Nutrition counselling provides a strategy for not only reducing patient suffering but also for reducing the health care costs associated with these illnesses. Therefore Dietitians should be consulted for nutrition counselling most-especially in nutrition-related chronic diseases[11].
  • Evidence shows such interventions are excellent economic investments because, if provided early to patients, they can reduce the need for the more expensive treatment.
  • Countries with inadequate health insurance coverage are unlikely to provide universal access to essential CDs interventions.

CDs management interventions are essential for achieving the global target of a 25% relative reduction in the risk of premature mortality from CDs by 2025, and the sustainable development goals (SDGs) target of a one-third reduction in premature deaths from CDs by 2030[1]. WHO, in their publication titled "Integrating the response to mental disorders and other chronic diseases in health care systems", describes three governing principles for an integrated response to mental disorders and other chronic diseases in health systems[7].

  • A genuinely public health approach is needed. This includes a focus on disease prevention and health promotion over the life course, as well as the provision of accessible, comprehensive, and coordinated services to those with identified needs.
  • A systems approach is key and involves good governance, appropriate resourcing, and timely information, as well as the actual delivery of health services or technologies.
  • A whole-of-government, the multisectoral approach is required. Tackling the health, social, and economic consequences of mental disorders and other chronic diseases is not something that the health sector can or should do alone.

Physiotherapy and chronic disease

Physiotherapist play roles both in the prevention and management of chronic diseases. Their roles include and are not limited to[12]:

  • Prescription and implementation of therapeutic exercise at an individual or group level, and lead exercise and education classes for people who have been diagnosed or with chronic diseases.
  • Management of people with chronic lung diseases including asthma through exercise prescription and cardio-pulmonary rehabilitation.
  • Prescription of exercise therapy to improve glucose control in people with or at risk of developing diabetes.
  • Cardiac rehabilitation programs for people with various forms of heart diseases.
  • Health promotion and education that takes place in a variety of settings, ranging from one on one consultations to formal group education sessions including disease-specific self-management classes, education on lifestyle modifications such as smoking cessation, reduction of alcohol intake, pain and fatigue management.

Conclusion

Chronic diseases are already the major cause of death in almost all countries, and the threat to people’s lives, their health and the economic development of their countries is growing fast.

  • Chronic diseases are the leading cause of death and disease burden worldwide, in all WHO regions except Africa.
  • Chronic diseases are the leading cause of death in all World Bank income groups (four income groups — high, upper-middle, lower-middle, and low).
  • The death and burden of disease rates are similar in men and women and increase with age.
  • Chronic disease death rates are higher in low and middle-income countries than in high-income countries.
  • Some 45% of chronic disease deaths and 86% of the burden of chronic diseases occur in people under 70 years of age.
  • The knowledge exists to deal with this threat and to save millions of lives.
  • Effective and cost-effective interventions, and the knowledge to implement them, have been shown to work in many countries.
  • If existing interventions are used together as part of a comprehensive, integrated approach, the global goal for preventing chronic diseases can be achieved. The question is how governments, the private sector and civil society can work together to put such approaches into practice[1].

References

  1. 1.0 1.1 1.2 1.3 1.4 World Health Organization. Preventing chronic diseases: a vital investment. WHO global report. Geneva: 2005. Available from: https://www.who.int/chp/chronic_disease_report/ ( Accessed 19th February 2020).
  2. Hajat C, Stein E. The global burden of multiple chronic conditions: A narrative review. Preventive medicine reports. 2018; 12:284-93. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6214883/ (last accessed 19th February 2020).
  3. 3.0 3.1 Center for Disease Control and Prevention. Chronic Diseases in America. Available from: https://www.cdc.gov/chronicdisease/about/index.htm (Accessed 30th September 2020).
  4. 4.0 4.1 Bernell S, Howard SW. Use Your Words Carefully: What Is a Chronic Disease? Front Public Health. 2016;4:159.
  5. Medicinenet. Available from: https://www.medicinenet.com/script/main/art.asp?articlekey=33490 (last accessed 19th February 2020)
  6. Wikipedia. Chronic Condition. Available from: https://en.wikipedia.org/wiki/Chronic_condition (Accessed 2nd October 2020).
  7. 7.0 7.1 World Health Organization. Integrating the Response to Mental Health Disorders and Other Chronic Diseases in Health Care Systems. Report. Geneva: WHO. 2014. Available from: https://apps.who.int/iris/bitstream/handle/10665/112830/9789241506793_eng.pdf;jsessionid=BB5BF95350F3E8DC5CBC4A96E237BDFE?sequence=1(Accessed 3 October 2020).
  8. EU CHRODISplus Chronic Diseases: Everyone’s Business Available from:https://www.youtube.com/watch?v=da8iw9hvQX4 (last accessed 19.2.2020)
  9. 9.0 9.1 9.2 Vichealth Better Health Channel. Available from:https://www.betterhealth.vic.gov.au/health/healthyliving/chronic-illness (last accessed 19 February 2020).
  10. Austgovt. The impact of chronic disease. Available from: https://www.aihw.gov.au/getmedia/65964785-e0df-4305-ae03-a9c4d1bbe2e4/ah16-factsheet-chronicdisease.pdf.aspx (last accessed 19.2.2020).
  11. Nicholas L, Roberts DC, Pond D. The role of the general practitioner and the dietitian in patient nutrition management. Asia Pac J Clin Nutr. 2003;12(1):3-8.
  12. Australian Physiotherapy Association. Chronic Disease and Physiotherapy. Available from: https://australian.physio/sites/default/files/RESOURCES/Advocacy_Position_Chronic_Disease_2009.pdf (Accessed 2nd October 2020).