Aging and Chronic Disorders
FM.qxd 15/4/07 11:09 AM Page i
Stephen J. Morewitz Mark L. Goldstein
Aging and Chronic
Disorders
Stephen J. Morewitz, PhD Stephen J. Morewitz, PhD &
Associates
Buffalo Grove, IL 60089 USA
Mark L. Goldstein, PhD Northbrook, IL 60062 USA
Library of Congress Control Number: 2007922445
ISBN-10: 0-387-70856-1 e-ISBN-10: 0-387-70857-X ISBN-13: 978-0-387-70856-0 e-ISBN-13: 978-0-387-70857-7
Printed on acid-free paper.
© 2007 Springer Science+Business Media, LLC
All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.
The use in this publication of trade names, trademarks, service marks and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights.
9 8 7 6 5 4 3 2 1 springer.com
FM.qxd 15/4/07 11:09 AM Page iv
This book is dedicated to Dad and Lora, Sharone,
Lisa, Ashley, and Jonathan
vii
Preface
Five of the six leading causes of death among older Americans in 2004 were chronic diseases, such as cardiovascular disease, can- cer, cerebrovascular disease (stroke), chronic pulmonary disease, and diabetes mellitus. All of these diseases negatively affect qual- ity of life, contributing to reduced functioning and the increased eventuality of having to move to a nursing home or retirement community. The increased birth rate after World War II and the significant increase in life expectancy since the early twentieth century have resulted in an increased prevalence of disabling and costly chronic diseases.
There are many questions still to be addressed in the fields of aging and chronic disease. What are the risk factors associated with the increased prevalence of chronic diseases in older popu- lations? What are the major complications that contribute to dis- ability and increased health care utilization and costs? What impact do chronic diseases have on disability and quality of life? What are the most effective treatments and rehabilitation programs? What steps can be taken to avoid overuse and/or misuse of drugs? How can patient education and self-management activities be improved to help these patients and their caregivers better understand and cope with their conditions? How can caregiver burden be reduced?
This book addresses these questions by focusing on how major chronic disorders, such as diabetes, arthritis, cardiovascular dis- ease, and cancer, affect health care utilization, costs, coping, dis- ability, and quality of life in aging populations. Research studies are used to illustrate a wide range of topics from the epidemiology of chronic diseases in older populations, health care utilization and costs, to quality of life concerns, treatment outcomes, and care- giver burden. Case studies from a clinical psychologist’s private practice are used to clarify some psychosocial issues underlying chronic diseases and health care.
FM.qxd 15/4/07 11:09 AM Page vii
Chapter 1 analyzes the epidemiology of eight chronic diseases in older adults. Data on the prevalence of diseases and associated risk factors are stressed in this chapter. Health care planners can use these analyses to improve primary and secondary health care prevention activities through more effective uses of health care resources.
Chapter 2 examines the latest information on health care uti- lization and costs for older adults that can point to a more effi- cient means of reducing the rising health care costs associated with the treatment of chronic diseases.
In Chaps. 3-5, Dr. Mark L. Goldstein, a clinical psychologist, reviews the literature and uses composite case studies from his practice to illustrate quality of life issues, psychosocial problems, and cognitive difficulties in older adults.
In the remaining chapters, each of the eight chronic diseases is evaluated in terms of five major issues. First, the latest trends in complications associated with each chronic condition are explored.
Second, the impact of each disease on disability and quality of life is analyzed. Third, the processes of stress, coping, and social sup- port are described. Fourth, the latest information on treatment and rehabilitation outcomes is discussed. Last, new trends in patient education and self-management are presented.
The information in this book will be relevant to a wide range of professionals and students in the fields of gerontology, medi- cine, nursing, public health, mental health, social work, educa- tion, health administration, health policy, and social sciences.
Buffalo Grove, Illinois Stephen J. Morewitz
Northbrook, Illinois Mark L. Goldstein
viii Preface
ix
Acknowledgments
I would like to thank Mrs. Myra Kalkin Morewitz and Dr. Harry A.
Morewitz for their advice and support. I also want to thank Bill Tucker, Executive Editor, Health and Behavior, at Springer, who has been supportive as well as thorough and thoughtful.
