Explaining Diagnoses To Your Older Patient
Clear explanations of diagnoses are critical. Uncertainty about a health problem can be upsetting. When patients do not understand their medical conditions, they tend not to follow the treatment plans.
In explaining diagnoses, it is helpful to begin by finding out what the patient believes is wrong, what the patient thinks will happen, and how much more he or she wants to know. Based on the patient’s responses, you can correct any misconceptions and provide appropriate types of information.
What Is Considered A Chronic Illness
A chronic illness is a medical condition that develops over time and lasts over three months. When left untreated, acute ailments can become more serious and require more extensive care. Many chronic diseases can last for years and dont have a cure. However, at Nest Family Medicine, Dr. Priti Ranjan specializes in providing treatments to her patients in Plano, TX with chronic illness and disease.
As a board-certified family physician of over 20 years, she has the experience necessary to treat a variety of different medical conditions for patients of all ages. Whether a persistent infection, high blood pressure, diabetes, or other chronic illnesses, its important to seek chronic illness treatment regularly to manage your symptoms. We will perform a thorough health exam to re-confirm your diagnosis and to make treatment suggestions.
What Is Dementia Symptoms Types And Diagnosis
Dementia is the loss of cognitive functioning thinking, remembering, and reasoning to such an extent that it interferes with a person’s daily life and activities. Some people with dementia cannot control their emotions, and their personalities may change. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of living.
Dementia is more common as people grow older but it is not a normal part of aging. Many people live into their 90s and beyond without any signs of dementia.
There are several different forms of dementia, including Alzheimers disease. A persons symptoms can vary depending on the type.
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What Causes Parkinson Disease
Parkinson disease arises from decreased dopamine production in the brain. The absence of dopamine makes it hard for the brain to coordinate muscle movements. Low dopamine also contributes to mood and cognitive problems later in the course of the disease. Experts don’t know what triggers the development of Parkinson disease most of the time. Early onset Parkinson disease is often inherited and is the result of certain gene defects.
What To Do If A Loved One Is Suspicious Of Having Dementia
- Discuss with loved one.;Talk about seeing a medical provider about the observed changes soon. Talk about the issue of driving and always carrying an ID.
- Medical assessment.;Be with a provider that you are comfortable with. Ask about the Medicare Annual Wellness exam.
- Family Meeting.;Start planning, and gather documents like the Health Care Directive, Durable Power of Attorney for Health Care, Estate Plan.
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More Useful Links And Resources
Risk factors.Alzheimer Society of Canada, 2021. Read about risk factors for dementia in our downloadable, print-friendly infosheet. This sheet also contains strategies and lifestyle changes that can help you reduce your risk of developing dementia.
Understanding genetics and Alzheimer’s disease.Alzheimer Society of Canada, 2018.In our downloadable, print-friendly infosheet, learn more about the role that genetics plays as a risk factor for dementia, and find out whether you should pursue genetic testing.
Risk factors and prevention. Alzheimer’s Society UK. This comprehensive webpage from the Alzheimer’s Society UK has some helpful nuggets of research and advice related to reducing your risk of dementia.
Tobacco use and dementia. World Health Organization , 2014. This report from the WHO details the evidence behind smoking tobacco as a risk factor for dementia.
Women and Dementia: Understanding sex/gender differences in the brain. brainXchange, 2018. This webinar discusses understandings of sex and gender, sex differences in Alzheimerâs disease, how the higher number of women with Alzheimer’s may be due to both, and a discussion of the role of estrogen in the health of brain regions associated with Alzheimerâs disease. In partnership with the Alzheimer Society of Canada and the Canadian Consortium of Neurodegeneration in Aging .
Chronic Lung Diseases Including Copd Asthma Interstitial Lung Disease Cystic Fibrosis And Pulmonary Hypertension
Chronic lung diseases can make you more likely to get severely ill from COVID-19. These diseases may include:
- Asthma, if its moderate to severe
- Chronic obstructive pulmonary disease , including emphysema and chronic bronchitis
- Having damaged or scarred lung tissue such as interstitial lung disease
- Cystic fibrosis, with or without lung or other solid organ transplant
- Pulmonary hypertension
Get more information:
Having HIV can make you more likely to get severely ill from COVID-19.
Get more information:
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Common Forms Of Dementia
There are many different forms of dementia. Alzheimer’s disease is the most common form and may contribute to 6070% of cases. Other major forms include vascular dementia, dementia with Lewy bodies , and a group of diseases that contribute to frontotemporal dementia . The boundaries between different forms of dementia are indistinct and mixed forms often co-exist.
Chronic Kidney Disease Affects 18% Of Seniors
Chronic kidney disease causes a slow decline in kidney function over time. That causes an increased risk of heart disease or kidney failure.
