![]() The stability of the condition over time is also an important determinant of overall health burden.īelow we summarize the spectrum of chronic diseases as early, moderate, and late stage. Age of onset may also influence complications and burden for example, older onset rheumatoid arthritis is associated with more shoulder involvement and symptoms of polymyalgia rheumatica and less frequent hand deformities compared with younger onset disease (Turkcapar et al., 2006). For example, some illnesses (e.g., diabetes) have high self-management requirements, whereas others (e.g., Alzheimer’s disease) may require substantial care from others. Table 2-1 displays selected patterns of chronic illnesses along important dimensions. This results in disparate patterns of human suffering across the spectrum of chronic illnesses. Similarly, the health burden in terms of symptoms and functional impairment, requirements for self-management, effects on significant others, and individual economic impact vary. Other chronic diseases, such as treated breast or prostate cancers, may follow a quiescent pattern for many years. Some specific conditions have typical time courses for clinical progression. Chronic diseases can vary in multiple ways, including their stage at presentation and characteristic clinical symptoms and their natural history (time course). Although some (e.g., polymyalgia rheumatica, depression) may resolve, most are lifelong diseases. The National Center for Health Statistics has defined chronic diseases as those that persist for 3 months or longer or belong to a group of conditions that are considered chronic (e.g., diabetes), regardless of when they began. We then discuss the effects of these illnesses on the ability to live well with them. In this section, we first consider the nature of chronic diseases, including their similarities and differences. THE SPECTRUM OF CHRONIC ILLNESSES: DIFFERENCES IN TIME COURSE/CHRONICITY, HEALTH BURDEN, AND CONSEQUENCES This chapter explores the differences and similarities among many chronic diseases,Ĭonsiders several exemplar diseases, health conditions, and impairments in more detail, and examines the people living with these illnesses and the ways in which they are affected. They are similar in that their effects on health and individual functioning share common pathways and outcomes. ![]() They are disparate in that they affect different organ systems and are frequently characterized by different time courses and the severity of disease burden. There is, in fact, a spectrum of chronic diseases that are in some ways quite disparate, yet they share certain commonalities that merit their being listed together. In many people with chronic illnesses, a mild impairment in any single one of these aspects of health leads to impairments in other aspects and may progress further to disability. These include problems with physical health (e.g., distressing symptoms, physical functional impairment), mental health (e.g., emotional distress, depression, anxiety), or social health (e.g., social functional impairment), all of which are associated with lower quality of life (Cella et al., 2010). Chronic illnesses often cause bothersome health problems for those affected and/or those around them, problems that persist over time. The quality of life impact of these chronic illnesses is not as widely appreciated in public health, clinical practice, or health policy planning. There are many other chronic illnesses, however, that may or may not directly cause death but may have multiple effects on quality of life. Cardiovascular disease, many cancers, stroke, and chronic lung disease are the most common causes of death in the United States (Mokdad et al., 2004 Thacker et al., 2006). Some chronic diseases are well known as “causes” of mortality.
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