The Effects of Chronic Illness on Middle Aged Adults

THE EFFECTS OF CHRONIC ILLNESS ON MIDDLE AGED 1

The Effects of Chronic Illness on Middle Aged Adults

Stephanie Bannerman, Carol Fortner and Emily Hogan

Missouri State University

María Barba Ramírez

Satakunta University of Applied Sciences

University of Cádiz


The Effects of Chronic Illness on Middle Aged Adults

According to the World Health Organization (WHO), health is defined as “a state of

complete physical, mental and social well-being and not merely the absence of disease or

infirmity.” Comparatively, the group discussed and agreed upon the following variation as the

definition of health: a state of being holistically and perceptually well according to one's own

subjective ideas based on one's own genetics, attitude, prior experiences and understanding of

their body.

The group has chosen the focus of this paper to be, the effects of chronic illness on

middle aged adults. Middle age is defined as the period in a person's life from about age 40 to

age 60. The purpose of this paper is to examine how middle-aged adults cope with chronic

illness. WHO includes cardiovascular disease, cancer, chronic respiratory disease, diabetes,

mental disorders, and coronary artery disease as chronic health issues. The effects of these

diseases are multifactorial and depend on the determinants of health affecting the individual.

This paper will address chronic illnesses, nursing concerns, rehabilitation and other issues

pertinent to chronic illnesses and middle aged individuals in the United States, Spain and

Finland. Additionally, the structure of the different country’s healthcare systems will be

discussed along with which health organizations are helping chronic illnesses in the middle-aged

and how they are meeting the public’s needs.

Chronic illnesses encompass conditions such as, heart disease, stroke, cancer, chronic

respiratory disease, kidney disease, osteoporosis, depression, arthritis, and diabetes. Most chronic

illnesses do not fix themselves and usually cannot be cured. Consequently, there are many areas


of concern that nurses needed to address when considering the health promotion and disease

prevention strategies in middle aged adults who have chronic illnesses (Better Health Channel,

2012). One area of concern that a nurse must address is the complex causes and multiple risk

factors that accompany chronic illnesses and have a drastic effect on middle aged adults’ lives.

There are many chronic illnesses that become a problem in an individual’s life because of an

unhealthy way of living, such as hypertension and diabetes, or some can be passed on

genetically, with breast cancer being an example. Sometimes, it is hard to know the exact cause

of a chronic illness which can make health care planning, education, and motivation toward

healthy living difficult for health care providers (Better Health Channel, 2012). Along with many

causes and risk factors, some chronic illnesses have long latency periods which mean the time

between exposure and the onset of the illness and symptoms can be lengthy. Doctors say that

rheumatoid arthritis predominantly affects middle aged adults and can start as early as late

twenties, but some people do not realize they have it until they are middle aged and experience

the pain involved with a chronic illness (HealthStatus, 2015). It is important that nurses

encourage screening at an early age for people with many risk factors of certain chronic illnesses

because by the time someone is diagnosed with a chronic illness at the middle age stage of their

life, it might be too late for screening and prevention strategies.

Another area for concern is the patient and their family’s mental health and quality of

life. Some chronic illnesses can be life-threatening, like strokes and heart attacks, and affect the

patient’s life in a more drastic way. At this point in their lives, middle aged adults usually have

families and careers set in motion, so chronic illnesses can negatively affect their mental health,

leading to depression, anxiety, and low-self-esteem, which also affects the quality of life of the

person’s family and friends (IRISS, 2015). Middle aged adults who have already settled down in


life have to adjust to the demands of the illness and therapy used to treat their condition. Since

the middle aged adult may become depressed and have low self-esteem, the nurse would need to

suggest some support groups for their psychosocial health. Depression and low self-esteem may

also affect the patients will to work on activities involving health promotion and disease

prevention, so the nurse must keep encouraging patients with chronic illnesses to not give up and

remember the importance of the care they are receiving.

Nurses must also consider health promotion and disease prevention strategies with

middle aged adults with chronic illnesses because an important concern is the patient’s confusion

of trying to understand their condition along with their treatment regimen, while trying to

maintain an emotional balance to cope with negative feelings and low self-esteem. As a result

their emotional imbalance, some individuals find it hard to maintain their trust and confidence in

health care providers when recovery is not possible. This can make it difficult for nurses to help

their patients understand that they should be eating nutritiously, taking their medications a

certain way, or receiving regular checkups (like checking blood pressure with hypertension, or

blood sugar monitoring for diabetes) (Better Health Channel, 2012).

