• chronicity150x150

    By Barb Gunderson, School of Nursing Faculty

    Chronic disease is a growing health concern. What is chronic disease? According to the Center for Managing Chronic Disease, it is “a long-lasting condition that can be controlled but not cured” (2011, para. 1). Our health care system and nursing education seems to be more focused on acute care and interventions directed towards cure, however. 

    Nurses may prefer working in areas where they can see progress and see that they have made a difference. So there is a need to prepare nurses in the care of patients with chronic illness.

    Although chronic illnesses are very prevalent in society today, this has not always been the case. What makes this an issue today? It is because 133 million Americans—45% of the population—have at least one chronic disease (Center to Fight Chronic Disease, n.d.). Thus, a good number of the patients nurses care for today will have at least one chronic condition. Those people with chronic diseases represent those who frequently access the health care system. The numbers of persons with chronic conditions is increasing significantly, and thus the costs associated with that care is increasing as well. It is reported that 70% of health care dollars spent, 81% of hospital admits, 91% of medications prescribed, and 76% of physician office visits relate to chronic illness (Center to Fight Chronic Disease, n.d).

    Why is this happening? Chronic disease has traditionally been thought of “old age” disease. In the not too distant past, people died of acute conditions such as pneumonia and other infections, heart attacks, and emphysema soon after diagnosis. People did not live long enough to have chronic problems. But because of increased knowledge about disease, technology, medications, and an increased focus on prevention, life expectancies have dramatically increased. And our societal conditions today lead to the development of chronic conditions at an earlier age. People now live many years after a diagnosis of a chronic disease such as diabetes, cardiovascular disease, hypertension, chronic obstructive pulmonary disease, and kidney disease. Interventions are now focused on managing the condition, maintaining the quality of life, and minimizing limitations of the disease (palliative care).

    Other contributing factors in the rise of chronic disease are our environment and lifestyles. Our bodies are exposed to so many chemicals and pollutants, and toxins in our food, water, and air. In other cases, our diets are high in saturated fats and sodium. Our lives are now filled with modern conveniences that decrease the amount of physical activity we get. Sedentary lifestyles and poor nutrition have contributed to a rise in obesity which leads to chronic conditions such as hypertension, cardiovascular disease, and diabetes. The effects of substances such as tobacco products and alcohol lead to chronic lung and liver problems. All of these exposures increase the risk for the development of a chronic disease. These chronic conditions have a very slow progressive insidious onset and thus diagnosis may not be made until the disease has progressed significantly.

    Chronic disease puts a person at risk for a shortened life span.  And another challenge is that usually a person has more than one chronic diagnosis. Each chronic condition usually requires one or more prescription medications. Managing multiple chronic conditions is very complex. Multiple medications puts a person at risk for adverse drug reactions, geriatric syndromes, and impaired ability to perform activities of daily living.

    Nursing can play a big role in addressing this problem. Nurses need to be trained to care for patients with many co-morbid chronic conditions. Nurses need to be able to recognize inappropriate medication combinations and adverse drug reactions. Finally, nurses must be trained in preventive interventions. Educating and supporting people to make lifestyle changes that include healthy diets, increased physical activity, tobacco cessation, etc.  will go a long way to reduce the risk of chronic disease and improve the quality of life in old age. And this is not just a problem to be addressed by nursing. This will take an inter-professional approach of health care disciplines working together as a team with many health promoting approaches. 

    Barb Gunderson is a faculty member at Kaplan University. The views expressed in this article are solely those of the author and do not represent the view of Kaplan University. 


    Center for Managing Chronic Disease. (2011). What is chronic disease? Retrieved from: http://cmcd.sph.umich.edu/what-is-chronic-disease.html 

    Partnership to Fight Chronic Disease (n.d.). The growing crisis of chronic disease in the United States. Retrieved from: http://www.fightchronicdisease.org/sites/fightchronicdisease.org/files/docs/GrowingCrisisofChronicDiseaseintheUSfactsheet_81009.pdf 

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