What chronic diseases are relevant to my practice?
All chronic diseases are relevant to home and community care. Multimorbidity occurs when a person has two or more chronic conditions. The primary focus of home care services is to aide individuals in managing chronic conditions, assist in recovery, support disabled individuals, relieve palliative patients with the overall goal to maintain and support positive health outcomes of the individual (Health Quality Ontario, 2013). According to the Health Council of Canada multimorbidity is common among home care clients with diabetes (26.4%), Alzheimer disease/dementia (22.7%), stroke (18.4%), chronic obstructive pulmonary disease (COPD) (17.2%), cancer (13.7%), heart failure (12.9%), and psychiatric diseases (12.7%) the most prevalent (2012).
How Does Home Care Handle Chronic Disease?
Bronskill et al., (2011) evaluation of vulnerable cohorts in Ontario found that community dwelling older adults with dementia are at higher risk for hospitalization compared to those without the disease and are more susceptible to visit emergency departments for potentially preventable conditions. This resource states that 91% of community-dwelling older adults in Ontario that are diagnosed with dementia have at least two coexisting chronic conditions. This resource also identifies various tools such as Method for Assigning Priority Levels (MAPLe), Activities of Daily Living (ADL) Hierarchy Scale and Instrumental Activities of Daily Living (IADL) Involvement Scale which all can be used to assess older adults using home care services and provide them with the tools they need to avoid hospital stays or LTC admission. These are some of the tools health care professionals utilize in order to first assess clients level of needs and then assist and implement the best suitable care plan to support the individual manage their own care in the home. Specific to my role in home and community care it is part of our protocol to use the implement the InterRAI Home Care Assessment System (HC) to best measures a clients needs and assess those living with chronic conditions and/ or those discharged from hospital or awaiting LTC.
Rates of Chronic Disease In Home Care in Ontario
Most of the older population 65+ live in the community (Statistics Canada,2016). Dementia, stroke, diabetes, COPD/Asthma, CHF. UTI, psychiatric issues, factures other than hip, hip fractures, cancer and renal failure are all chronic conditions that are responsible for the need of home care and LTC admission in Ontario. Diabetes is the most common chronic condition among older Ontarian’s, though my focus is specific to older adults living in the community with dementia as those living with the disease are likely to have experienced more than one chronic condition displayed in the figure below.
Dementia and Home Care
The World Health Organization (WHO), considers dementia as a chronic disease and emphasizes the importance of early diagnosis, home-based support/care, individual, family and caregiver involvement in self-management such as; learning about the disease and how to cope, risk management, and utilization of available resources(2019). Dementia deteriorates cognitive function effecting memory, thinking, orientation, comprehension, calculation, learning capacity, language, and judgement furthermore overtime effecting ones ability to complete activities of daily living (WHO, 2019). Those living with dementia often have more than two other chronic conditions and are less likely to be able to self-manage them (Ibrahim,2017, Snowden et al., 2017).
Ibrahim et al.,(2017) identifies diagnosis of dementia as a risk factor for older adults already living with other chronic illnesses. This study supports the importance of diagnosis dementia specifically for those with pre-existing conditions to help optimize self-management strategies. “patients with dementia require individually tailored strategies that accommodate and adjust to the individual and the cognitive domains that are impaired, to optimize their capacity for self-management (Ibrahim et al., 2017, p.49).”
Dementia results from a variety of diseases and conditions that negatively impact the brain including stroke, vascular disease, lewy body, frontotemporal dementia and most commonly Alzheimer’s Disease (WHO,2019, Public Health Agency of Canada , 2019). Dementia is a major chornic disease that is a challenge for all Canadians. The Alzheimer's Society (2019) has found the following statistics on dementia in Canada:
Family caregivers spent approximately 231 million hours on informal care, this number is expected to reach almost 756 million hours by 2038.
Increase in Canadians over the age of 65 living at home with dementia is expected to rise from 55% to 62% by 2038, increasing the burden on home and community-based services.