When talking about vulnerable groups of people in general and rehabilitation, it is

important, as nurses, to assist individuals in regaining a sense of control over their situation

through information and shared decision making, which reduces anxiety and helps the patient’s

motivation to participate in rehabilitation. Some people with chronic illnesses are very angry at

themselves and are dissatisfied with their current lifestyle, so certain kinds of activities can help

them channel their anger into progress in their rehabilitation, like vigorous exercises and sports.

Successful rehabilitation in these vulnerable groups does not just mean assisting individuals to

reach their highest functional abilities; it could also mean assisting them in achieving and


enhancing their quality of life and to maintain that quality of life. Vulnerable groups, in general,

may struggle to adhere to prescribed treatment and recommendations because they are struggling

from low self-esteem, depression, or anxiety. Some vulnerable groups, like people with chronic

illnesses, may have disabling conditions and require ongoing treatment, medical supervision, or

restrictions on activity to control their condition or to prevent complications, which can make it

very hard for them to stick to such a strict life-style (Falvo, 2014). Therefore, rehabilitation is

very important in middle aged adults with chronic illnesses because it allows these individuals to

maintain their functional ability and help them learn how to prevent exacerbations. In general,

rehabilitation allows people to grow stronger and have a better quality of life, along with helping

people become more confident in their own abilities. Without rehabilitation, individuals may not

have a way to fully heal from their surgeries or injuries and may not be able to reach the level of

health they had achieved before their injury/surgery which could negatively affect them for the

rest of their lives. Consequently, rehabilitation is an extremely important piece of healthcare in

the care of those with chronic illnesses.

The best rehabilitation plan set in action for this group of individuals holds little value if

the individuals do not follow the treatments and recommendations made to manage their

problems to prevent complications in their lives. Some individuals in vulnerable groups, like

people with chronic illness, may be reluctant to return to their former roles and obligations that

they had before their struggles and may try to retain their vulnerable roles because they find that

they enjoy the attention they receive. When this happens, rehabilitation progress is hindered.

Effective rehabilitation enables individuals in vulnerability groups to strive to be the best they

can be and be able to function effectively in their lives and maintain a good quality of life. This


involves interdisciplinary efforts of many types of medical and nonmedical professionals (Falvo,

2014).

Rehabilitation in the U.S. includes a mixture of different types of therapy: occupational

therapy, physical therapy, speech therapy, and any therapy nurses might include in their

treatments, such as massage therapy. American rehabilitation services hire registered nurses,

licensed practical nurses, occupational therapists, certified occupational therapist assistants,

physical therapists, physical therapist assistants, and speech-language pathologists. In the U.S.,

rehabilitation is all about recuperating and getting back to normal as quickly as possible so

individuals can get back to their busy schedules and not miss out on anything. Americans expect

the process of rehabilitation to be quick, which can make some people angry or depressed when

they do not progress as quickly as they wish too. The U.S. has both inpatient and outpatient

rehabilitation services. Rehabilitation services in the U.S. focus on the fact that everyone is

different, so everyone needs different types of therapy, and they focus on creating attainable

goals before beginning therapy (Life Care Centers of America, 2015). When looking at problems

the U.S. has with rehabilitation, surveys state considerable unmet rehabilitation needs that are

often caused by funding problems for assistive technologies (WHO, 2011).

MARIA

In Spain rehabilitation of diseases is of great importance. It is a global and continuous

process of limited duration and aimed at promoting and achieving optimum levels of physical

independence and functional abilities, as well as psychological, social, vocational and economic

adjustment to enable the individual to become independent in his own life. The objectives of

rehabilitation in Spain include: treat the disease and prevent complications, deal with possible

disabilities, and improve function, and teach the patient and family to adapt to a healthy lifestyle.


This rehabilitation depends on several factors: the type and severity of the disease, disorder or

injury, the type and degree of any resulting impairments and disabilities, the overall health of the

patient and family support.

Rehabilitation, all over the world, targets body functions and structures, environmental

factors, activities and participation, and personal factors. Rehabilitation includes identification of

an individual’s problems and needs, defining rehabilitation goals, relating the problems to

relevant factors of the person and their environment, planning and implementing the measures

needed, and assessing the effects of rehabilitation. According to Article 26 that the United

Nations Convention on the Rights of Persons with Disabilities (CRPD) created, and when

looking collectively at the global population of the world, rehabilitation means

“… appropriate measures, indulging through peer support, to enable persons with

disabilities to attain and maintain their maximum independence, full physical, mental,

social and vocational ability, and full inclusion and participation in all aspects of life”

(World Health Organization, 2011, p. 95).