Buffalo Grove, Illinois Stephen J. Morewitz
Northbrook, Illinois Mark L. Goldstein
FM.qxd 15/4/07 11:09 AM Page ix
xi
List of Abbreviations and Acronyms
ACE—angiotensin-converting enzyme
AD—Alzheimer’s disease ADLs—activities of daily living AF—atrial fibrillation
AIDES—Assessment, Individualization,
Documentation, Education, Supervision
ALOS—average length of stay AMI—acute myocardial
infarction
BMD—bone mineral density BP—back pain
CAD—coronary artery disease CAM—complementary and
alternative medicines CDC—Centers for Disease
Control and Prevention CGA—comprehensive geriatric
assessment
CHD—coronary heart disease CHF—congestive heart failure CLBP—chronic low back pain CR—cardiac rehabilitation CT—computerized tomography DM—diabetes mellitus
DMARD—disease modifying anti-rheumatic drugs EEG—electroencephalogram
EPESE—Established Population for the Epidemiological Study of the Elderly EPIC—European Prospective
Investigation of Cancer ESRD—end-stage renal disease FDA—Food and Drug
Administration FFS—fee-for-service FM–fibromylgia
HABC—Health, Aging and Body Composition Study HEARTFELT—Heart Failure
Effectiveness & Leadership HF—heart failure
HMO—health maintenance organizations
HRQL—health-related quality of life
IA—inflammatory arthritis IADLs—instrumental activities
of daily living IVR—Interactive Voice
Response
LAC—laparoscopic assisted colectomy
LBP—low back pain
LED—lower extremity disease
LPN—licensed practical nurse
MC—managed care
MI—myocardial infarction MMN—mismatch negativity MMWR—Morbidity & Mortality
Weekly Report
MRIs—magnetic resonance imaging
MS—multiple sclerosis NA—nursing assistant NCHS—National Center for
Health Statistics
NHANES—National Health and Nutrition Examination Survey NIH—National Institutes of
Health
NSAIDS—non-steroidal anti-inflammatory drugs NSCLC—non-small-cell lung
cancer
OA—osteoarthritis OP—osteoporosis OTC—over-the-counter PAD—peripheral arterial
disease
PAID—Problem Areas in Diabetes Protocol
PENS—percutaneous electrical nerve stimulation
PET—positron emission tomography
PM—particulate matter PPO—preferred provider
organizations
PSA—prostate-specific antigen PTH—parathyroid hormone PTSD—post traumatic stress
disorder
QSD-R—Questionnaire on Stress in Patients with DM RA—rheumatoid arthritis REM—rapid eye movement SCLC—small-cell lung cancer SES—socioeconomic status SF-36—Short-Form-36 Health
Survey
SHAPE—Screening for Heart Attack Prevention and Education
SLUMD—St. Louis Mental Status Exam
STEMI—ST elevation myocar- dial infarction
TEMS—transanal endoscopic microsurgery
TM—transcendental meditation TME—total mesorectal excision TNF—tumor necrosis factor UFT-tegafur/uracil
USDHHS—U.S. Department of Health and Human Services
VA—Department of Veterans Affairs
VATS—video-assisted thoracoscopic resection
xii List of Abbreviations and Acronyms FM.qxd 15/4/07 11:09 AM Page xii
Contents
Preface . . . . vii
Acknowledgments . . . . ix
List of Abbreviations and Acronyms . . . . xi
1. Chronic Disorders in an Aging Population: Epidemiology . . . . 1
2. Elders and Health Care Utilization and Costs . . . . 15
3. Chronic Disease and Quality of Life in Older Adults . . 28
4. Psychological Problems in the Elderly . . . . 35
5. Cognitive Changes in Older Adults . . . . 44
6. Seniors with Diabetes Mellitus . . . . 56
7. Rheumatoid Arthritis, Osteoarthritis, Osteoporosis, Fibromyalgia, and Low Back Pain in Older Adults . . . 90
8. Cardiovascular Disease in the Elderly . . . 125
9. Seniors with Cancer . . . 141
References . . . 161
About the Authors . . . 207
xiii
Author Index . . . 209 Subject Index . . . 217
xiv Contents
FM.qxd 15/4/07 11:09 AM Page xiv
