Chronic illness can affect older adults’ mental health when it limits mobility and other activities, and/or is associated with depressed mood or pain. There are often costs associated with the management of chronic illnesses such as medications, non-medical treatments, special transportation and assistive devices. For seniors with lower incomes especially, this can increase their vulnerability to loneliness and social isolation.
Preventing and Managing Chronic Disease
Chronic diseases are long-term diseases that develop slowly over time, often progressing in severity, and can often be controlled, but rarely cured. They include conditions such as cardiovascular diseases (heart disease and stroke), cancer, diabetes, arthritis, back problems, asthma, and chronic depression. Chronic diseases may significantly impair everyday physical and mental functions and reduce one’s ability to perform activities of daily living.
Worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability. Non-communicable diseases now account for 59% of the world’s 57 million annual deaths, and 46% of the global burden of disease. The picture for Ontario is similar. In 2003, heart disease was the leading cause of death in the province – and myocardial infarction the largest single cause of death within heart disease – followed by cancers, stroke, and chronic obstructive pulmonary disease (COPD).
Chronic disease is most frequent among older Ontarians, since chronic diseases can take decades to develop. In 2003, almost 80% of those over the age of 45 or 3.7 million people were living with a chronic condition, including 34% with arthritis, 9% with diabetes, 30% with high blood pressure, and 12% with osteoporosis.
Chronically ill Ontarians are also likely to have more than one chronic disease. In 2003, 70 percent of chronically ill Ontarians over the age of 45 had multiple conditions. The high levels of co-morbidity reflect the fact that, untreated, a serious chronic condition tends to lead to additional conditions and other health problems. Ontarians with diabetes account, for example, for 32% of heart attacks, 43% of heart failures, 30% of strokes, 51% of new dialysis, and 70% of amputations in the province.
Statistics Canada estimates that major chronic diseases and injuries account for over 33% of direct health care costs. In Ontario, chronic diseases account for 55% of direct and indirect health costs, which includes years of healthy life lost from premature death and lost productivity from disability as well as direct health care costs. Moreover, Ontarians with multiple serious chronic conditions consume disproportionately more health care than others with chronic conditions.
Death rates, and in some cases, prevalence rates (diagnosed cases in the population), have been declining for some chronic diseases but increasing for others in recent years. A decline in death rates (crude rates, 1995 to 1999) has been seen for breast cancer (12%) and asthma (8%) while an increase has been seen for lung cancer (5%).5 The prevalence of cancers fell by (5%) in 2003 from 2001, but the prevalence increased for COPD (11%), arthritis (4%), and type 2 diabetes (7%) – mainly because people are living longer.6 Hospitalizations for cardiovascular diseases are predicted to continue to decrease and, while some risk factors for this group of diseases are falling (e.g., hypertension), others are rising (e.g., obesity, aging). The health care costs of diabetes and associated conditions are estimated to rise by as much as 48% over the next decade.