This article calls on countries to organize, strengthen, and extend comprehensive rehabilitation

services and programs, as soon as possible, based on multidisciplinary assessment of individual

strengths and needs, and should include the use of assistive technologies and devices. Vulnerable

people experience health disparities and greater unmet needs in comparison to the general

population in all countries. Every country needs to work towards removing the barriers blocking

vulnerable people from getting health care such as rehabilitation and make existing health care

systems more inclusive and accessible to vulnerable people. A study done in 2007 on

rehabilitation needs in China found that about 40% of vulnerable people who needed

rehabilitation services and assistance received no help. Along with this, the unmet need for


rehabilitation services was high for aids and equipment, rehabilitation therapy, and financial

support for poor individuals. A survey of physical rehabilitation in Slovenia, Czech Republic,

Slovakia, Hungary, and Croatia found a general lack of access to rehabilitation services. Also,

facilities for prosthetic and orthotic professionals and other health care providers of rehabilitation

services are deeply inadequate in relation to need worldwide (WHO, 2011).

Rehabilitation services take place in different settings across the nation, but medical

rehabilitation is typically provided in acute care hospitals for conditions with acute onset. Follow

up rehabilitation, though, can be provided in a wide range of settings like specialized

rehabilitation wards or hospitals, rehabilitation centers, institutions such as residential mental and

nursing homes, hospices, respite care centers, military residential settings, or single or multi-

professional practices. Long-term rehabilitation may be provided within community settings,

such as schools, work places, or home-care therapy services. Since the 1970s, community-based

rehabilitation has been a major strategy to respond to the needs of vulnerable people, particularly

in developing countries. Community-based rehabilitation was originally promoted to give

rehabilitation services in countries with limited resources and field manuals gave family

members and community workers practical information about how to implement basic

rehabilitation interventions. More than 90 countries around the world continue to develop and

strengthen their community-based rehabilitation programs. The Rehabilitation Council of India

created a national program (1999-2004) that aimed to educate medical officers working in

primary health care facilities about vulnerable populations and about the need to spread

knowledge about rehabilitation, along with other things like health promotion and early

identification of diseases. This raised awareness about services for vulnerable people.


Conclusion of the program ended with 18,657 medical officers receiving training out of 25,506

(WHO, 2011).

Overall, patients in other countries suffer from many of the same health problems the

U.S., but because of geographic location and economic situation, these patients do not have

access to rehabilitation medicine. Even though rehabilitation is become more widespread, it still

does not exist in many countries (UNC School of Medicine, 2015). Therefore, countries around

the world are realizing the importance of rehabilitation needs of vulnerable populations and some

countries are starting to do something about it. It is important to remember when looking at

different vulnerable groups around the world; each type of vulnerability does not have specific

health, education, rehabilitation, social, and support needs. Diverse responses are always

required for each individual. Countries need to promote community-based rehabilitation,

especially in less-resourced areas, to help vulnerable people receive rehabilitation care.

Rehabilitation, no matter where the individual is from, is always voluntary, and some people

may need support with decision-making about rehabilitation choices. For some vulnerable

people, rehabilitation is of the upmost importance to be able to even participate in education, the

labor market, and civic life. No matter where someone is from, rehabilitation should help to

empower vulnerable population groups and their families (WHO, 2011). An important factor in

the support of providing health promotion, rehabilitation and care for the middle-aged with

chronic diseases is the health care system of the country and the support it provides to the

different aspects of health involved in the care of individuals with chronic illnesses.

The U.S.’s healthcare system is unlike any other developed nation because it is extremely

expensive and it doesn’t have a universal delivery system; instead it has many different sectors

that provide care for a variety of individuals throughout the population. The U.S government


does not centrally control the healthcare system which means financing of health care comes

from a mix of private and public companies. The majority of Americans have private insurance,

but those who do not may be enrolled in Medicare, Medicaid, SCHIP, TRICARE, or managed

care which includes HMOs and PPOs. Medicare is for individuals age 65 and older, disabled

individuals or those who have end stage renal disease, while Medicaid covers children, low-

income individuals at any age and individuals with disabilities. SCHIP is for children in

uninsured families households who do not qualify for Medicaid and TRICARE is health

insurance that is financed by the military for active-duty military personnel. Managed care is

financed by an employer or the government and the prices for services and the salary of the

health professionals are pre-determined. Individuals in the managed care system have limited

choices for healthcare providers. In short, the U.S. healthcare system essentially provides

freedom of choice to individuals on their healthcare coverage and access to care is based on the

coverage they receive. The government fills the gaps in the private sector including gaps in

coverage for vulnerable populations (Shi & Singh, 2005).

