Chronic Illness, Medication Management and Communication with Health Care Providers

Learning Objective
After completing this module, you will be able to:

1. Recognize healthy wellness habits
2. Recognize the signs and symptoms suggesting common chronic illnesses in older adults
3. Find assistive devices to support independence
4. Know effective communication techniques with physicians and other health care providers
5. Know techniques to manage medications

Index/Content of this Module 

In this module you will learn the importance of wellness habits, signs and symptoms of a range of illnesses, tips for managing medications and how to communicate effectively with doctors and other care providers.  

Click on a topic below to go to that area of the page: 

1  Wellness Is the Goal
2  Healthy Nutrition Practices and Wellness Habits
3  Raising Awareness – Not Giving Medical Advice
4  Age and Illness
5  Osteoporosis
6  Arthritis
7  Hypertension
9  Heart Attack and Angina
10 Diabetes
11 Dementia
12 Alzheimer’s Disease
13 Multi-Infarct Dementia
14 Depression
15 Delirium
16 Parkinson’s Disease
17 Managing Medications
18 Communicating with Health Care Providers
19 Resources for Caregivers
20 The Aspen Tree
21 Sources of Data  

Wellness is the Goal at All Ages – A Healthy Balance for You and Your Family Member

· Spiritual
Meaning in Life
· Financial
· Mental
Activities and hobbies
Continuing Education

Healthy Nutrition Practices and Wellness Habits

Support healthy nutrition practices by –

•  Learning about nutrition
•  Discussing the effect of medical conditions on one’s diet with physician and/or dietitian
•  Realizing that people over 70 may require smaller portions of all groups except more of the milk, yogurt and cheese group
•  Encouraging drinking 64 ounces of water each day
•  Encouraging eating fresh fruits and vegetables
•  Encouraging using meals that can be frozen or quickly heated
•  Arranging for Meals on Wheels or other community assistance, if eligible
•  Discussing vitamins and other supplements with the physician
•  Observing healthy nutrition habits yourself

Learn about the USDA 2012 dietary guidelines:       

One size doesn’t fit all

USDA’s new MyPyramid symbolizes a personalized approach to healthy eating and physical activity. The symbol has been designed to be simple. It has been developed to remind consumers to make healthy food choices and to be active every day. 

You can support wellness habits for yourself and for your care recipient:

   •  Become an active partner with the physician and other health care providers

   •  Encourage nutrition

   •  Encourage stretching and light exercise, if approved by physician and the person is able to participate.  Exercise increases physical and mental wellness.

Encourage physical activity at the individual’s capacity.

•  Walking

•  Exercise bicycle

•  Weight training using hand weights

•  Dancing

•  Stretching

•  Yoga or Tai Chi

Raising Awareness – NOT Giving Medical Advice

Experts suggest that education about the health issues of loved ones helps reduce the stress of caregiving.

The information in this module is intended to be general in nature, and should not be considered medical advice Contact your loved one’s doctor for help with diagnosing or treating a medical problem. This information is provided to:

•  Raise awareness of signs and symptoms of illness
•  Provide information about assistive devices
   •   Build and maintain a partnership with health care providers for health care advice and treatment
   •   Go to internet websites and to community organizations and advocacy groups to obtain general information about specific illnesses

Age and Illness

Being an older adult does not mean being ill!

   •  Aging does not cause disease nor does disease cause aging
   •  Dizziness, confusion, forgetfulness and incontinence are not normal aging, but usually signs of a disease process
   •  Even if someone has a disease, symptoms may be corrected or relieved

Some age-related conditions are normal and some are caused by disease processes:

   •  Normal Aging: Declining vision, hearing, touch, taste and smell
   •  Disease Processes: Dementia and Alzheimer’s disease, arthritis, hypertension, stroke, heart disease, diabetes, depression, osteoporosis, kidney and bladder problems, lung disease, prostate disease, cancer


Osteoporosis is a disease process causing bones to become more fragile and likely to break.  The disease often progresses painlessly and the first symptoms may be a broken bone, height loss or curvature of the spine.   Any bone can be affected but the hip and spine are frequent sites.

