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The Additive Impact of Chronic Conditions

A recent RAND study cites the prevalence of multiple chronic conditions in seniors, adults over the age of 65, at 81% (Buttorff et. al., 2017).  To understand the challenges and impact this has on public health, we investigate some of the nuances and challenges of managing chronic conditions.   

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What are Chronic Conditions?

Chronic conditions are medical conditions that are persistent and require regular monitoring, management or treatment. The 10 most common chronic conditions that impact seniors are:


1) Hypertension (High Blood Pressure)

2) High Cholesterol

3) Arthritis

4) Ischemic/Coronary Heart Disease

5) Diabetes

6) Chronic Kidney Disease

7) Heart Failure

8) Depression

9) Alzheimer’s Disease and Dementia

10) Chronic Obstructive Pulmonary Disease


In some cases, the onset of a chronic condition can be prevented through incorporation of lifestyle habits like a healthy diet and exercise.  However, in other cases, one may be genetically predisposed to the condition. In either scenario, once someone has been diagnosed with a chronic condition, regular medical and lifestyle management are required to appropriately maintain the course of one’s health.    


How are Chronic Conditions are Managed?

When trying to understand the management of chronic conditions, we typically reference “best practices” and “evidence-based interventions.” While there are a variety of strategies and goals healthcare providers can recommend to their patients, there are commonalities among most of these approaches.


For example, medication adherence is common to all chronic care management strategies.  Whether referring to hypertension, diabetes or depression, taking medications as prescribed is essential. Other common self-management functions include maintaining a particular diet, getting the appropriate amount of exercise, proper sleep hygiene and monitoring of vitals/labs/weight.         


Multiple Chronic Conditions: 1 + 1 ≠ 2

Chronic conditions are not simply additive in either complexity and cost. If someone is suffering from diabetes, hypertension and chronic kidney disease, it is not enough to just manage each condition individually. Not only do the conditions interact and exacerbate each other, but the management strategies and treatments do as well. The relative severity of each of these conditions also impacts the overall management approach, highly personalized and often complex care plans are necessary to account for these individual nuances.        


What happens with Dementia?

Alzheimer’s Disease and other forms of dementia are commonly age-related conditions, primarily impacting the oldest segments of the population. While the cognitive and behavioral challenges associated with dementia are significant, the consequences on other chronic conditions are perhaps even more dire.  


Self-management of chronic conditions can be severely compromised with dementia, where medication adherence and following a care plan can be impossible for the patient. Even conditions that are typically well managed, like hypertension, can become a major issue for someone with dementia. The inability to fully participate in chronic care management severely confounds the challenges associated with dementia, unfortunately accounting for tremendous morbidity in seniors in today (the fastest growing segment of the US population).


Author: Kevin Liang, PhD