There are four models of healthcare and the U.S. is a mixture of all of them. The

Beveridge model is a system of healthcare that is financed by the government via taxes which is

similar to coverage for American veterans. The Bismarck Model is a network of insurance

companies in conjunction with employers that don’t make a profit, but provide insurance to

everyone; this is similar to the working class in the U.S. who usually get their insurance from

their employer. The National Health Insurance Model is a universal insurance program run by

the government with private health care providers and a good example of this in the U.S system

of healthcare is Medicaid and Medicare. And in the Out-of-Pocket model the individual is

responsible for paying for healthcare services if they are not covered by insurance. This model is


demonstrated in the U.S. by the part of the population with no insurance at all (Physicians for a

National Health Program, 2010).

Due to the disorganization of the healthcare system, the cost of healthcare in the U.S. is

skyrocketing. Therefore, until sufficient reorganization of health services is achieved costs will

continue to rise and cause more problems. One challenge to reorganization of the U.S’s

healthcare system is the idea of choosing collaboration and interdisciplinary teams over focusing

on the individual health care provider. The continuum of care idea is important in preventing

fragmentation of health care and the patient will be the center of care. A barrier to collaboration

is also the current financial model of healthcare which is the fee-for-service system. The fee-for-

service system draws more attention to the volume of services compared to the quality of the

service and focus on the individual and what is in their best interest. An important player in

reorganization of healthcare is professional organizations that need to back changes in the

payment system and model of care.

On the other hand, the organizational structure of the health system in Finland is a health

system based on compulsory levies, with universal coverage covering the entire resident

population officially. It jointly involved the central government and municipalities. Therefore,

Finland follows the Beveridge Model of health care because all patients have access to care and

medical care is paid via taxes. Finland has a public health care model, as well. According to an

article entitled, “Integrated primary health care: Finnish solutions and experiences”, criticism of

the model is centered on the lack of equal availability to all localities because access is limited to

rural areas. Finland’s National Institute for Health and Welfare is a research and development

institution. Kehitysyhteistyön palvelukeskus (Service Centre for Development Cooperation) is a

service in Finland working on the development of work in global issues. Nationally, the Ministry


of Social Affairs and Health is in charge of making legislation and monitor compliance. Locally,

they are responsible for organizing health through Municipal Health Committees and by the

Councils. The existing 444 municipalities are responsible for the promotion and prevention of

health, primary care, rehabilitation and dental services.

One of the many objectives of Finland’s health system is to provide quality care and continue

with cost control measures for the existing increase in pharmaceutical spending. Also, another

goal is to maintain Quality Guidelines Mental Health put in place in 2001; improvements in

access; to respond to patient preferences; and run the free choice of general practitioner and

hospital choice as well as better coordination between primary care (GP) and specialist care

(medical specialists and hospitals).


According to the law, health services in Spain are public, universal and free at the time of

delivery, so it provides great benefits to society as a whole, such as improved equity and social

cohesion. Moreover, the quality and safety of health care has improved health indicators so the

SNS is one of the best in the world. Within the European Union, we find that Spain has a high

life expectancy and very good clinical results. Each of the healthcare systems in the different

countries vary in ideas and government involvement, but each country is striving toward creating

useful organizations that will benefit the health of individuals, including those with chronic

diseases.

The U.S. has many government and non-government organizations that are in place to aid

middle aged individuals with chronic illnesses; however, I will be focusing on those

organizations that can be found in the state of Missouri. The Missouri Department of Health and

Senior Services and the Missouri Department of Social Services provide information, support

and resources for individuals with chronic illnesses. The Missouri Department of Health and

Senior Services website has a home page specific to chronic diseases that provides links to

information on risk factors and prevention strategies, statistics, and resources for the public, the

community, and the health provider. A huge new opportunity in managing chronic illnesses in

Missouri is “health homes” for those on Medicaid which come out of the Patient Protection and

Affordable Care Act (ACA). Missouri is one of the first states to initiate this new optional

benefit of the ACA which provides federal funds for a two year stay in a “health home” for those

with chronic conditions on Medicaid. Missouri may decide to open this service to specific

chronic conditions or all of them. The goals of the houses are to provide continuity in the care of

these individuals and present a holistic method of supporting the individual so they are not solely

defined by their chronic illness (Silow-Carroll & Rodin, 2011). Another government


organization that is funded by the CDC is the Chronic Disease Self-Management Program

(CDSMP). The CDSMP equips individuals with chronic health conditions through education

and the development of skill related to the self-management of disease through workshops that

usually last around 6 weeks. The CDSMP is a national program, however Missouri is home to

many regional arthritis centers that offer classes specifically to those with arthritis, but they also

offer other self-management programs for those with other chronic conditions (Center for

Disease Control and Prevention, 2012).