The National Osteoporosis Foundation web site is a good resource for information on this disease.

Here are some of the most common risk factors for osteoporosis:

    •  Greater risk with aging, which
    •  Tends to cause bones to weaken and lose density

    •  Four times more common in women than men
    •  One in three women and one in 12 men over the age of 50

Family History and Personal History of Fractures as an Adult:
    •  Women whose mothers have a history of vertebral fractures seem to have reduced bone mass
    •  Personal history of a fracture as an adult

    •  Caucasian and Asian women are more likely to develop osteoporosis
    •  African American and Hispanic women at significant risk

Bone structure and body weight:
    •  Small-boned and thin women (under 127 pounds)

    •  Cigarette smoking, alcohol abuse, consuming an inadequate amount of calcium or getting little or no weight-bearing exercise
    •  Medications
    •  Chronic Diseases (discuss with doctors)

Bone Mineral Density scan is a safe and painless test for osteoporosis.  It is recommended for all women age 65 and old and for younger women who have significant risk factors. The test is often reimbursable by Medicare or other insurance.

You can take some steps to prevent or reduce the impact of osteoporosis including having a healthy diet and getting regular weight-bearing exercise such as walking.

Discuss any possible treatments such as hormone replacement therapy or use of some of the newer drugs designed to reduce bone loss and increase bone density carefully with your doctor to be sure you fully understand risks and possible side effects of the treatment.


Arthritis is an inflammatory disease of the joints characterized by stiffness and difficulty moving joints through their full range of motion along with swelling or redness in affected areas.  There are over 100 different types of arthritis.

In the case of rheumatoid arthritis there may also be extreme fatigue, weight loss, deformed joints, and loss of appetite.

The website of the Arthritis Foundation is a good resource for information –

In Osteoarthritis the cartilage surrounding joints breaks down. The most common sites for osteoarthritis are knees and hips but the back and fingers can also be affected. People who overuse joints are at greater risk of developing osteoarthritis.

Rheumatoid arthritis is a disease of the tissue surrounding the joints. It can appear at any age, but is most commonly diagnosed among women between the ages of 20 and 50. Rheumatoid arthritis may call for more rigorous drug therapy than osteoarthritis and surgery may even be necessary.
Other types of arthritis include gout and ankylosing spondylitis.  Gout is caused by a buildup of uric acid crystals in the fluid that bathes the joint.  It usually affects the big toe and causes severe pain and swelling in the affected joint.  Ankylosing Spondylitis is a degeneration of the joints that support the spinal column.

Risk factors for arthritis include hormonal changes, age, gender, heredity, obesity, joint injuries and infection.

Often the symptoms of arthritis can be relieved by basic self-care practices.  Treatment options include:
•  Adequate rest
•  Stretching and daily range of motion exercises
•  Maintaining ideal weight
•  Taking aspirin and ibuprofen (e.g., Advil®, Motrin®)
•  Hot and cold treatments for minor discomfort
•  Over-the-counter preparations containing capsicum, camphor, or menthol
•  For more severe cases, corticosteroid injections to fight inflammation

Aspirin and ibuprofen cost just pennies a day Over-the-counter preparations containing capsaicin, camphor, or menthol may help relieve minor joint pain and stiffness For more severe cases, doctors may suggest corticosteroid injections to fight inflammation. In addition, research indicates that an intake of at least 386 units of vitamin D each day can keep knee osteoarthritis in check.

You should contact a doctor in these situations:

•  Pain is accompanied by fever
•  Sudden unexplained swelling, redness or pain in any joint
•  Pain is so great that use of the joint is lost
•  Cannot use the joint or it limits regular activities
•  If the problem does not improve after five to six weeks and home care is not working.

There are a wide range of assistive devices that can be helpful in living with arthritis.  There also are a number of websites that provide helpful information for dealing with arthritis.

