INDIAN GERONTOLOGICAL ASSOCIATION, JAIPUR CHRONIC DISEASES IN INDIA – CROSS CUTTING ISSUES : POVERTY,ENVIRONMENT & GENDER BY DR. K.L.SHARMA INDIAN GERONTOLOGICAL ASSOCIATION, JAIPUR

MODIFABLE RISK FACTORS FOR NON-COMMUNICABLE DISEASES GENERAL ENVIRONMENTAL EXPOSURES Physical Environment : Ambient air quality , Water quality Occupational and work site Food safety and availability

MODIFABLE RISK FACTORS FOR NON-COMMUNICABLE DISEASES Social Environment : Income Cognitive Education Cultural Education Access to Health Services Availability of Public Health and Community Services

MODIFABLE RISK FACTORS FOR NON-COMMUNICABLE DISEASES Personal Environmental Exposures Smoking ( and tobacco use) Nutrition and Obesity Dietary Intake, Micronutrient adequacy and Caloric balance Physical Activity, Alcohol/ Drug Abuse Genetic endowment, monogenetic, gene-environment interaction

What Are Chronic Diseases? Chronic diseases are non communicable illnesses that are prolonged in duration, do not resolve spontaneously, and are rarely cured completely. Examples of chronic diseases include heart disease, cancer, stroke, diabetes, and arthritis.

Key Chronic Diseases : The Facts Heart disease and stroke are the first and third leading causes of death, accounting for more than 30% of all U.S. deaths each year.   Cancer, the second leading cause of death, claims more than half a million lives each year.   Diabetes is the leading cause of kidney failure, non traumatic lower extremity amputations, and new cases of blindness each year among U.S. adults aged 20–74 years.   Arthritis, the most common cause of disability, limits activity for 19 million U.S. adults.   Obesity has become a major health concern for people of all ages. 1 in every 3 adults and nearly 1 in every 5 young people aged 6–19 are obese.

CHRONIC DISEASES SOME FACTS : Chronic diseases cause 7 in 10 deaths each year in the United States.   About 133 million Americans—nearly 1 in 2 adults—live with at least one chronic illness.   More than 75% of health care costs are due to chronic conditions.   Approximately one-fourth of persons living with a chronic illness experience significant limitations in daily activities.   The percentage of U.S. children and adolescents with a chronic health condition has increased from 1.8% in the 1960s to more than 7% in 2004.

CHRONIC DISEASES SOME FACTS : Chronic diseases—such as heart disease, cancer, and diabetes—are the leading causes of death and disability. These diseases also cause major limitations in daily living.

Chronic Diseases Leading to deaths

Distribution in Indian elderly:(n=1000) CHRONIC DISEASES Distribution in Indian elderly:(n=1000) India   Rural Urban Chronic Disease M F Cough 250 195 179 142 Piles 33 16 32 18 Joint Problems 363 404 285 393 High/low BP 108 105 200 251 Heart Disease 34 27 68 53 Urinary Problem 38 23 49 24 Diabetes 36 28 85 66 Cancer 2 3 4 Any of the above 527 514 528 560 National Sample Survey 52nd Round Survey, 1995-96

Distribution of Physical Disability in Aged (n=1000) India   Rural Urban Disability M F Visual 249 291 225 260 Hearing 139 156 111 132 Speech 32 38 29 3 Locomotor 107 115 80 94 Amnesia/Senility 96 113 61 Any Disability 380 425 333 367 National Sample Survey 52nd Round Survey, 1995-96

Estimated Cost of major CD & S

HEALTH PROMOTION & DISEASE PREVENTION DEFINITION: Health promotion activities are those activities in which an individual is able to practically engage, in order to advance or improve his or her health.

Health Promotion Three levels of health promotion activities: Primary Prevention: Activities are designed to completely prevent a disease. Example : Immunization against Pneumonia or Influenza Secondary Prevention : Early detection and management of diseases. Example : Colonoscopy to detect small cancerous polyps Tertiary Prevention : To manage clinical diseases in order to prevent them from progressing or to avoid complications of the disease. Example : Use of beta blockers to help remodel the heart in congestive heart failure.

AREAS OF HEALTH PROMOTION The need to focus on the following areas in order to promote health and prevent disabilities in the elderly client : 1. Physical activities 2. Nutrition 3. Tobacco use 4. Safety 5. Immunization

Activities of Daily living and Health Promotion Independence in activities of daily living is an important goal for health promoting activities. Preventing Strategies in lessening disabilities : 1.)Smoke Cession 2.) Immunization 3.)Physical activity 4.)Weight control 5.)Blood pressure control 6.)Arthritis 7.)Diabetes self management program

SELF MANAGEMENT OF CHRONIC DISEASES (CDSMP) CDSMP Of Kate Loring (M.D.) was supported by Agency for Health Care Research and Quality (AHRQ). It is a 17 hours. course for patients with chronic diseases that is taught by lay peoples.

CHRONIC DISEASE SELF MANAGEMENT PROGRAMME The course aims at : To teach patients to improve symptom management. To maintain functional ability. To adhere to medical regiment. HOW TO JUDGE THE EFFECTIVENESS OF THE PROGRAMME ? BY THE IMPROVED SELF EFFICACY OF CLIENTS WHO PARTICIPATE IN THE PROGRAMME.

CHRONIC DISEASE SELF MANAGEMENT PROGRAMME WHAT IS THE DIFFERENCE BETWEEN SELF MANAGEMENT PROGRAMME AND HEALTH PROFESSIONALS GOAL ? THE GOAL AND CONCERNS ARE DIFFERENT FIVE ELEMENTS OF SELF MANAGEMENT PROGRAMME : PROBLEM SOLVING DECISION MAKING RESOURCE UTILIZATION FORMING A HEALTH CARE PROFESSIONAL / CLIENT PARTNERSHIP TAKING ACTION

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