Prevent CKD or reduce symptoms by:
- Reducing the risk of diabetes and high blood pressure or managing symptoms essential because these are the 2 biggest risk factors for kidney damage
- Staying current on screenings for early detection and treatment
- Taking prescriptions to reduce and manage symptoms
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Supporting Older Patients With Chronic Conditions
Approximately 85% of older adults have at least one chronic health condition, and 60% have at least two chronic conditions, according to the Centers for Disease Control and Prevention. For many older people, coping with multiple chronic conditions is a real challenge. Learning to manage a variety of treatments while maintaining quality of life can be problematic.
People with chronic conditions may have different needs, but they also share common challenges with other older adults, such as paying for care or navigating the complexities of the health care system.
Clinicians can play an important role in educating patients and families about chronic health conditions and can connect them with appropriate community resources and services.
Try to start by appreciating that people living with chronic disease are often living with loss the loss of physical function, independence, or general well-being. Empathize with patients who feel angry, sad, lost, or bewildered. Ask, “Is it hard for you to live with these problems?” From there you can refer patients to community resources that may meet their needs or, when available, recommend a disease management program or case managers in the community.
May Progress To Functional Impairment Or Disability
Chronic illness persists throughout your lifetime. There is no permanent cure. Over time, the illness and other symptoms related to it may lead to disability or an inability to complete daily activities.
Many diseases may be considered chronic or long term. However, they may not all cause disability or prevent you from completing your daily activities. These are among the most common chronic illnesses:
- chronic obstructive pulmonary disease
- chronic kidney disease
A chronic illness can be difficult on a daily basis. If someone in your life has been diagnosed with a long-term condition or chronic illness, these techniques may be helpful for you and your friend:
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Medical Conditions In Adults
- This list is presented in alphabetical order and not in order of risk.
- CDC completed an evidence review process;for each medical condition on this list to ensure they met criteria for inclusion on this webpage.
- We are learning more about COVID-19 every day, and this list may be updated as the science evolves.
Who Can Diagnose Dementia
Visiting a primary care doctor is often the first step for people who are experiencing changes in thinking, movement, or behavior. However, neurologists doctors who specialize in disorders of the brain and nervous system are often consulted to diagnose dementia. Geriatric psychiatrists, neuropsychologists, and geriatricians may also be able to diagnose dementia. Your doctor can help you find a specialist.
If a specialist cannot be found in your community, contact the nearest medical school neurology department for a referral. A medical school hospital also may have a dementia clinic that provides expert evaluation. You can also visit the Alzheimers Disease Research Centers directory to see if there is an NIA-funded center near you. These centers can help with obtaining a diagnosis and medical management of conditions.
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How Is Chronically Ill Legally Defined
Legal definitions are often different than everyday meaning. In the case of chronic illness, the legal definition may be used to determine eligibility for certain services.
Legally in the United States, someone who is chronically ill must fit these criteria to be considered eligible for certain services and care:
- Theyre unable to fulfill at least two activities of daily living for at least 90 days.
- They have a level of disability that is similar to the above criteria.
- They require substantial supervision and assistance in order to protect themselves against health and safety threats because of physical or cognitive impairment.
These definitions can be used to confirm a person is eligible for long-term care insurance, disability insurance, or other care. However, its important to note that individual companies, businesses, and even countries may have different definitions and criteria for long-term illness.
Depending on your illness, symptoms, and level of impairment, you may not qualify for some benefits and services when you initially apply or make a request. However, if your condition or the legal requirements change, it may be worth applying again.
Not every person with a chronic illness is recognized as disabled. In some cases, the impairments caused by the illness can reach the level of disability because the illness prevents you from fulfilling daily activities. In others, you may never have physical impairments severe enough to qualify for disability.
Characteristics Of A Chronic Illness
Chronic illnesses are mostly characterised by:
- complex causes
- long latency periods
- a long illness
- functional impairment or disability.
Most chronic illnesses do not fix themselves and are generally not cured completely. Some can be immediately life-threatening, such as heart disease and stroke. Others linger over time and need intensive management, such as diabetes. Most chronic illnesses persist throughout a persons life, but are not always the cause of death, such as arthritis.
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Let’s Discuss Living With
Mrs. Smoley has diabetes and heart disease. Although she takes her medicine as prescribed by the doctor, she has not been able to quit smoking. She recently was diagnosed with emphysema and needs oxygen. Dr. Nguyen suggests that Mrs. Smoley participate in a disease management program at a local hospital. “It could help you quit smoking,” the doctor explains. “And you might learn some tips about how to manage your day so that you have some more energy.”
Aluminum In Cookware And Other Products
It would be difficult to significantly reduce exposure to aluminum simply by avoiding the use of aluminum products such as pots and pans, foil and beverage cans.
That’s because the use of aluminum in these products only contributes to a very small percentage of the average person’s intake of aluminum. It’s important to remember that aluminum is an element found naturally in the environment and our bodies at levels that are normal and not harmful.
