Chronic health conditions are a prominent feature of the contemporary world, as manifested by the designation of the years 2007 to 2017 as the Decade of Action on Nutrition and Health and this year’s theme for World Health Day, with a specific focus on the State of the World’s Nursing Report. The global prevalence of chronic conditions (cardiovascular disease, diabetes, cancer, and chronic respiratory disease) is expected to increase by 57% by 2030. These conditions can culminate in cumulative morbidities, impaired functioning, and a decreased quality of life. The purposes of this essay are therefore (1) to provide a comprehensive and insightful examination of basic concepts and terminologies concerning chronic diseases and their consequences; (2) the imperative need for health care practitioners to acquire an in-depth understanding of the normal functioning of the various systems of the body, as well as the effects on interrelationships, to be able to comprehend chronic diseases and their courses; and (3) the different approaches and domains important for grasping the systemic nature of emerging concepts and trends on chronic diseases and potential therapies in the fight against them.
Like all public health issues, the context that frames the phenomenon is important for chronic conditions. While we classify diseases as acute or chronic or diseases of life or diseases of underdevelopment, this distinction is no longer tenable in the complex aetiologies and pathophysiological mechanisms of the conditions. Therefore, the simplistic notion that chronic ailments are diseases of life is untenable in a changing ecology and the epidemiology of life-threatening infectious diseases in conjunction with other constants—diseases due to behavioral risk factors. In other words, the chronic community of physicians needs to find methodologies to combat life-threatening diseases in an under-resourced society. Basic life processes have complexity that has resulted from more than 10 million years of animals being vertebrates with brains evolved by natural selection. Evolution appears to favor cells and organisms in which processes are replicated at several levels, with benefits over simple systems. The disadvantage is that organisms become more prone to disruption at several levels than if cellular processes were only involved at the lowest levels. Regulatory systems have been developed to counter this disruption. Chronic disorders develop from defective processes in such complex humans (physiological or psychological) where the regulatory systems cannot or do not adequately compensate. It is these diseases that are the focus of this course, with a focus on those impairing communities in which the potential exists throughout the world; it will be clear that the course must be multidisciplinary in orientation.
Definition and Classification of Chronic Health Conditions
Chronic health conditions are those that last beyond the normal time of acute healing and/or physical trauma, are not usually associated with well-defined pathology, and can be accompanied by associated limitations of activity, which will substantially influence a person’s quality of life experience. They may also prevent a person from engaging in employment and result in social isolation. There are various ways to classify chronic conditions; for example, the classification is important in increasing awareness of chronic conditions and treatment. From profession to profession, the classification of chronic diseases as related or unrelated to chronic conditions may depend on various factors, some of which are mentioned herein, including weaknesses of the training hospitals where clinical experience was taught and developments in the understanding of pathophysiology in many of the chronic diseases. Classifying these diseases and conditions is important for a number of reasons. For healthcare professionals, there are critical implications of the classification because, together with the characteristics of the individual in front of them, it impacts the care plan and treatment appropriate for the individual concerned. The ‘problem total’ is also diagnosed differently depending on the classification category. Chronic diseases, the major cause of morbidity and increased need for health care, are recognized to maintain themselves over the long term. The interaction of genetic, environmental, and lifestyle factors is involved in the classification of these chronic diseases. These chronic diseases have long latency periods, and although they manifest at different rates after exposure, they can develop insidiously. The classifications of chronic diseases are also important for the formation of health care policies and research. They tend to change the gradual evolution of chronic diseases as a result of the interaction of environmental factors with the modified lifestyle according to the genetic structure. It may take many years for these diseases to manifest themselves.
Epidemiology and Global Burden
Chronic illnesses, such as diabetes, cardiovascular diseases, and chronic respiratory diseases, have seen an increase in prevalence worldwide and are currently the leading causes of mortality and morbidity. The majority of chronic diseases develop with age and have an impact on multi-morbidity. Although all ages are affected by chronic diseases, older adults bear the greatest burden. Predictions for chronic disease state that by 2020, chronic diseases will cause three-quarters of all deaths worldwide. Approximately 60% of people with a chronic disease in the world currently live in low- and middle-income countries.
