Illness Behavior in the Elderly C. Eberle, M.D. University of Nebraska Medical Center

Healthy Aging Paul Tatum, 76 y/o Competing in cross country cycling event.

Illness Behavior in the Elderly Objectives Describe ways a person may respond to illness. Identify reasons an older person may not report symptoms. Identify reasons an older person may not report symptoms. Explain how a person’s response to his/her illness impacts his/her health. Discuss the role of disability in elders’ illness.

Illness Behavior in the Elderly Illness Behavior in the Elderly What is the impact of this behavior? Is it really any different than yours or mine? How does this affect my interaction?

Illness Behavior in the Elderly Any behavior that occurs due to the illness: –Symptom reporting –Compliance/ Adherence –Medications –Lifestyle (diet, exercise, habits, etc)

Response to illness This frequently occurs without conscious thought. If done reflexively, how is it learned/ taught ? – Trial & error – Feedback – Repetition

Responses to Illness Minimize... ‘Just a cold.’ Deny... Don’t come in. Withdrawal... Isolates self. Fight... ‘…beat it.’ Over-react... Lose control. Embrace the sick role. Dependent Matter of fact... Deal/Cope w it.

Different Patterns of Illness JAMA 262(7): , 1989

Healthy Aging Lenny Aikins, 83 y/o Parachutes 6 times / week

Age / Aging AGE Distance from birth –Chronologic measure AGING Encompasses whole person –Ubiquitous process –Not a disease ! –Timeline v Puddle

Aging PuddleTimeline Birth School College Work Retire Married ? Children ?

Illness Behavior in the Elderly Truth v Myth  Old people are somatic or hypochondriacal.  Old people are noncompliant.  Old people are set in their ways. - “Can’t teach an old dog new tricks.”

Illness Behavior in the Elderly Hypochondriacal ? Self Rated Health

Illness Behavior in the Elderly Hypochondriacal ? Symptom Shortness of Breath Chest Pain “Feeling Blue” Coughing a lot Difficulty with urine Reported : Not Reported %

Illness Behavior in the Elderly Hypochondriacal ? 1.“Normal” aging 2.Ignored or minimized previously 3.Physician already knows 4.Fear of consequences Why Symptoms Aren’t Reported

Kaplan,...Jl Gerontol 43(4):s ,1988 Illness Behavior in the Elderly Hypochondriacal ?

Illness Behavior in the Elderly Truth v Myth Old people are somatic or hypochondriacal. Old people are somatic or hypochondriacal. Old people are noncompliant.Old people are noncompliant. EVERYONE is non-adherent. Learned early in our experience with antibiotic therapy Old people are set in their ways.Old people are set in their ways. - “Can’t teach an old dog new tricks.”

Medication Adherence Daily % Daily % Twice daily....76% Twice daily....76% Three times daily...75% Three times daily...75% Four times daily...58% Four times daily...58% Cockburn, BMJ, 1987

Illness Behavior in the Elderly “Set in their ways” U.S. NCHS, NHIS, 1985, unpublished Habit 18 y/o + 65 y/o +

Illness Behavior in the Elderly Truth v Myth Old people are somatic or hypochondriacal.Old people are somatic or hypochondriacal. Old people are noncompliant.Old people are noncompliant. Old people are set in their ways. Old people are set in their ways. “Can’t teach an old dog new tricks.”

Illness Behavior in the Elderly Is it Different ? NO DenialDenial NonadherenceNonadherenceYES Attribute signs/symptoms to ageAttribute signs/symptoms to age FearFear

Illness Behavior in the Elderly Reason for Differences Different types of illnesses Different types of illnesses Acute v Chronic Atypical presentation of illnessAtypical presentation of illness Aging: Decreased reserveAging: Decreased reserve Age: Variable loss of reserveAge: Variable loss of reserve

Illness in the Elderly Main health problem is:Main health problem is: CHRONIC DISEASECHRONIC DISEASE Frequently results in:Frequently results in: Physical impairment andPhysical impairment and Functional disabilityFunctional disability Perhaps dependence on others.Perhaps dependence on others.

Acute vs Chronic Illness ACUTE –Sudden –Short, limited –Return to normal –limited sick role –Identify & cure. CHRONIC –Sudden-Gradual –Long-unknown –? If able to return to Normal –sick role, dependent –Can’t cure … –Why me?, what did I do? ONSET DURATION EXPECTED OUTCOME ROLES ETIOLOGY

Prevalence of Disability in Older Persons IADLS

ADL Prevalence of Disability in Older Persons U.S. Dept. of Health & Human Services, 1986.

Prevalence of Disability in Older Persons (Hospital) Study Cognition Mobility Continence

Health and Disabilty

Hoenig H. JAGS, 1997 & GRS. Cascade to Disability and Handicaps

Patient Care Needs Rule of Thumb Based on ADL and IADL abilities:

Illness Behavior in the Elderly Summary Response to illness is very similar between young and old –Denial, Fear, Isolation, Fight, Sick Role There are differences –Older individuals frequently fail to report symptoms, attributing them to ‘normal’ aging and may be more fearful of illness.

Illness Behavior in the Elderly Summary Failure to recognize and report symptoms leads to delay in diagnosis and treatment, and poorer outcomes. Disability is an important element of chronic disease/illness that requires intervention in our management.

Healthy Aging Earl Shaffer, 79 y/o Through-walked the Appalachian Trail, 98 (The 3rd time)