Non-government agencies, or NGOs, benefiting those with chronic illnesses are very

prominent in Missouri and one example is the Missouri Foundation for Health. The Missouri

Foundation for Health works with a variety of organizations in regional communities to provide

support to activities and programs that are striving to improve health issues for all Missourians.

The foundation provides funding for a program called ACCESS which stands for Advancing

Chronic Care through Excellence in Systems and Support. The ACESS program provides

support for a holistic framework of health care that will enable health providers to manage

individuals with chronic illnesses and all aspects of their lives that their condition effects

(Missouri Foundation of Health, 2015). The Center for Health Care Strategies (CHCS) is a non-

profit NGO that partners with states, such as Missouri, to aid health care advances related to

those with complex needs. Those with complex needs include individuals on Medicaid and

Medicare, children in foster home situations, high-cost populations and those with complex

medical needs such as middle-aged adults with chronic health conditions. The CHCS works in

healthcare policy to improve access, quality, and cost of public healthcare in the U.S. In

Missouri, the CHCS works closely with the Missouri Department of Social Services and reports

to the department on advances in care for the vulnerable citizens of Missouri. Another NGO is


the Chronic Disease State Plan Workgroup of Missouri that produced a publication called On

Common Ground. The workgroup’s publication is a comprehensive plan to prevent and manage

chronic disease in the state of Missouri. The publication provides background information on the

burden of disease in Missouri, risk factors, disparities in care, and self-care management

strategies. It goes on to list a number of strategy areas that should be addressed and objectives

that should be met when planning the management of chronic illnesses.

Nation-wide government organizations benefiting chronic diseases in the U.S include the

Centers for Disease Control (CDC), National Institute of Health (NIH), the Food and Drug

Administration (FDA), and the Health Resources and Services Administration (HRSA). The

CDC is an excellent resource for information related to current health situation involving the

population of the United States. Additionally, statistics related to morbidity and mortality,

disease rates, prevalence and transmission can be found on this site. The Mission of the CDC is

stated as, “to protect America from health, safety and security threats, both foreign and in the

U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable,

human error or deliberate attack, CDC fights disease and supports communities and citizens to

do the same” (CDC, 2015). NIH is referred to as the nation’s medical research agency and

provides Information related to clinical trials. Their mission is, “to seek fundamental knowledge

about the nature and behavior of living systems and the application of that knowledge to enhance

health, lengthen life, and reduce illness and disability” (NIH, 2015). HRSA is a division of the

Department of Health and Human Services. This site is an excellent resource for information

about the Affordable Health Care Act, drug pricing programs, rural health, and a myriad of other

services.


There are also many national NGOs in the U.S. which provide support to individuals with

chronic illnesses, such as the Joint Commission, the Bill and Melinda Gates Foundation, the

Kaiser Family Foundation, and the Global Alliance for Chronic Disease (GACD). The Joint

Commission is an independent non-profit organization in charge of accrediting health

institutions. According to their website, “Guided by the belief that every life has equal value, the

Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives.” I

think there should be a reference in this paragraph. This site is a great way to access different

helps works the foundation is working on. Their focus is on underserved populations. The

Kaiser Family Foundations website has a wealth of information about Medicare, Medicaid,

HIV/AIDS, private insurance and other health reform issues pertinent to today’s chronically ill

individuals. The GACD is composed of many health institutions from different countries that

invest in global research studies that benefit health plans regarding chronic non-communicable

diseases. Their focus is on meeting the needs of those with chronic illnesses in low to middle

income countries through an interdisciplinary approach.

There are many government organizations in Spain, but these do not cover all chronic

diseases in general. Moreover, these organizations are intended not only for patients, but also

their families. The most important are: Spanish Association against Cancer, Federation of

Spanish Diabetics, Spanish Federation of Rare Diseases, Association of Relatives of Alzheimer’s

and Spanish Confederation of Families and Persons with Mental Illness.