There are strong disparities between different parts of the world with regard to chronic disease. Among those affected by chronic disease, a few people are still diagnosed or managed, and the majority of people usually do not have access to affordable and quality care. The high prevalence and the fact that the onset is early means that in the absence of appropriate interventions, Africa will experience an increase in the number of deaths and disability-adjusted life years due to major non-communicable diseases. The flexibility of local health systems and the economic impact of chronic diseases are very stressed. The effectiveness of promising cost-effective behavior change strategies to reduce chronic disease expectations has also been demonstrated. Large status distributions exist worldwide with respect to exposure prevalence and chronic conditions themselves. Populations in the Gulf Region have the highest rates of these conditions in comparison to anywhere else.
Risk Factors and Prevention Strategies
There are many opportunities to prevent or delay the onset of chronic diseases. Health providers and patients will benefit from an improved understanding of risk factors associated with chronic diseases. The risk factors for chronic diseases are usually divided into two categories, which include those that can be modified and other factors that cannot be modified. Obesity, tobacco use, alcohol use, inactivity, dietary factors, genetics, toxin exposure, infections, chronic low-level stress, nutrient deficiencies, poor sleep patterns, and environmental factors are modifiable and non-modifiable risk factors. Public health initiatives are also important in preventing chronic diseases through vaccination, significant reduction in the risks, and reducing the direct and indirect costs.
In primary prevention, the causes of chronic conditions are poorly understood, but the results of the interplay between a person’s genetics and a range of lifestyle factors. Many adults currently have multiple chronic health conditions, but cancer survivors are more exposed and susceptible to chronic conditions. Because doctors and their patients often recognize that the development of cancer may lead to more effective efforts to address modifiable risk factors, the identification of risk factors is crucial. Healthcare providers need to promote and practice primary prevention, and efforts are required to develop more active health promotion initiatives in the healthcare environment. It’s time to move multiple chronic medical conditions with the help of patients and their healthcare providers to proactively target and promote preventive care.
Impact on Individuals and Society
Chronic health conditions impact nearly one-half of North Americans. On an individual level, they can significantly impact the quality of life, daily functioning, and mental and emotional well-being of those with chronic health conditions, increasing stress and anxiety for the sufferer and their family members. The economic implications of chronic diseases to society are significant. Chronic disease in Canada would account for a substantial portion of total costs, with the economic impact of lost productivity due to chronic disease across key chronic diseases per annum estimated to be significant. The economic burden of chronic diseases ranges widely, but the costs to manage diabetes are considered to be particularly high, accounting for a notable percentage of all direct health care costs.
Chronic diseases pose challenges for the individuals who have them and also for families who are supporting them. Chronic diseases can interfere with personal relationships within the family. The relationship of the parents, with each other, their children, elderly parents, or extended family can be adversely affected by chronic diseases. Chronic diseases may also present challenges to broader ethnic communities, who will bear financial and emotional responsibilities in response to the growing numbers of individuals being affected. These individuals may be more likely to rely on community supports as they age, including transportation services, nutritional programs, social networking, and spiritual support services. Patients often state that support received from family and friends is critical. Social support does, however, change, with some relationships becoming strained. Some patients indicate their social circle is becoming smaller and that they have to rely heavily on a few friends or family members.
Notifications for chronic disease management are primarily concerned with the management of a specific area and often do not fully incorporate and examine social determinants of health. Social determinants of health are understood to be the social and economic influences that disproportionately affect health outcomes. A healthcare framework that focuses on the social determinants of health would contribute to reduced healthcare utilization by those with chronic diseases and improve health outcomes for this group of people. Chronic disease can also be judged differently across international cultures. For instance, chronic diabetes in certain cultures may be judged as stronger than that of chronic conditions where pain is the presenting factor. Cultural competency is necessary to provide high-quality health care and decrease healthcare utilization, including ER visits and hospitalization. The current primary health care treatments and the very structure of the health act challenge the needed patient-centered long-term approach to managing chronic conditions. Local population chronic disease consultation may get it wrong! Some chronic diseases are more important than others to the population. A consultation may provide information to public health on all the wrong chronic diseases and how extensively they are prevalent.
