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Multiple chronic conditions make managing elder care difficult.

Medical researchers are beginning to recognize what anyone who’s cared for an older loved one learns in the first or second doctor’s appointment: older folks often deal with multiple chronic conditions.  This can make medical care very complicated. This news flash has been deduced by scientists at the U.S. Centers for Disease Control and Prevention (CDC) after analyzing data from the first large-scale survey of residential care facilities — think assisted living centers and board-and-care homes that serve individuals who aren’t able to live completely independently, but don’t need all the services of a nursing home.

What seemed to surprise the researchers was the level of medical impairment of this population. As a data brief released last year outlines, almost 75% had been diagnosed with at least two of the 10 most common chronic medical conditions.  The list included high blood pressure, Alzheimer’s or other dementia, heart disease, depression, arthritis, osteoporosis, diabetes, chronic obstructive pulmonary disease, cancer and stroke. Half the group had been diagnosed with two or three of the conditions, and more than a quarter of the surveyed population had been diagnosed with at least four of those diseases.

To quote the research summary, “These findings suggest a vulnerable population with a high burden of functional and cognitive impairment.”

Really? You had to survey more than 3,600 facilities to figure this out? I bet a conversation with 10 primary caregivers could have led to the same conclusion.

The New York Times recently created a nifty, interactive Venn diagram that visually describes how these conditions can overlap, using data from the 2010 study. But, in many ways, the population described in a 2012 CDC data brief on the survey’s results could just as easily include those who live with family members when tasks like meal preparation and medical management become too much to handle on their own. Anyone who’s taken on the role of in-home caregiver for someone over 85 (as were more than half of those in the survey) knows, the coexistence of multiple chronic conditions is nothing new. As I’ve written here previously, my father was dealing with four of the listed conditions (heart disease, arthritis, diabetes and chronic obstructive pulmonary disease) along with two more I’m surprised aren’t on the list: kidney disease and peripheral artery disease. Each condition had its own doctor and medications. It didn’t require a high degree of cognitive impairment to find the situation complicated — it regularly posed challenges for me and most of his doctors, as well.

Perhaps medical researchers are finally beginning to notice what clinical physicians see every day: The frequent coexistence of some of these conditions could have implications for the causes of those conditions as well as their treatment.

In a recent editorial in the American Journal of Psychiatry, Dr. P. Murali Doraiswamy of the Duke Institute for Brain Sciences pointed out how current diagnostic criteria for Alzheimer’s and cerebrovascular diseases has created a possibly artificial divide between these two conditions when, in fact, evidence seems to be piling up that cerebrovascular disease could be a contributor to the development of Alzheimer’s disease.

“Hence, the opportunity for education, lifestyle modification, and clinical trials of novel protective strategies appears significant,” he writes, noting the growing need to examine possible connections between disorders, versus protecting medical-specialty fiefdoms. “Why don’t we start today?”

Follow Chuck at chuck-ross.com, his blog Life With Father or on Twitter

Photo via Flickr Creative Commons e-MagineArt.com

 

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