There are 1.1 million Canadians affected directly or indirectly by the disease
The annual cost to Canadians to care for those living with dementia is $10.4 billion
These facts highlight the importance of early diagnosis of dementia and the need for strong primary health care and home care to support individuals living with dementia cope and continue to age in their own home. The health care system is responsible for promoting healthy behvaiours to prevent or delay the onset of dementia. However, as a substantial portion of the population is already living with dementia the health care system needs to ensure appropriate policies, structures and resources are in place and available to those living with chronic diseases such as dementia. Home care has a significant impact on supporting individuals, families and communities impacted by dementia.
This resource was created to engage policy makers, home care leaders and researchers to create discourse and ideas to promote home care as a tool for chronic disease management within the community. This presentation supports that by providing appropriate services, like home care, in the early diagnosis stage can lead to better health outcomes and management of care overtime.
This figure adapted from Goldhar et al.,( 2014) supports that there is a continuum of care that must be followed to properly assist individuals to age within their homes for as long as possible, but also have plans in place to navigate within the healthcare system if need be. Many older adults avoid putting their names on LTC lists or avoid requesting home care services as they don’t predict that they will require such services. As a result, many older adults end up putting themselves at a higher risk for developing multiple chronic conditions as they often end up caring for a loved or spouse.
References
Alzheimer's Society Canada. (2019, March 07). Dementia numbers in Canada. Retrieved June 27, 2019, from https://alzheimer.ca/en/Home/About-dementia/What-is-dementia/Dementia-numbers
Bronskill, S., Camacho, X., Gruneir, A., & Ho, M. M. (2011, November). Health System Use by Frail Ontario Seniors. Retrieved June 26, 2019, from https://www.ices.on.ca/Publications/Atlases-and-Reports/2011/Health-System-Use
Goldhar, J., Daub, S., Dhalla, I., Ellison, P., Purbhoo, D., & Sinha, S. (2014). Integrated Client Care for Frail Older Adults in the Community: Preliminary Report on a System-Wide Approach. Healthcare Quarterly, 17(3), 61-69. doi:10.12927/hcq.2014.24022
Health Council of Canada. Seniors in need, caregivers in distress: what are the home care priorities for seniors in Canada? (April,2012) Toronto, ON: 64 p. ISBN 978-1-926961-38-5]. Available from: http://www.healthcouncilcanada.ca/tree/HCC_HomeCare_FA.pdf .
Health Quality Ontario (2013). In-home care for optimizing chronic disease management in the community: an evidence-based analysis. Ontario health technology assessment series, 13(5), 1–65.
Home Care Knowledge Network. (2013, June 19). Dementia/Alzheimer’s Managing the Care of Individuals with Dementia/Alzheimer’s Disease in the Home Care Setting. Better Care for People Living with Chronic Disease. Retrieved June 26, 2019, from http://www.cdnhomecare.ca/media.php?mid=3481
Ibrahim, J. E., Anderson, L. J., MacPhail, A., Lovell, J. J., Davis, M. C., & Winbolt, M. (2017). Chronic disease self-management support for persons with dementia, in a clinical setting. Journal of multidisciplinary healthcare, 10, 49–58. doi:10.2147/JMDH.S121626
Public Health Agency of Canada. (2019, June 17). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/diseases/dementia.html
Snowden, M. B., Steinman, L. E., Bryant, L. L., Cherrier, M. M., Greenlund, K. J., Leith, K. H., … Fitzpatrick, A. L. (2017). Dementia and co-occurring chronic conditions: a systematic literature review to identify what is known and where are the gaps in the evidence. International journal of geriatric psychiatry, 32(4), 357–371. doi:10.1002/gps.4652
Statistics Canada. (2016, July 28). Research Highlights on Health and Aging. Retrieved June 26, 2019, from https://www150.statcan.gc.ca/n1/pub/11-631-x/11-631-x2016001-eng.htm
World Health Organization. (2019, May). Dementia. Retrieved June 26, 2019, from https://www.who.int/news-room/fact-sheets/detail/dementia
Comentários