Physical Health
Individuals suffering from chronic diseases often face significant physical health challenges. Reduced mobility, chronic pain, fatigue, shortness of breath, dizziness, fainting, difficulties with speaking, swallowing, or digestion, nausea, sleep disturbances, and sexual dysfunction are just a few symptoms they might experience on a daily basis. As a result, they might be more at risk of falls, experience pressure sores, take more medications that may cause side effects or negatively interact with one another, and have less frequent and less well-balanced meals, worsening their overall physical state. Healthcare providers should be aware of this in their interactions with patients and incorporate strategies to deal with such symptoms in their provision of care. Larger or multiple physical symptoms might also have psychological consequences and can even lead to suffering.
Chronic illnesses might also lead to a decline in physical health over time due to the progression of the underlying disease and cumulative effects of long-term illness. Thus, comprehensive management of chronic health conditions also requires attention to preventing these complications, sustaining overall physical health, and rehabilitation. Chronic conditions can also be a major cause of limitations in mobility and activities of daily living, resulting in not just fewer opportunities for exercising, but also increasing the risk of physical deconditioning. Therefore, prevention strategies to avoid such limitations are important in achieving the vital goal of sustained physical health. Physical activity is known to have a beneficial influence on the prevention of many chronic health conditions and in maintaining overall physical health. It can also improve outcomes once chronic diseases develop. Physical rehabilitation strategies constitute an important treatment modality and management plan in many chronic health conditions, this being especially important for people with physical illness. To inspire patients to participate in physical activity and rehabilitation programs, they need to be provided with the evidence base as well as the necessary physical tools to be able to undertake activities within their abilities. There should be an improved choice in physical structure and activities for people with chronic diseases. To progress such a perspective, there should be a change in focus, evolving from a single-disease model of rehabilitation towards an integrated care model considering the physical and care needs of people with multiple physical diseases.
These patients need to have a rewarding, well-balanced intra-rehabilitation regime to develop the faculty and capabilities they possess, enabling them to reconstruct their lives given their current limitations. Providing such an intra-rehabilitation course will allow patients with chronic illness to decrease suffering and enable them to undertake their daily activities in an active way as much as possible. Comprehensively managing the physical aspects of chronic diseases should promote education and abilities development to allow patients choice in their physical health future as well as increasing access and reducing barriers. The overall objective is to promote a renewed vision in all aspects of physical health care and treatment and to respect and promote the welfare and development of people with physical or mental chronic illness.
Mental Health
While mental health is not often explicitly discussed in chronic illness management, there are various mental health conditions that are associated with chronic disease. Some of the key psychological issues associated with living with a chronic illness include anxiety, depression, and stress. Many individuals living with a chronic health condition may present with a diagnosed or undiagnosed mental illness, which is why some experts recommend screening all clients for mental health challenges. Mental illness may exacerbate or compound the symptoms of the chronic illness, and people living with mental illness are more likely to develop a chronic health condition. These mental health conditions are not only negative manifestations of living with chronic illness but are also barriers to successful management and treatment. People diagnosed with these conditions respond poorly to treatment, miss appointments, are non-compliant with treatment, and may not exert the effort to improve their health. Physical health and mental health are interconnected, and living with a chronic illness can have just as profound an effect on a person’s mental health as it does on their body. Therapeutic interventions should be tailored based on the specific patient and their unique situation. Knowing the patient, the nature of their illness, stress, relationships, personal strengths, coping, level of health literacy, financial status, cultural background, and so on, allows the health professional to recognize how a person might be affected. The role of family and friends, support groups, mental health professionals, and trusted clergy, if appropriate, is also important for both supporting and destigmatizing mental health problems. Unfortunately, there is a stigma associated with mental illness, and many people with chronic mental illness try to hide it because they are ashamed and embarrassed. Therefore, they suffer alone, and many develop an avoidance of mental health services because of this internalized stigma. I believe that it is the responsibility of the patient’s healthcare team to uphold mental health as important and thus break down any stigma by involving it in the patient’s healing process. Techniques might include seamlessly involving mental health questions and supports into disease management training; as healthcare professionals, educating peers about the potential for mental health suppression; and being open to discussing our own mental health.