Tools and Gadgets (Assistive Devices) for Independent Living

Here is a website worth checking out:

Hypertension (Blood Pressure above 140/90)

Elevated blood pressure may not produce obvious symptoms so can be easily missed without regular blood pressure checks.  If untreated, it is related to the development of arteriosclerosis and may cause stroke, heart attack, congestive heart failure and/or kidney failure.

Treatment approaches include medication, low salt diet, exercise, stress management and weight management.


It is important to recognize signs and symptoms of a stroke since prompt treatment can make a difference in level of recovery from the stroke.

Here are common signs and symptoms – sudden onset of:

   •  Numbness or weakness of face, arm or leg, especially on one side of the body
   •  Confusion, trouble speaking or understanding
   •  Trouble seeing in one or both eyes
   •  Trouble walking, dizziness, loss of balance or coordination
   •  Severe headache with no known cause
   •  Nausea, fever and vomiting distinguished from a viral illness by the speed of onset (minutes or hours vs. several days)
   • Brief loss of consciousness or period of decreased consciousness (fainting, confusion, convulsions or coma)
  • A transient ischemic attack (TIA) is a small stroke with symptoms that are less intense and of shorter duration than a full stroke.


   •  Physical therapy (PT) to restore physical functioning and skills like walking and range of movement
   •  Occupational therapy (OT) to relearn the skills needed for everyday living such as eating, toileting, dressing and taking care of oneself
   •  Speech/language therapy (ST)


   •  Encourage use of affected extremity to increase muscle strength
   •  Avoid doing things for him/her that he or she can do
   •  Be supportive and sympathetic but firm and direct
   •  Expect some emotional ups and downs
   •  May need to install hand rails by toilet, bed, etc

Stroke survivors, although able to think as well as before the stroke, may experience an interference in the use or understanding of language  The individual is unable to get the right words out or is unable to process words coming in.  This condition is called aphasia.

Here are some things you can do to help a person deal with aphasia:

   •  Be patient
   •  Allow the person time to understand and respond
   •  Use visual cues and gestures
   •  Use short, clear words
   •  Use visual aids
   •  Nod when understanding
   •  Allow person to write instead of speak.

Heart Attack  

These are the most common signs and symptoms of a heart attack:

   •  Discomfort in the center of the chest that lasts more than a few minutes
   •  Discomfort in other areas of the upper body in one or both arms, the back, neck, jaw or stomach
   •  Shortness of breath accompanied by chest discomfort or can occur before the chest discomfort
   •  Breaking out in a cold sweat, nausea or lightheadedness

If you believe someone is having a heart attack don’t delay – prompt treatment can help reduce the severity of the heart attack!

Call  9-1-1; Start CPR if individual stops breathing (only if qualified)
American Heart Association

The risk of dying from a heart attack is higher for women than men.  As with men, women’s most common heart attack symptom is chest pain or discomfort.  Women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

The Red Dress was designed to build awareness that women are at risk; give a sense of hope that women can reduce their risk and empower them to do so; and provide a clear call to action coupled with a sense of urgency.

Angina is mild to severe chest pain which may radiate to the neck or shoulders, lasting less than three minutes. It is caused by some obstruction in a major blood vessel of the heart (arteriosclerosis).  Angina can be brought on by exertion, cold, eating a heavy meal or excitement.
Management strategies for angina include losing weight, stopping smoking and managing stress.

A nitroglycerin tablet is placed under the tongue and allowed to dissolve to treat an angina attack.   This response normally works in ½ to 3 minutes.


Diabetes is caused when the body is unable to make use of sugars and starches.  Glucose accumulates in the blood and may appear in the urine.  Diabetes is expected to increase as much as 165% over the next 50 years, especially among those age 75 and older.

Signs and symptoms of diabetes include:

     •  Frequent urination
     •  Excessive thirst
     •  Extreme hunger
     •  Unusual weight loss
     •  Increased fatigue
     •  Irritability
     •  Blurry vision
     •  Itching
     •  Poor wound healing.