Non-government organizations found in Spain with the objective of benefiting middle-

aged individuals with chronic illnesses include: the Asociación de enfermería comunitaria

(Community Nursing Association or AEC), the Sociedad Española de Salud Pública y

Administración Sanitaria (Spanish Society of Public Health and Health Administration or


SESPAS), and the Sociedad Española de Medicina de Familia y Comunitaria (Spanish Society of

Family and Community Medicine or semFYC). The AEC is a nongovernmental organization that

has several functions. On one side it is responsible for training of community health nurses. On

the other hand it makes working sessions to promote health and prevent disease. The SESPAS’s

mission is to improve health and the health care services of the Spanish population. The semFYC

is composed of 17 societies of family and community medicine that are represented by 19,500

doctors. Its main functions are to promote health and prevent disease.

The challenges in providing healthcare for middle-aged individuals with chronic illnesses

will only increase as the incidence of chronic diseases in the world increase, as well as the

amount of money spent in relation to their care. The governments and organizations in both

countries must focus on prevention of chronic illnesses and providing more resources for

managing long-term care. Many organizations such as the CDC and WHO are working to shift

the healthcare focus, around the world, toward expanding prevention strategies including far-

reaching screening methods, follow-up care that will aid in maintaining health, and improving

education materials for leading a healthy lifestyle. The new ACA, Healthy People 2020, and

Millennial Developmental Goals (MDGs) are all ways the U.S. is addressing community health

concerns, such as chronic health conditions, and they are providing solutions and goals to

prominent gaps in community health care.

In Spain, the Community Health has the scope of primary health care. The National

Health System - Sistema Nacional de Sanidad (SNS) in Spanish - is the one who deals with the

Community Health concerns. The SNS is the set of health services of the State and the

autonomous communities and integrates all the functions and health benefits. The SNS, by law,

is run by the Spanish government. According to the Spanish constitution there is public


financing, universal coverage and free health services at the time of use. The SNS has a

multitude of strategies

In the SNS there is a strategy proposed by the progressive development of interventions

aimed at winning health and preventing disease, injury and disability. This is the strategy of

Health Promotion and Prevention and its mission is to promote a society in which individuals,

families and communities can reach their full potential for development, health, welfare, and

autonomy because the assumption is that working toward health is a task for everyone.

One strategy in the SNS, among many, is to address chronic disease. This strategy is

governed in Spain by certain principles. People, both individual and within the social sphere, are

the focus of the SNS. The person-centered care requires health systems to be focused on the

disease and to be directed toward addressing the needs of the population whole and of each

individual.

Addressing chronicity must have a population health approach, designed to improve the

health of the entire population (healthy people and sick people) by addressing a wide range of

social determinants of health. We must recognize the human being as a biopsychosocial being

and take account of differences, diversity, equity, social justice, and multiculturalism.

Consideration of the life cycle perspective and the social determinants of health is important to

consider throughout all stages of development (prenatal, infancy , childhood, adolescence, youth,

adulthood and old age) and to promote health, disease prevention and adequate access to health

and social services, prioritizing the most vulnerable and disadvantaged groups strengthening

interdisciplinary collaboration in health in order to achieve favorable results in the health,

welfare and quality of life of people. Another principle is the consideration of all health

conditions and activity limitations in chronic illnesses. Normally, strategies for prevention and


control of chronic diseases focus on those most prevalent and cause increased mortality (cancer,

diabetes, cardiovascular disease, but we must also take into account the health conditions,

although not very frequent, can cause a worsening of the quality of life of those affected and

their environment.

Primary care is the mainstay of patient care with health conditions and activity limitations in

chronic illnesses. All professionals in the SNS must be involved and work on improving the

integrated approach to chronic, being necessary to promote the role of primary care teams and in

particular the professional family medicine, pediatrics and nursing, as coordinators of health care

processes related to chronicity. It is now necessary to develop instruments and coordinate health

services and social services in order to achieve progressively comprehensive care for chronic

health problems.

Circuit work and patient traffic dynamics should be redirected depending upon the

objectives that must be achieved to establish effective coordination between different care

settings and within them. Such coordination requires improving the exchange of information,

agreement and setting the exercise of the powers of each professional and optimizing

intervention without duplication of services in order to maximize health outcomes. The

professionals of the SNS have to share with all citizens the responsibility for health care and the

appropriate use of health and social services. To achieve this goal it is necessary to promote

actions aimed at raising awareness among professionals and the public, ensuring that people have

adequate and sufficient information to enable them to have an active attitude and commitment to

self-care, involving them in decision-making about your health.