Diagnosis and Management
Diagnosis is one of the key steps in managing chronic health conditions, and there is no management without a correct diagnosis. Diagnosis helps in planning treatment and looking into the prognosis of the disease. It helps in providing necessary education about the disease to the patient. Education is needed as it will help a patient in self-management. Patients should be empowered with the potential warning signs and how they can take care of themselves in case of severe illness. With scientific innovation, diagnostic tools have also advanced. Clinicians use advanced imaging, molecular biology, and histological approaches to diagnose chronic diseases. There are non-invasive techniques available to monitor biochemical, nuclear, and other markers of chronic health diseases at home. Invasive approaches also allow one to diagnose chronic health conditions accurately. These invasive and non-invasive tools can help in getting the biomarkers to diagnose the condition. If a patient suffers from a chronic condition throughout life, there is a need to take a patient-centered approach. This approach ensures all diagnostic and management efforts will be highly personalized for disease management. To manage their disease, every patient should be involved in every step of the management, from the diagnostic to the treatment. It comes from the belief that by participating in decisions about their health and care, the patient is more likely to adhere to medical plans, take an active role in self-management, and make better and informed decisions about their health. Chronic diseases are difficult to manage in the long term. Some conditions might remodel their pattern with time and need updated diagnosis and management. Some of the conditions might lead to exacerbation with time and result in very severe consequences. All these changes occur throughout the disease and make it difficult to manage. For the effective management of chronic complications, a multidisciplinary approach is needed. It is an approach to promote effective and constructive output to maintain the quality of life of the patient. There is a need to have an interdisciplinary approach for chronic disease management. A team approach to chronic health conditions is highly recommended. A physician, a specialist, midwives, pharmacologists, dieticians, physiotherapists, and psychologists are included to develop a preventive and management plan for such diseases. The care team uses regular check-ups and evidence-based management to manage the progression of a chronic health condition. Plans might vary with the treatment and the response of the patient. Regular monitoring helps clinicians understand the needs of the patient. This further leads to adjustments and modifications of the plan with the help of the patient. This includes medicines, lifestyle, diet, and nutrition. Monitoring exercise can support and engage the patient in achieving better long-term outcomes. The care team in the management of chronic illnesses can work with healthcare settings by controlling health expenses. The promotion of prevention is part of the care plan for the management of chronic health conditions. Preventive strategies, such as physical activity and healthy nutrition, are simple and effective prevention actions for all ages. Given the difficulty of managing lifelong chronic conditions over a period of time, chronic diseases are experienced in different parts of life from the patient’s perspective. About half of the adults in one study were found to have a chronic condition in the United States, Canada, England, and the Netherlands. For those aged 75 or over, 87% of people in the United States have a chronic health problem.