Stress such as infection or surgery may worsen symptoms.  Diabetes requires a lifelong focus on diet, lifestyle, and medical monitoring.  Diabetics should wear a bracelet or necklace to alert responders to the condition.

Treatment strategies for diabetes include:

    •  Balanced diet
    •  Controlled amounts of sugar and starch
    •  Weight management
    •  Exercise
    •  Insulin injections
    •  Oral medications
    •  Good skin care, especially for the feet
    •  Daily blood sugar monitoring.


Dementia is not a specific illness but a syndrome or group of symptoms.  It causes memory problems that affect everyday life.  Dementia has a gradual onset and get progressively worse. 4 million Americans have dementia.

It is estimated that 5% of people over age 65 and 20% of those over 85 have some form of dementia.  Alzheimer’s disease accounts for 60% of all cases of dementia with 15-20% caused by strokes (cerebrovascular dementia) and 15-20% resulting from other neuro-psychological disorders, i.e. Parkinson’s disease and Huntington’s disease.

There are many types of dementia. While everyone who has Alzheimer’s disease has dementia, not everyone who has dementia has Alzheimer’s disease.

The only definite diagnosis for Alzheimer’s disease is finding plaques and tangles in the brain during autopsy after death.

Diagnosis of dementia or Alzheimer’s is based on a range of tests:

   ·  A complete medical history includes information about the person’s general health, past medical problems, and any difficulties the person has carrying out daily activities.

   ·  Medical tests – such as tests of blood, urine, or spinal fluid – help the doctor find other possible diseases causing the symptoms.

  ·  Neuropsychological tests measure memory, problem solving, attention, counting, and language.

   ·  Brain scans allow the doctor to look at a picture of the brain to see if anything does not look normal.

Alzheimer’s Disease

Alzheimer’s disease is an illness of the brain that causes nerve cells in the brain to die.  It results in disrupted memory, thinking and functioning.  There is a somewhat greater risk for people with a family history of the disease.  Race or ethnicity does not seem to be a factor.

Here are the ten warning signs of Alzheimer’s disease:

   •  Memory loss
   •  Difficulty performing familiar tasks
   •  Problems with language
   •  Disorientation to  time and place
   •  Poor or decreased judgment
   •  Problems with abstract thinking
   •  Misplacing things
   •  Changes in mood or behavior
   •  Changes in personality
   •  Loss of initiative

There are three stages of Alzheimer’s disease:

Mild –

•  Often looks and acts normal
•  Short-term memory fades making it difficult to learn new things
•  Speech becomes slightly impaired
•  Hygiene can be neglected and judgment hindered
•  Minor personality changes
•  Emotional response unpredictable and exaggerated
“Sundown Syndrome” of late afternoon or early evening may include agitation, confusion, or restlessness can occur at this stage or in the next (moderate) stage

Moderate –

•  Memory impairment is obvious
•  Short term memory vanishes and stories and actions are likely to be repeated over and over again
•  Individual needs supervision as complex tasks become overwhelming and decision-making is impaired
•  Sleep cycles are disrupted
•  Poor coordination, agitation, wandering and pacing may emerge Contact local Alzheimer’s Associations about their Safe Return Program
•  Behavior problems are more frequent with exaggerated moods, hostility and aggression

Severe –

•  Person needs help in basic activities of daily living, such as bathing, eating and toileting
•  Fragments of memory remain
•  Troublesome behaviors are less prevalent
•  Individuals suffer acute confusion, hallucination, delusions, paranoia, physical rigidity and/or seizures

Multi-Infarct Dementia

Multi-infarct dementia results from repeated strokes that destroy small areas of the brain.  It can lead to dementia, Alzheimer’s disease, other strokes, migraine-like headaches and disturbances of coordination and speech. Symptoms depend on the area of the brain that is affected. Individuals may improve for short periods of time but then decline again.