When comparing organizations in the United States, Spain and Finland, there are

similarities in their governmental organizations in the realm of science and research. The


differences are found in the source of funding for health. Finland has a public health model,

whereas the United States has private and publically funded sources and Spain has a primary

care model that is universal. Access to healthcare is available in both countries; however the

cost is quite different. Finland’s cost for a regular visit is 16.10 euros, which is approximately

$18.10. This is obviously quite different compared to high cost health care in the United States

and the free healthcare in Spain. Those with chronic illnesses face substantial cost either for

insurance or physician visits adding to the burden of illness. Finland’s availability of services in

all locations has been criticized, therefore making it difficult for everyone to obtain access.

Those with chronic illness would face a difficulty accessing services. On the other hand, Spain

provides many strategies and objectives to meet when providing primary care to those with

chronic illnesses. Despite the differences in healthcare systems, the nurse still plays a vital role in

care of all individuals, especially those who are chronically ill.

The role of a nurse in any position or health care organization, in any country, is to

become familiar with community resources in the area, whether they are government or non-

government organizations. Once the nurse is knowledgeable they can refer to individuals that fit

the focus of a specific organization. The nurse must learn to assess middle-aged individuals with

chronic illnesses and determine what their needs are so that they can be met by different area

programs or organizations. Nurses can also impact health care policy by giving their support to

certain reforms or taking their ideas and suggestions to individuals in the local or state

government.

An important aspect in nursing is determining primary, secondary, and tertiary health

promotion practices in order to aid the health plan for chronic illnesses. Primary health

promotion, at this point in the health of a chronically ill person, would focus on education about


preventing associated illnesses that can happen due to the progression of disease. The very

word, chronic, means the illness has progressed beyond the acute state and is therefore outside

the realm of secondary health promotion. Secondary health promotion focusing on screening is

too late at the chronic stage of disease. The primary focus for health intervention is obviously

tertiary at this time. Managing the disease and its long term effects on an individual and family

is where the focus must be placed.

A health model is vital in a health care plan of any individual and according to the

Improving Chronic Illness Care website,

“The Chronic Care Model (CCM) identifies the essential elements of a health care system

that encourage high-quality chronic disease care. These elements are the community, the

health system, self-management support, delivery system design, decision support and

clinical information systems. Evidence-based change concepts under each element, in

combination, foster productive interactions between informed patients who take an active

part in their care and providers with resources and expertise. The Model can be applied to

a variety of chronic illnesses, health care settings and target populations. The bottom line

is healthier patients, more satisfied providers, and cost savings” (2015).

Interventions based on this model focus on planned visits and group visits. Planned visits serve

the purpose of keeping patients informed about the progression of their disease. The hope is,

with patient education and care; patients will not be hospitalized with such great frequency.

Patients will be more satisfied with their care and become more comfortable with care at home

without visiting the emergency room as often.


In conclusion, the state of health of middle aged adults with chronic illnesses vary

according to their subjective idea of their own well-being while taking part in health promotion

and prevention strategies or progression through the rehabilitation for their specific illness. Each

country, the U.S., Spain and Finland, is doing their part in supporting these individuals to ensure

they have access to healthcare and a multitude of government and non-government

organizations. Patient education is vital for individuals with chronic illnesses; therefore it is

important for an interdisciplinary team of healthcare workers to continue to care and research for

these individuals so the every middle-aged adult can achieve their own optimal state of health, no

matter the person or their chronic illness.


References

Better Health Channel. (2012). Chronic illness. In Better Health Channel. Retrieved October 2, 2015, from http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Chronic_illness?open

Centers for Disease Control and Prevention. (2015) Chronic disease prevention and health promotion.

Centers for Disease Control and Prevention. (2015) Preventing chronic disease.

Center for Disease Control and Prevention. (2012). Self-management education. Retrieved from http://www.cdc.gov/arthritis/interventions/self_manage.htm#2

Center for Health Care Strategies, Inc. (2015). About us. Retrieved from http://www.chcs.org/about-us/

Chronic Disease State Plan Workgroup. (2013). On common ground for health: Our coordinated efforts to prevent and manage chronic disease in Missouri. Retrieved from http://health.mo.gov/living/healthcondiseases/chronic/pdf/OnCommonGround4Hlth.pdf

Expat Finland. (2015)Public healthcare and services in Finland.

Falvo, D. (2014). Medical and psychosocial aspects of chronic illness and disability (5th ed., pp. 9-32). N.p.: Jones and Bartlett Publishers. Retrieved October 3, 2015, from http://www.jblearning.com/samples/0763744611/4461_ch02_pass3.pdf

Fiandt, K. (2006) The chronic care model: Description and application for practice. Topics in Advanced Practice Nursing eJournal, 6, 4.

