Illness Behavior in the ElderlyIllness Behavior in the Elderly
C. Eberle, M.DC. Eberle, M.D..University of Nebraska Medical CenterUniversity of Nebraska Medical Center
Healthy AgingHealthy Aging
Paul Tatum, 76 y/oPaul Tatum, 76 y/o
Competing in cross Competing in cross country cycling event.country cycling event.
Illness Behavior in the ElderlyIllness Behavior in the ElderlyObjectivesObjectives
Describe ways a person may respond to illness.Describe ways a person may respond to illness.
Identify reasons an older person may not report Identify reasons an older person may not report symptoms.symptoms.
Explain how a person’s response to his/her illness Explain how a person’s response to his/her illness impacts his/her health.impacts his/her health.
Discuss the role of disability in elders’ illness.Discuss the role of disability in elders’ illness.
Illness Behavior in the ElderlyIllness Behavior in the Elderly
What is the impact of this behavior?What is the impact of this behavior?
Is it really any different than yours or mine?Is it really any different than yours or mine?
How does this affect my interaction?How does this affect my interaction?
Illness Behavior in the ElderlyIllness Behavior in the Elderly
Any behavior that occurs due to the illness:Any behavior that occurs due to the illness:– Symptom reporting Symptom reporting – Compliance/ AdherenceCompliance/ Adherence
– MedicationsMedications
– Lifestyle (diet, exercise, habits, etc)Lifestyle (diet, exercise, habits, etc)
Response to illness Response to illness
This frequently occurs without conscious This frequently occurs without conscious thought.thought.
If done reflexively, how is it learned/ taught ? If done reflexively, how is it learned/ taught ? – Trial & errorTrial & error– FeedbackFeedback– RepetitionRepetition
Responses to IllnessResponses to Illness
MinimizeMinimize .. .. ..‘Just a cold.’‘Just a cold.’
DenyDeny .. .. . . Don’t come in.Don’t come in.
WithdrawalWithdrawal .. .. . . Isolates self.Isolates self.
FightFight .. .. . . ‘…beat it.’‘…beat it.’
Over-reactOver-react .. .. . . Lose control.Lose control.
Embrace the sick roleEmbrace the sick role .. DependentDependent
Matter of factMatter of fact .. . . . . Deal/Cope w it.Deal/Cope w it.
Different Patterns of IllnessDifferent Patterns of IllnessJAMA 262(7):907-913, 1989JAMA 262(7):907-913, 1989
-35
-25
-15
-5
5
Physical Life Role Social MentalHealth
Perceptions Pain
Hypertension Arthritis GI MI
Healthy AgingHealthy Aging
Lenny Aikins, 83 y/o
Parachutes 6 times / week
Age / AgingAge / Aging
AGE Distance from birthAGE Distance from birth– Chronologic measureChronologic measure
AGING Encompasses whole personAGING Encompasses whole person– Ubiquitous processUbiquitous process– Not a disease !Not a disease !– Timeline Timeline v v PuddlePuddle
AgingAging
PuddlePuddle TimelineTimeline
BirthBirth
SchoolSchool
CollegeCollegeWorkWork
RetireRetireMarried ?
Children ?
Illness Behavior in the ElderlyIllness Behavior in the ElderlyTruth Truth v v MythMyth
Old people are somatic or hypochondriacal.Old people are somatic or hypochondriacal.
Old people are noncompliant.Old people are noncompliant.
Old people are set in their ways.Old people are set in their ways.- “Can’t teach an old dog new tricks.”- “Can’t teach an old dog new tricks.”
Illness Behavior in the ElderlyIllness Behavior in the ElderlyHypochondriacal ?Hypochondriacal ?
Self Rated HealthSelf Rated Health
0 10 20 30 40
Excellent
Very good
Good
Fair
Poor
Illness Behavior in the ElderlyIllness Behavior in the ElderlyHypochondriacal ?Hypochondriacal ?
SymptomSymptomShortness of BreathShortness of Breath
Chest PainChest Pain
““Feeling Blue”Feeling Blue”
Coughing a lotCoughing a lot
Difficulty with urineDifficulty with urine
Reported : Not ReportedReported : Not Reported
5757 43 43 %%
6969 3131
4242 5858
6262 3838
6060 4040
Illness Behavior in the ElderlyIllness Behavior in the ElderlyHypochondriacal ?Hypochondriacal ?
1.1. ““Normal” agingNormal” aging
2.2. Ignored or minimized previouslyIgnored or minimized previously
3.3. Physician already knowsPhysician already knows
4.4. Fear of consequencesFear of consequences
Why Symptoms Aren’t Reported
Kaplan, ...Jl Gerontol 43(4):s114-120,1988Kaplan, ...Jl Gerontol 43(4):s114-120,1988
50
75
100
0 1 3 4 5
Years
% s
urv
ival Healthy
Fairly HSickVery sick
Illness Behavior in the ElderlyIllness Behavior in the ElderlyHypochondriacal ?Hypochondriacal ?
Illness Behavior in the ElderlyIllness Behavior in the ElderlyTruth Truth v v MythMyth
Old people are somatic or hypochondriacal.Old people are somatic or hypochondriacal.
• Old people are noncompliant.Old people are noncompliant.EVERYONEEVERYONE is non-adherent is non-adherent..