With multi-infarct dementia, damage is noticeable as a series of small steps:

   •  confusion
   •  problems with recent memory
   •  wandering or getting lost in familiar places
   •  loss of bladder or bowel control (incontinence)
   •  emotional problems such as laughing or crying inappropriately
   •  difficulty following instructions, and problems handling money

Multi-infarct dementia generally begins between the ages of 60 and 75 and affects men more often than women.  Early treatment and blood pressure management may prevent further progression.


Depression is often misdiagnosed in older adults as dementia but is very different in that it is highly treatable.  As many as 65% of older adults may experience depression.  Depression is a pattern of several symptoms that occur most of the time and nearly every day for several weeks.

Symptoms include:

•  Depressed mood
•  Feelings of worthlessness, hopelessness, helplessness, inappropriate guilt
•  Changes in eating habits; and a significant weight loss or gain
•  Changes in sleeping habits and sleeping too much or too little
•  Decreased energy or increased fatigue
•  Inability to concentrate or make decisions
•  Memory loss, confusion, and disorientation
•  Irritability, short-temperedness
•  Persistent sadness or anxiety
•  Lack of attention to physical appearance
•  Concern with physical problems Chronic aches or pains that cannot be diagnosed as physical disorders
•  Loss of pleasure in daily activities; withdrawal from formerly pleasurable activities and relationships
•  Increased dependence on family
•  Unexplained crying
•  Suicidal thoughts

Older adults may not realize or even may deny that they are depressed and often do not seek treatment.

There are many possible causes of depression. Some common causes for older adults include:

•  Stress and loss
•  Physical Illness
•  Medications
•  Substance abuse of alcohol, prescription and non-prescription drugs
•  Lack of physical activity
•  Lack of emotional and social outlets
•  Poor stress management tools
•  History of a major depression
•  Family history of depression

It is important to not just assume that depression is normal as people grow older but to seek treatment.

Get help! Talk to a physician:
•  Ask about possible side effects of medications
•  Talk about changes in how the person is feeling and changes in usual behavior and routines
•  Ask about a referral to a mental health professional who understands older adults
•  Most importantly, seek treatment promptly

Medications prescribed by physician:
•  Seratonin uptake inhibitors (SSRIs): Zoloft, Paxil and other anti-depressants

•  Contact 2-1-1, the Mental Health Association or local Mental Health Mental Retardation (MHMR) Center
•  Use company employee assistance programs (EAP)
•  Find support systems from friends, family and the community.


Delirium is a disorder that causes confusion, disorientation and memory loss. It differs from dementia in that it occurs suddenly. The key difference between dementia and delirium is that delirium is caused by an acute condition and is usually reversible.

Symptoms of delirium occur rapidly – not over time as with dementia – and include:

•  Change in level of consciousness
•  Lack of alertness or drowsiness
•  Difficulty with attention
•  May be agitated and have hallucinations
•  Risk increases for those who have dementia, are dehydrated, and/or are taking drugs that affect the nervous system

Parkinson’s Disease

Parkinson’s disease is caused by degeneration or damage of nerve cells located at the top of the brain stem. Over 1 million people in the US suffer from Parkinson’s with 50,000 new cases diagnosed annually. Parkinson’s can affect adults as young as age 40. There is no cure but symptoms can be treated with medication. Surgery may reduce tremors and rigidity.

Here are the signs and symptoms of Parkinson’s disease:

•  In early stages, a slight tremor of one hand, arm or leg
•  Tremor worsens when the limb is at rest or when the person experiences emotional stress
•  Older adults may experience muscle stiffness
•  In later stages, difficulty getting out of a chair, turning, or performing tasks, i.e. buttoning clothes
•  In later stages, difficulty walking and speaking

Managing Medications

Hints to Aid in Handling Medication

Medication Schedule and Check Off

Remembering to take medications can be a problem for older adults.  There are some things you can do to help your care recipient remember their medications:

•  Explain why it is necessary to take the medication
•  Place larger, more legible labels on bottles
•  Make sure a readable clock is visible
•  Tips from other caregivers:
•  Draw a large clock and put color codes on it, if necessary
•  Create a chart and check-off system
•  Use a color coding system to distinguish different medications and different medication times
•  Post reminders and/or place medicines in visible locations

Understanding the abbreviations for medication timing can also be a problem.  Here are the some common medication abbreviations:

BID 2 times per day
TID 3 times per day
QID 4 times per day
HS hour of sleep

Partner with a pharmacist to learn more about medications and their side effects.