Global Alliance forChronic Disease. (2015) Alliance of Health Research Funders.


GROSSE-TEBBE, S. y FIGUERAS, J. (2005). Snapshots of health systems. European Observatory on Health Systems and Policies. Retrieved 3 October, 2015

HealthStatus. (2015). Middle age arthritis- when you least expect it. In HealthStatus. Retrieved October 3, 2015, from https://www.healthstatus.com/health_blog/back-shoulder-joint-pain/middle-age-arthritis-when-you-least-expect-it/

Hernández Tápanes, S. (2004). Medicina de Rehabilitación. Retrieved 1 October, 2015, from http://www.sld.cu/sitios/rehabilitacion/temas.php?idv=615

Improving Chronic Illness Care. (2015). The chronic care model. Retrieved from http://improvingchroniccare.org/

IRISS. (2015). Life after stroke: the long-term emotional and psychological needs of stroke survivors and their careers . Retrieved October 3, 2015, from http://www.iriss.org.uk/resources/life-after-stroke-long-term-emotional-and-psychological-needs-stroke-survivors-and-their-c

Kokko, S. (2009). Integrated primary health care: Finnish solutions and experiences. International Journal of Integrated Care, 86, 1-8.

Lee, T. H., & Berenson, R. A. (2008). The organization of healthcare delivery: A roadmap for accelerated improvement. In The health care delivery system: A blueprint for reform (Chapter 2). Retrieved from https://www.americanprogress.org/wp-content/uploads/issues/2008/10/pdf/health_delivery_ch2.pdf

Life Care Centers of America. (2015). Rehabilitation. Retrieved October 3, 2015, from http://lcca.com/rehabilitation/

Medline Plus. (2015) Coping with chronic illness. U.S. National Library of Medicine.

Ministerio de Sanidad (2012). Retrieved 1 October, 2015, from http://www.msssi.gob.es/organizacion/sns/docs/sns2012/SNS012__Espanol.pdf

Ministerio de Sanidad (2012). Retrieved 1 October, 2015, from http://www.msssi.gob.es/organizacion/sns/planCalidadSNS/pdf/ESTRATEGIA_ABORDAJE_CRONICIDAD.pdf

Ministerio de Sanidad (2013). Retrieved 1 October, 2015, from http://www.msssi.gob.es/profesionales/saludPublica/prevPromocion/docs/EstrategiaPromocionSaludyPrevencionSNS.pdf


Missouri Foundation for Health. (2015). Ongoing funding: Chronic Care. Retrieved from https://www.mffh.org/content/783/ongoing-funding.aspx

Molzahn, A., Shields, L., Bruce. A., Stajduhar, K., Schick, K., Beuthin, R., Shermak, S., (2012) People living with serious illness: Stories of spirituality. Journal of Clinical Nursing, 21 (2347-2356).

National Center for Chronic Disease Prevention and Health Promotion. (2009). The power of prevention: Chronic disease…the public health challenge of the 21st century. Retrieved from http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf

Paul, L., Weinert, C. (1999) Welness profline of midlife women with a chronic illness. Public Health Nursing 16(341-350).

Physicians for a National Health Program. (2010). Health care systems – Four basic models. Retrieved from www.pnhp.org/single_payer_resources/health_care_systems_four_basic_models.php

Shi, L., & Singh, D. (2005). Major characteristics of U.S. health care delivery. In Essentials of the U.S. health care system (Chapter 1). Retrieved from http://www.jblearning.com/samples/0763763802/63800_CH01_Final.pdf

Silow-Carroll, S., & Rodin, D. (2011). Health homes for the chronically ill: An opportunity for states. States in Action: Innovations in State Health Polity. Retrieved from http://www.commonwealthfund.org/publications/newsletters/states-in-action/2011/jan/december-2010-january-2011/feature/feature

UNC School of Medicine. (2015). Global partners in medical rehabilitation. In Department of Physical Medicine & Rehabilitation. Retrieved October 3, 2015, from https://www.med.unc.edu/phyrehab/local-global-outreach/global-partnership-in-medical-rehabilitation/global-partnerships-in-medical-rehabilitation

Who. (2004). WHO website. Retrieved 1 October, 2015, from http://www.who.int/disabilities/cbr/activities/es/

World Health Organization . (2011). World Report On Disability. Geneva, Switzerland: World Health Organization. Retrieved October 3, 2015, from file:///C:/Users/Emily/Downloads/9789240685215_eng.pdf

Documents

The Effects of Chronic Illness on Middle Aged Adults