Transcript No Slide Title - University of Nebraska Medical Center

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.
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
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
.
.
Deny
.
.
Withdrawal .
.
Fight
.
.
Over-react
.
.
Embrace the sick role
Matter of fact .
.
.‘Just a cold.’
. Don’t come in.
. Isolates self.
. ‘…beat it.’
. Lose control.
. Dependent
. Deal/Cope w it.
Different Patterns of Illness
JAMA 262(7):907-913, 1989
5
Physical
Life Role
Social
Mental
Health
Perceptions
-5
-15
-25
-35
Hypertension
Arthritis
GI
MI
Pain
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
Retire
Married ?
Children ?
Work
College
School
Birth
Puddle
Timeline
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
Poor
Fair
Good
Very good
Excellent
0
10
20
30
40
Illness Behavior in the Elderly
Hypochondriacal ?
Symptom
Shortness of Breath
Chest Pain
“Feeling Blue”
Coughing a lot
Difficulty with urine
Reported : Not Reported
57
43 %
69
31
42
58
62
38
60
40
Illness Behavior in the Elderly
Hypochondriacal ?
Why Symptoms Aren’t Reported
1.
2.
3.
4.
“Normal” aging
Ignored or minimized previously
Physician already knows
Fear of consequences
Illness Behavior in the Elderly
Hypochondriacal ?
% survival
100
Healthy
Fairly H
Sick
Very sick
75
50
0
1
3
4
5
Years
Kaplan, ...Jl Gerontol 43(4):s114-120,1988
Illness Behavior in the Elderly
Truth v Myth

Old people are somatic or hypochondriacal.
• Old people are noncompliant.
EVERYONE is non-adherent.
Learned early in our experience with antibiotic
therapy
• Old people are set in their ways.
- “Can’t teach an old dog new tricks.”
Medication Adherence
•
•
•
•
Daily. .
.
Twice daily. .
Three times daily.
Four times daily.
Cockburn, BMJ, 1987
.
.
.
.
.
.
.
.
95%
76%
75%
58%
Illness Behavior in the Elderly
“Set in their ways”
Habit
Sleep (< 6 h)
Meals
Smoker (d)
Smoker (curr)
Sedentary
EtOH
Obese (30%>)
18 y/o +
65 y/o +
22
24
39
30
16
38
13
20
8
31
16
14
12
13
U.S. NCHS, NHIS, 1985, unpublished
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
Is it Different ?
NO
• Denial
• Nonadherence
YES
• Attribute signs/symptoms to age
• Fear
Illness Behavior in the Elderly
Reason for Differences
•
Different types of illnesses
Acute v Chronic
• Atypical presentation of illness
• Aging: Decreased reserve
• Age: Variable loss of reserve
Illness in the Elderly
• Main health problem is:
• CHRONIC DISEASE
• Frequently results in:
• Physical impairment and
• Functional disability
• Perhaps dependence on others.
Acute vs Chronic Illness
ONSET
ACUTE
– Sudden
CHRONIC
– Sudden-Gradual
DURATION
– Short, limited
EXPECTED
OUTCOME
– Return to
normal
ROLES
– limited sick
role
– sick role, dependent
ETIOLOGY
– Identify & cure.
– Can’t cure …
– Long-unknown
– ? If able to return to
Normal
– Why me?, what did I do?
Prevalence of Disability in
Older Persons
IADLS
100
80
60
Need help
Receive help
40
20
0
65 +
65-74
75-84
85 +
Prevalence of Disability in
Older Persons
ADL
100
80
60
Difficulty
Receives help
40
20
0
65 +
65-74
75-84
U.S. Dept. of Health & Human Services, 1986.
85 +
Prevalence of Disability in
Older Persons (Hospital)
Study
Rosin, 1966
Cognition
18-28
Mobility Continence
---
6
Warshaw, 1982 50
65
21
Pinholt, 1987
32
29
29
Bonar, 1990
35
74
34
Health and Disabilty
Cascade to Disability and Handicaps
Hoenig H. JAGS, 1997 & GRS.
Patient Care Needs
Rule of Thumb
Based on ADL and IADL abilities:
Bathing
Medication admin
Meal preparation
Dressing
Feeding
Continence
Ambulation, Tfr
3 visits per week
Daily
Daily, 2-4 hours
Daily, 2-4 hours
Daily, 8 hours
24 hours
24 hours
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)