Chronic Conditions and Medical Complexity
You have surely noticed in your professional practice that we are seeing more and more people developing and being diagnosed with chronic conditions and illnesses. The incidence of chronic diseases and the related disabilities is expected to rise, especially as the “Baby Boomers” (more than 37 million people in this age group within the US) turned 65 in 2011. 1 Older adults are at high risk for developing chronic illnesses and related disabilities. As these older adults age and the diseases progress, the medical complexity increases, requiring focused and patient-centered care that includes therapy interventions, prevention and health promotion and wellness strategies.
The Centers for Medicare and Medicaid Services report that “…more than two-thirds, or 21.4 million beneficiaries, had at least two or more chronic conditions… and 14% [have] 6 or more chronic conditions.” 2 Additionally, it is projected that levels of obesity will be at 41 percent by 2015 bringing with it the sequelae of conditions.3 As a clinician, working with this population can be challenging, and it may be difficult to determine the focus areas. Following these tips can help ensure that these older adults receive everything they need for all of their conditions:
- Examine and evaluate all involved systems (cardiac, pulmonary, etc.).
- Ensure full understanding of the existing diseases and conditions (etiology, pathophysiology).
- Determine the impairments that need to be addressed.
- Take care to address aerobic capacity as indicated.
- Select the correct objective Tests and Measures to best assess and monitor change.
- Consider the use of a Rating of Perceived Exertion scale.
- Establish a baseline and use guidelines to determine appropriate treatment intensity levels.
- Educate patients about their diseases, “red flags” to look out for and self management.
- Set goals specific to the individual.
Once you have the impairments selected and all baselines from the tests and measures compiled, it will be easier to see where the deficits are (compare to norms/physician guidelines) and to determine the exact areas to address. Working closely with the therapy team (PT, OT, SLP) to make sure all needs are met and not duplicated is essential.
Before discharge from skilled care, ensure all assessments and recommendations are clearly documented and communicated and that any needed follow-up care and referrals are established. All older adults, especially those with chronic conditions, benefit from continued exercise and activity after skilled treatment. Formal establishment of an exercise plan combined with a thorough hand-off and teaching of those who will continue the care is critical. Following these suggestions will help produce optimal results from treatment and therapy.
Mary Moretti, DPT, PT, is RehabCare’s Director of Clinical Operations and supports the development of clinical programming, protocols and evidence-based practice across all of RehabCare’s clinical settings. Mary also oversees Smart Moves, RehabCare’s wellness program.
1. American Hospital Association; First Consulting Group. When I’m 64: How boomers will change health care. Chicago: American Hospital Association; 2007. 23 p.
2. Centers for Medicare and Medicaid Services. Chronic Conditions among Medicare Beneficiaries, Chartbook, 2012 Edition. Baltimore, MD. 2012. Retrieved at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf on October 16, 2013.
3. Wang Y, Beydoun MA. The obesity epidemic in the United States—Gender, age, socioeconomic, racial/ethnic, and geographic characteristics: A systematic review and meta-regression analysis. Epidemiologic Reviews. 2007;29:6–28. Available at PubMed: 17510091