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Discussing Treatment With Your Older Patient
Some older patients may refuse treatment because they do not understand what it involves or how it will improve their health. In some cases, they may be frightened about side effects or have misinformation from friends and relatives with similar health problems. They may also be concerned about the cost of the treatment.
Treatment can involve lifestyle changes, such as diet and exercise, as well as medication. Make sure you develop and communicate treatment plans with the patient’s input and consent. Tell the patient what to expect from the treatment, including recommended lifestyle changes, what degree of improvement is realistic, and when he or she may start to feel better.
Keep medication plans as simple and straightforward as possible. For example, minimize the number of doses per day. Tailor the plan to the patient’s situation and lifestyle, and try to reduce disruption to the patient’s routine. Indicate the purpose of each medication. Make it clear which medications must be taken and on what schedule. It is helpful to say which drugs the patient should take only when having particular symptoms.
After proposing a treatment plan, check with the patient about its feasibility and acceptability. Work through what the patient feels may be obstacles to maintaining the plan. They may not be medical. For instance, transportation might be an issue.
Do not assume that all of your patients are able to read. Make sure the print is large enough for the patient to read.
Ways To Cope With Chronic Illness
There is a range of ways to deal with the stress of chronic illness. These include:;
- finding information this can help if you feel helpless or out of control
- emotional support from others particularly family and friends, this can be a source of great help
- joining a well facilitated support group
- setting concrete, short-term goals to restore certainty, power and control
- thinking about possible outcomes discussing them with the doctor can help you to face them before they become a reality.
The overall aim of these strategies is to help put your illness into context and give some meaning to what is happening.
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Chronic Conditions Affect Brain Function
As care improves, cognitive impairment is likely to be seen earlier in patients with coronary artery disease, diabetes, and HIV.
Community pharmacies are uniquely positioned to provide added value to both patients and the providers who refer them.
The renewed role of the pharmacist as an educational resource for patients can be invaluable in identifying patients who are at risk of or are beginning to suffer from cognitive decline. In this age of polypharmacy, pharmacists often have weekly or monthly interactions with these patients. Thus, pharmacists often have more data points from which to observe the cognition of these patients. Screening tools such as Cognivue Thrive, the first device that uses computer-assisted technology cleared by the FDA to identify cognitive decline before it progresses to mild cognitive impairment, allow pharmacists to identify cognitive challenges earlier than a provider who may see a patient less frequently.
Cardiovascular disease is associated with both degenerative and vascular dementia. Atherosclerosis-induced hypoperfusion of the brain, inflammation, and oxidative stress contribute to the neuropathology of Alzheimer disease .7
RICHARD WYNN, MD, is cofounder of Amity Medical Group in Charlotte, North Carolina, and is an adjunct professor in the Department of Family Medicine at the University of North Carolina at Chapel Hill.MANDY IRVIN, PHARMD, CPP, AAHIVP, is a clinical pharmacist practitioner for Amity Medical Group.
Children With A Chronic Illness
For children with a chronic illness, there are programs and opportunities for funding support attached to government, Catholic and independent sector schools. If your child has a chronic illness, speak to your school principal;for help developing a health support plan and applying for programs or funding support for your child.;
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Additional Demands Of Chronic Illness
As well as needing to find ways to deal with the stress involved with chronic illness, you also need to:;
- understand the condition
- know about the treatment and therapy
- maintain trust and confidence in the doctors, especially when recovery isnt possible
- know how to control the symptoms
- maintain social relationships and a strong support network when faced with an uncertain medical future or when symptoms arise
- avoid social isolation.
The Effects Of Alzheimers On The Brain
Damage to the brain begins years before symptoms appear. Abnormal protein deposits form plaques and tangles in the brain of someone with Alzheimers disease. Connections between cells are lost, and they begin to die. In advanced cases, the brain shows significant shrinkage.
Its impossible to diagnose Alzheimers with complete accuracy while a person is alive. The diagnosis can only be confirmed when the brain is examined under a microscope during an autopsy. However, specialists are able to make the correct diagnosis up to 90 percent of the time.
The symptoms of Alzheimers and dementia can overlap, but there can be some differences.
Both conditions can cause:
- behavioral changes
- difficulty speaking, swallowing, or walking in advanced stages of the disease
Some types of dementia will share some of these symptoms, but they include or exclude other symptoms that can help make a differential diagnosis. Lewy body dementia , for example, has many of the same later symptoms as Alzheimers. However, people with LBD but are more likely to experience initial symptoms such as visual hallucinations, difficulties with balance, and sleep disturbances.
People with dementia due to Parkinsons or Huntingtons disease are more likely to experience involuntary movement in the early stages of the disease.
Treatment for dementia will depend on the exact cause and type of dementia, but many treatments for dementia and Alzheimers will overlap.
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