1. 1 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 30 Major Health Issues and Chronic Disease Management of Adults Across the Life Span

2. 2 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives 1. Define terms commonly used in the care of adults. 2. Describe historical and current perspectives of adult health and health policy. 3. Discuss sources of population-based public health data and health status indicators about adults to be used to align community resources to support adults with chronic illnesses.

3. 3 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 4. Use appropriate assessment tools and development strategies to care for adults across the life span. 5. Discuss the concepts of self-management and the implementation of the Chronic Care Model to support adults with chronic illness. 6. Explain the dynamic forces that contribute to shared and gender specific diseases, health disparities, cultural diversity, and culturally competent care of adults in their communities.

4. 4 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Objectives, Cont’d 7. Appraise the role of cultural, social, and behavioral factors in accessibility, availability, acceptability, and delivery of community- based models of care for adults. 8. Examine role opportunities for nurses in providing care in the community.

5. 5 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Perspectives  Gender inequalities  Predominantly men working, including in medicine and research  Health researchers focused on issues predominantly oriented toward men  Early 1900s: Women’s health focused on reproduction and women’s roles as mothers  1920s: Women’s health expanded to address family planning and reproductive health (beginning of birth control movement)  1980s: USPHS Task Force on Women’s Health Issues  1990: Society for Women’s Research founded

6. 6 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health Policy and Legislation  Older Americans Act of 1965  Americans with Disabilities Act of 1990  Family Medical Leave Act of 1993  Personal Responsibility and Work Opportunity Reconciliation Act of 1996  “Welfare reform”

7. 7 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Ethical and Legal Issues, and Legislation for Older Adults  Abuse  Neglect  Financial exploitation  Patient Self-Determination Act of 1991  Advanced medical directives  Living will  Durable medical power of attorney  Do-no-resuscitate (DNR) order

8. 8 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Environmental Impact  Men and women are often exposed to different environmental factors because of upbringing, employment, cultural or tradition variations.  Men and women may respond differently to environmental factors.  CDC’s Environmental Hazards and Effects (EHHE) Program

9. 9 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health Status Indicators  Mortality  Life expectancy  Mortality rates  Morbidity  Increasing prevalence of chronic diseases and other conditions associated with aging  High prevalence of adults with risk factors

10. 10 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Adult Health Concerns Chronic Disease Cardiovascular Disease Hypertension Stroke Diabetes Cancer STDs/HIV/AIDS Weight Control

11. 11 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Chronic Disease  Most common:  Heart disease  Diabetes  Stroke  Cancer  Arthritis  Chronic disease is leading cause of preventable deaths, disability, and decreased quality of life  Wagner’s Chronic Care Model (CCM)

12. 12 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Cardiovascular Disease (CVD)  An estimated 81,100,000 adults have one or more types of CVD.  Leading cause of death for African Americans, American Indians or Alaska Natives, Hispanics, and Caucasians in the United States  Twenty-three Healthy People 2020 objectives focus on CVD.  Gaps in knowledge and awareness for heart disease  Particularly in women

13. 13 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Hypertension (HTN)  One in 3 adults in the United States have HTN.  Uncontrolled HTN leads to heart attack, stroke, kidney damage, and a host of other complications.  22.4% of people with HTN are not aware they have it  Racial, ethnic, and socioeconomic differences

14. 14 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Stroke  Has decreased in the United States since the 1950s  2006: Estimated prevalence was 6,400,000 (down from 7 million in 2002)  Responsible for 1 in 18 deaths  Women more likely to die from stroke than men (because they live longer and strokes increase with age)  Community-based programs and policy regarding stroke care (AHA)

15. 15 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Diabetes (DM)  23.6 million people with DM  One in 12 to 13 adults has DM  Costs the United States $174 billion each year  Many complications associated with DM  Eighteen Healthy People 2020 goals related to DM

16. 16 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Cancer  Second leading cause of death in the United States  Overall costs of cancer in 2008: $228.1 billion  Needed to reduce the burden of cancer:  Early screening and detection  Promotion of healthy lifestyles  Expanding access to services  Improving cancer treatments

17. 17 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. STDs/HIV/AIDS  19 million new STD infections each year  Almost half occur in people 15 to 24 years of age  Many cases go undiagnosed  In 2007, 42,655 new cases of HIV/AIDS  African Americans: 51%  Caucasians: 29%  Hispanics: 18%  Healthy People 2020:  Promote responsible sexual behaviors, strengthen community capacity, and increase access to quality services to prevent STDs and their complications

18. 18 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Weight Control  Overweight and Obesity  United States health care cost: $147 billion  BMI  2008 Physical Activity Guidelines  Anorexia  Bulimia

19. 19 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Women’s Health Concerns  Reproductive health  Preconceptual counseling  Gestational diabetes  Menopause  Breast cancer  Osteoporosis

20. 20 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Men’s Health Concerns  Lack of health screenings  Dangerous employment  Cancers unique to men  Prostate cancer  Testicular cancer  Depression  Erectile dysfunction

21. 21 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Health Disparities  Adults of color  Incarcerated adults  Lesbian/gay adults  Adults with physical and mental disabilities  Impoverished and uninsured adults  Frail elderly  Importance of cultural competency

22. 22 Copyright © 2012 by Mosby, an imprint of Elsevier Inc. Copyright © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Community-Based Models for Care of Adults  Nursing roles  Community care settings  Senior centers  Adult day health  Home health and hospice  Assisted living  Long-term care and rehabilitation