Use a commercial drug divider to portion out medications for each day or each medication time. Think ahead and have refills approved and filled before medications are gone. Check expiration dates periodically and throw out old medications.

The goal with drug therapy can be summarize as “The Five Rights”:

the right drug for
the right patient in
the right dose by
the right route at
the right time.

Communicating with Health Care Providers

Planning ahead for doctor visits can help you be organized and thoughtful about what questions you might want to ask.

Checklist/Worksheet – Communicating with the Doctor and Health Care Providers

Here are some pointers for visits to the doctor:

•  Accompany him/her to doctors’ appointments, at least occasionally
•  Plan what to ask
•  Bring medications to appointments 
•  Write questions down
•  Tell the doctor about other physicians and health care
•  Be clear about what you want to say to the doctor; avoid rambling
•  Don’t hesitate to ask questions; expect clear answers
•  Let your family member talk when asked questions, adding information as needed.

Here are some more tips for partnering with medical providers:

•  Make a consultation appointment with the doctor if you have several questions and concerns
•  Learn the routine of the doctor’s office
•  Get to know the nurse and office staff
•  Ask if you can contact the nurse directly with questions
•  Find out if the physician will see patients in a nursing facility
•  Find out how the doctor feels about end of life issues

Effective communication with health care providers is extremely important.  Here are some guidelines from the Communicating with Health Care Professionals training of  National Family Caregivers Association:

1.  Show respect and expect respect
2.  Breathe deeply
3.  Make eye contact
4.  Stay in the moment
5.  Establish rapport
6.  Maintain a strong sense of self
7.  Be prepared
8.  Clearly state your purpose
9.  Stay focused on the current problems, issues, treatments, and follow-up
10.  Offer relevant Information
11.  Ask questions
12.  Be assertive

Resources for Caregivers

•  2-1-1 throughout Texas. Provides information and access to health and human service information for all ages
•  1-800-252-9240 to find local Texas Area Agency on Aging
•  1-800-677-1116 – Elder Care Locator to find help throughout the U.S.


•  Benefits Check-up for an online way to determine benefits for which someone qualifies.

To schedule a caregiver presentation for your church, business, library, civic group, or other organization call your local area agency on aging or contact us

Assistance available through the Area Agency on Aging for caregivers:
•  Information and referral
•  Caregiver education and training
•  Caregiver respite
•  Caregiver support coordination
•  Case management
•  Transportation assistance 

Assistance available through the Area Agency on Aging for persons age 60 and older:
•  Benefits counseling
•  Ombudsman – advocacy for those who live in nursing homes and assisted living facilities
•  Home delivered meals
•  Congregate meals
•  Light housekeeping

Note:  Not all services are available in all counties. Call the Area Agency on Aging for information about a specific community.

The Aspen Tree ©   

We chose the aspen tree to represent family caregivers and older adults who need care.  Aspen trees appear to be individuals. In reality, they are one organism sharing the same far-reaching root system  These interconnected roots give the aspen resilience, strength and beauty, often in the harsh conditions of winter at high elevations. Like aspen trees, family caregivers, their aging family members, health and human service providers, and the community are all connected.

Just because you care does not mean you have to care alone.

Written by:  Zanda Hilger, M. Ed., LPC, Family Caregiver Education, Area Agency on Aging, Revised 2013.

Includes materials adapted from As People Grow Older, Jane Oderberg and Sue Smith, 1995 and as cited in the materials