Medical Interventions
Pharmacological treatments form the cornerstone of management for the majority of long-term health conditions. They are designed to reduce symptoms, improve physical functioning, and slow the progression of the disease. This requires specific medicines, often at maximally tolerated doses, to ensure optimal outcomes are achieved. There is evidence to support best practice or evidence-based interventions in long-term conditions rather than the approach for non-pharmacological or behavioral interventions that focus on personalization of the treatment. In some cases of long-term conditions, surgical interventions play a key role in managing conditions, such as new joints for people with severe osteoarthritis. Transplantation for those with severe end-organ disease is the aim of treatment. These approaches aim to provide a better quality of life, particularly as the end of life can be extremely deteriorating in chronic health conditions. In the last couple of decades, there have been an increasing number of new treatments that have been developed that can be used to improve outcomes through slowing the disease progression and additional symptoms. These will be expensive modalities of treatment and are notionally classed as Advanced Therapy Medicinal Products. Current onset and change in pathology need to be taken into account. For individuals with existing illness, the development and symptom progression will be influenced by the stage of the condition and therefore a different approach may be taken. As all individuals present differently, taking into account the illness experience, psychosocial and physical ramifications, and third-party influence will be imperative in forming the individualized treatment approach. Patient expertise also needs to be taken into account when forming treatment plans. Regular monitoring of any effects of treatment, either symptomatic or side effects, is critically important for individuals with long-term conditions and on treatment. This is an essential skill for healthcare professionals who manage chronic illness. The adjustment of the care plan will need to be intensive for newly diagnosed individuals and for those with rare or additional comorbid conditions that will necessitate additional care and treatment adjustment. Ensuring that individuals are taking the prescribed course of treatment is an ongoing challenge for healthcare professionals. Adherence will be affected by a range of various psychosocial and environmental factors.
Lifestyle Modifications
Lifestyle modifications are a large component of chronic disease management. Improved dietary and exercise routines are often recommended, along with possible behavior therapy and medications in some cases. Patient education is advocated so that the individual can make informed lifestyle choices. The benefits of lifestyle change are quite evident and include improvements in health outcomes and function when these adjustments are made. Despite the potential benefits of lifestyle modification, there are several barriers to the implementation of these adaptations. Socioeconomic factors have a negative influence on the ability of individuals to access these resources. In several communities, healthy food is not as accessible and carries a higher price tag. Additionally, there are not many safe spaces for individuals to get adequate exercise. Combating this issue is a national priority, and resources have been allocated toward creating more green space in urban centers so that more people can live healthy, active lives. There are also community-led initiatives to make fresh fruits and vegetables more accessible.
Patient-centered care incorporates numerous components, including smoking cessation programs, weight loss support, water therapy, physical therapy, psychological intervention, and coping strategies. Ideally, the plan of care must be multidisciplinary to encompass the expertise of a variety of healthcare professionals. The goal is to provide an individual plan of care that, over time, may also include self-management strategies that enable the patient to monitor and manage symptoms effectively. Improved health outcomes, including increased mobility and function, are generally reported. Often, the intent of treatment is to halt the progression of disease or provide relief of the comorbid or coexistent symptoms. The primary ambition of the treatment team is to improve the quality of life of the patient and ensure that the patient has the opportunity to participate in life as fully as possible on a day-to-day basis.
Research and Innovation in Chronic Disease Management
Research and innovation in the area of chronic disease management have provided new possibilities for pharmacological, psychological, and surgical therapeutic strategies, as well as the integration of technologies and treatment approaches into routine clinical practice. Most of these have been proposed for fibromyalgia syndrome characterized based on experimentally well-documented theories. However, further confirmation of the validity of theories from larger scale clinical trials and meta-analyses is needed to determine the most suitable therapy and treatment algorithms. New specialties have also emerged as deemed necessary in the light of current advances such as health informatics for the management of chronic disease.
There is an increasing requirement for evidence-based research in the treatment of chronic pathologies. Research in chronic disease management provides a promising path for the future prevention of chronic condition consequences and the development of new approaches to reduce the consequences of chronic illness. This research area will be beneficial not only for treating chronic conditions, but also for developing strategies for integrating new technologies into current practice. We must be vigilant with device and technology advancement and must not put our patients at risk. The greatest advance is that individualized assessment and treatment are now feasible. Equally accurate diagnosis and treatment in a routine setting could be accomplished. Our current effort is to translate the data into daily clinical applications and improve public health efforts. Research grants and findings must be utilized to promote and advance public health and clinical approaches. This research, which has been conducted for the last thirty years, should be continued as long as it is promising and influential in improving the outcomes of chronic diseases.