Learned early in our experience with antibiotic Learned early in our experience with antibiotic therapytherapy
• Old people are set in their ways.Old people are set in their ways.
- “Can’t teach an old dog new tricks- “Can’t teach an old dog new tricks.”.”
Medication AdherenceMedication Adherence
• Daily.Daily. .. .. .. .. 95%95%• Twice daily.Twice daily. .. .. .. 76%76%• Three times daily.Three times daily. .. .. 75%75%• Four times daily.Four times daily. .. .. 58%58%
Cockburn, BMJ, 1987Cockburn, BMJ, 1987
Illness Behavior in the ElderlyIllness Behavior in the Elderly“Set in their ways”“Set in their ways”
Sleep (< 6 h) 22 20Meals 24 8Smoker (d) 39 31Smoker (curr) 30 16Sedentary 16 14EtOH 38 12Obese (30%>) 13 13
U.S. NCHS, NHIS, 1985, unpublished
Habit 18 y/o + 65 y/o +
Illness Behavior in the ElderlyIllness Behavior in the ElderlyTruth Truth v v MythMyth
• Old people are somatic or hypochondriacal.Old people are somatic or hypochondriacal.
• Old people are noncompliant.Old people are noncompliant.
Old people are set in their ways.Old people are set in their ways.““Can’t teach an old dog new tricksCan’t teach an old dog new tricks.”.”
Illness Behavior in the ElderlyIllness Behavior in the Elderly Is it Different ? Is it Different ?
NONO• DenialDenial• NonadherenceNonadherence
YESYES• Attribute signs/symptoms to ageAttribute signs/symptoms to age• FearFear
Illness Behavior in the ElderlyIllness Behavior in the ElderlyReason for DifferencesReason for Differences
• Different types of illnessesDifferent types of illnessesAcute Acute vv Chronic Chronic
• Atypical presentation of illnessAtypical presentation of illness• Aging: Decreased reserveAging: Decreased reserve• Age: Variable loss of reserveAge: Variable loss of reserve
Illness in the ElderlyIllness in the Elderly
• Main health problem is:Main health problem is:• CHRONIC DISEASECHRONIC DISEASE
• Frequently results in:Frequently results in:• Physical impairmentPhysical impairment and and • Functional disabilityFunctional disability• PerhapsPerhaps dependence dependence on otherson others..
Acute Acute vsvs Chronic Illness Chronic Illness
ACUTEACUTE– SuddenSudden
– Short, limitedShort, limited
– Return to Return to normalnormal
– limited sick limited sick rolerole
– Identify & cure.Identify & cure.
CHRONICCHRONIC
– Sudden-GradualSudden-Gradual
– Long-unknownLong-unknown
– ? If able to return to ? If able to return to NormalNormal
– sick role, dependentsick role, dependent
– Can’t cure … Can’t cure … – Why me?, what did I do?Why me?, what did I do?
ONSET
DURATION
EXPECTED OUTCOME
ROLES
ETIOLOGY
Prevalence of Disability in Prevalence of Disability in Older PersonsOlder Persons
0
20
40
60
80
100
65 + 65-74 75-84 85 +
Need helpReceive help
IADLS
ADL
Prevalence of Disability in Prevalence of Disability in Older PersonsOlder Persons
0
20
40
60
80
100
65 + 65-74 75-84 85 +
DifficultyReceives help
U.S. Dept. of Health & Human Services, 1986.
Prevalence of Disability in Prevalence of Disability in Older Persons Older Persons (Hospital)(Hospital)
Rosin, 1966 18-28 --- 6
Warshaw, 1982 50 65 21
Pinholt, 1987 32 29 29
Bonar, 1990 35 74 34
Study Cognition Mobility Continence
Health and DisabiltyHealth and Disabilty
Hoenig H. JAGS, 1997 & GRS.
Cascade to Disability and HandicapsCascade to Disability and Handicaps
Patient Care NeedsPatient Care NeedsRule of ThumbRule of Thumb
Bathing 3 visits per weekMedication admin DailyMeal preparation Daily, 2-4 hoursDressing Daily, 2-4 hoursFeeding Daily, 8 hoursContinence 24 hoursAmbulation, Tfr 24 hours
Based on ADL and IADL abilities:
Illness Behavior in the ElderlyIllness Behavior in the ElderlySummarySummary
Response to illness is very similar between Response to illness is very similar between young and oldyoung and old– Denial, Fear, Isolation, Fight, Sick RoleDenial, Fear, Isolation, Fight, Sick Role
There are differencesThere are differences– Older individuals frequently fail to report Older individuals frequently fail to report
symptoms, attributing them to ‘normal’ aging symptoms, attributing them to ‘normal’ aging and may be more fearful of illness.and may be more fearful of illness.
Illness Behavior in the ElderlyIllness Behavior in the ElderlySummarySummary
Failure to recognize and report symptoms Failure to recognize and report symptoms leads to delay in diagnosis and treatment, leads to delay in diagnosis and treatment, and poorer outcomes.and poorer outcomes.
Disability is an important element of Disability is an important element of chronic disease/illness that requires chronic disease/illness that requires intervention in our management.intervention in our management.
Healthy AgingHealthy Aging
Earl Shaffer, 79 y/oEarl Shaffer, 79 y/o
Through-walked the Appalachian Trail, 98Through-walked the Appalachian Trail, 98(The 3rd time)(The 3rd time)
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