Chronic illness is a part of life for many older adults. In fact, about 80 percent of older Americans live with one chronic disease, according to the U.S. Centers for Disease Control and Prevention (CDC), and 50 percent have two or more. The impact of these diseases is often dramatic. In particular, chronic illnesses can affect seniors’ mobility, fall risk, energy, and ability to live independent lives. It’s also common for seniors to experience changes in their ability to socialize and maintain relationships as they’ve done in the past. And the cost of medical care and caregiving can significantly impact seniors’ finances, as well as the finances of their families.
The topics discussed below highlight some of the impacts on quality of life that your senior patients may be experiencing, along with some tips for helping them cope with these challenges.
It’s important to have the opportunity for privacy and solitude in one’s life. However, some older adults may choose or feel forced into seclusion and isolation as a result of their challenges with chronic illness.
For example, a senior woman may have enjoyed playing bridge regularly with some old friends, but then start to only attend games sporadically. She might eventually decide to stop attending her bridge club altogether and ask that someone else take her place. This could result from concerns about her memory and how it affects interactions with her friends, but she may not tell anyone that this is her reason for reducing her socialization.
An older adult might also choose to spend more time at home if he is concerned about his physical or cognitive ability to drive a car or navigate transportation. A dialysis patient, for example, may find himself withdrawing from his typical activities or social engagements while managing treatment multiple times per week.
As seniors age, their health often becomes one of the most popular topics of conversation. Some people try to avoid this because they do not want too much focus on their ailments. However, you may want to encourage your patients to share truthfully about a doctor visit or health condition with friends, who will likely empathize with their situation. Regardless of the topic or common ground, continued contact and interaction with peers helps enrich the lives of older adults.
If chronic illness is inhibiting your senior patient’s ability to stay connected with her family, friends, or community, try offering the following suggestions:
- Recognize and express feelings of loneliness. It may be difficult for some to admit or to recognize that they are lonely. Encourage your patient to talk about her feelings or write in a journal to help clarify them.
- Reach out. Some older adults feel isolated because friends or relatives no longer live in close proximity. Encourage the senior to connect through phone calls, written letters, email, or by utilizing technology.
- Pursue an activity or hobby. You’re never too old to learn a new skill or take on a new hobby. Pursuing an old or new activity provides opportunities to meet new people with similar interests.
- Join a group and get involved. Your patient may benefit from a support group that provides some connection based on the health challenges she is facing. Or, she might explore a group or volunteer activity related to her interests. Religious, civic, environmental, political, and social groups can generally be found through the local Area Agency on Aging, senior centers, the newspaper, and the Internet.
Seniors value their mobility, including their personal bodily movement and their ability to come and go as they please. Chronic illness can dramatically affect both, however, with limitations on mobility either contributing to the illness or resulting as a side effect. For example, pain and fatigue are common side effects of chronic illness and can directly impact an older adult’s physical capabilities. Lack of movement resulting from limited mobility can then exacerbate existing health conditions.
Changes in mobility for seniors who value independent living can also increase their risk of falling. Reduced mobility contributes to muscle weakness and lack of balance, which can lead to more falls. Some seniors with diabetes experience neuropathy, which could result in a loss of feeling in the feet or pain and difficulty walking. This in turn could affect their mobility, increasing fall risk because they feel less steady on their feet.
Movement, activity, and a healthy diet can all contribute to maintaining mobility, positively impacting health and independence, and lessening the severity and symptoms of a chronic condition. Some seniors may be able to prevent, lessen, or even reverse the consequences of immobility. A physical therapist can recommend activities that are suited to a patient’s health condition, or an occupational therapist can help him work within his current physical state to accomplish activities safely and independently.
According to a research review published in Clinical Science, fatigue is a common complaint of those living with chronic illness. However, it typically doesn’t receive much attention from healthcare professionals. Even so, patients cite fatigue as one of the main contributing factors to a decrease in their quality of life.
It is often unknown whether someone’s fatigue is a consequence of simply being chronically ill, or whether it represents a specific complication of that condition. Fatigue can be further exacerbated by life events, insomnia, stress, or depression. Treatments may also contribute to fatigue.
As with mobility, a personalized treatment approach can help your patient find the right activity and level of movement to support her health without straining or causing distress. A graded approach allows her to work up to the movement that best suits her needs. Exercise classes designed for seniors, such as aquatic-based classes, stretching, or restorative yoga, can be a great place to start. Seniors can generally find facilities in their area through insurance plans that offer Silver Sneakers or Silver and Fit programs, which are specifically geared toward seniors.
Many older adults experience a shift in their relationships as a result of living with a chronic illness. A senior may pull away from his primary relationships because of shame or embarrassment about his health, leading to seclusion and isolation. Or the opposite may be true, in which he experiences a change in roles when his spouse or child becomes a caregiver, and the relationship shifts to involve even more time together.
If family caregiving becomes necessary, it’s important for seniors to maintain the bonds they have with spouses, children, and extended family. Encourage your senior patients and their family caregivers to find activities or outings that keep them connected. If a family caregiver becomes overwhelmed, it could strain the relationship. You may want to suggest that she ask for help from other family members or from a professional caregiver.
Relationships can also suffer if communication is limited. Having open conversations allows each person to feel heard and can lay the groundwork for collaborative problem solving. It’s important for a senior who experiences ups and downs as a result of his condition to clearly communicate his needs. Without that, the caregiver may receive mixed messages. Also stress the importance of expressing gratitude and appreciation for even the smallest gesture — both from the senior and his caregiver.
Chronic illness can cause financial strain for many families due to increased medical costs, lost income for either the senior or the caregiver, or even renovation costs for home modifications. According to the CDC, 84 percent of all healthcare spending in 2006 was for people with one or more chronic illness. Seniors or family caregivers with a good understanding of their medical coverage are able to make more informed decisions about their healthcare. Encourage your patients to conduct reviews of their coverage annually, as these reviews could result in a needed change to insurance that provides better benefits or leads to lower out-of-pocket costs.
If your patient’s medication costs have become a burden, she may not share that with you or with her other healthcare providers, even if you are able to help. Prompting a conversation about her expenses could yield ways to alter her medication regimen and reduce annual costs. She may also be able to reduce prescription drug costs by shopping around to different pharmacies for the best price.
Any of one of these issues could impact your senior patient’s quality of life as a result of a chronic illness. Quality of life means different things to different people, though there are ways to measure it. The CDC offers a questionnaire for measuring an individual’s health-related quality of life, including functional status, sickness impact, and reported state of well-being. Tracking quality of life scores helps providers give meaningful, focused support to patients with chronic illness. When an older adult considers her own health-related quality of life, this could help her make certain decisions regarding a course of action, medical treatment, or use of alternative and complementary therapy.
Seniors can experience many challenges when living with a chronic illness. Offering guidance and empathy in addition to regular medical care can help provide the support they need to make changes or improvements in their lives.
For seniors at with chronic illnesses that put them at risk of falling, a medical alert device can help increase their safety and security. If you know a senior patient who would benefit from information about medical alert system, refer your patients to Lifeline.