Wellness and Chronic Illness

As a caregiver you may find yourself in the position of having to help your care receiver deal with medical issues such as chronic illness, medication management, and talking with doctors and other health care providers. Below we review the importance of healthy wellness habits, common chronic illnesses, and some of the resources available to caregivers. 

While experts recommend educating yourself about the health issues of loved ones to reduce the stress of caregiving the information on this website 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.

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Wellness is the Goal – at all ages

Wellness is a life-long goal. Creating a healthy balance for you and your care recipient includes much more than just being physically fit. 

  • Physical Fitness – Nutrition, exercise, adequate sleep, medical care
  • Spiritual – Finding meaning in life, contentment
  • Financial – Security, independence, flexibility
  • Mental – Activities and hobbies, problem-solving, continuing education

Healthy Nutrition Practices and Wellness Habits

You can 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

Check out the latest USDA dietary guidelines here:  https://www.dietaryguidelines.gov/


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

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

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.

Common risk factors for osteoporosis:
Age:
    •  Greater risk with aging, which
    •  Tends to cause bones to weaken and lose density

Gender:
    •  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

Race:
    •  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)

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

A 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

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.  The website of the Arthritis Foundation is a good resource for information, visit: arthritis.org.

There are over 100 different types of arthritis, including: 

  • Osteoarthritis is a condition where 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 (RA) is a disease of the tissue surrounding the joints. With RA there may also be extreme fatigue, weight loss, deformed joints, and loss of appetite.
    • 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.
  • 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 may also help relieve minor joint pain and stiffness. 
  • For more severe cases, corticosteroid injections to fight inflammation

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. Check out our blog on this topic: Tools & Gadgets (Assistive Devices) For Independent Living

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.

Stroke
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.

Common signs and symptoms:

  • 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.

Rehabilitation can include:

  • 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) to relearn the mechanics of speaking

Lifestyle changes – post stroke:

  • 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

Aphasia:

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  

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.

Common signs and symptoms:

  • 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.

Consider performing CPR if the individual stops breathing but do not attempt CPR if you are not trained as internal injuries or rib and sternum fractures are common and can cause even more harm! Visit the American Heart Association to learn more about CPR. 

Angina:

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

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. According to data from the American Diabetes Association in 2018, Diabetes is expected to increase as much as 165% over the next 50 years, especially among those age 75 and older. 

  • Prevalence: In 2018, 34.2 million Americans, or 10.5% of the population, had diabetes.
  • Undiagnosed: Of the 34.2 million adults with diabetes, 26.8 million were diagnosed, and 7.3 million were undiagnosed.
  • Prevalence in seniors: The percentage of Americans age 65 and older remains high, at 26.8%, or 14.3 million seniors (diagnosed and undiagnosed).
  • New cases: 1.5 million Americans are diagnosed with diabetes every year.
  • Pre-diabetes: In 2015, 88 million Americans age 18 and older had pre-diabetes.

Signs and symptoms of diabetes include:

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

Infection, surgery, or emotional/mental stress may worsen symptoms. Diabetes requires a lifelong focus on diet, lifestyle, and medical monitoring. People with diabetes should consider wearing a bracelet or necklace to alert responders to the condition.

Current treatment strategies for diabetes are evolving but may include:

  • Eating a healthy diet and controlling the amount of sugar and starch eaten
  • Weight management and eExercise
  • Insulin injections or oral medication
  • Good skin care, especially for the feet
  • Daily blood sugar monitoring.

Dementia

Dementia is not a specific illness but a syndrome or group of symptoms which causes memory problems affecting everyday life. Dementia has a gradual onset and get progressively worse. The burden of Alzheimer’s disease and related dementias in 2014 was 5 million people, which is 1.6 percent of the U.S. population in 2014—319 million people. This burden is projected to grow to 13.9 million, nearly 3.3 percent of the population in 2060–417 million people.

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.

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. 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. 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. To learn more visit The Alzheimer’s Association’s website.

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.

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

  1. Memory loss 
  2. Difficulty performing familiar tasks
  3. Problems with language
  4. Disorientation to  time and place
  5. Poor or decreased judgment
  6. Problems with abstract thinking
  7. Misplacing things
  8. Changes in mood or behavior
  9. Changes in personality
  10. Loss of initiative

There are three main 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

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 may 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.

Common causes for depression in older adults:

  • 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

Get help!

It is important to not assume depression is normal as people grow older, but to seek treatment. Talk to their physician about changes in how the person is feeling as well as changes in usual behavior and routines. If appropriate, ask about a referral to a mental health professional who understands older adults. Medications commonly prescribed by physicians include Seratonin Uptake Inhibitors (SSRIs): Zoloft, Paxil and other anti-depressants. Remember to ask about possible side effects. 

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

Most importantly, seek treatment promptly. 

Delirium

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 may include:

  • Change in level of consciousness
  • Lack of alertness or drowsiness
  • Difficulty with attention
  • Agitation and 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. Nearly one million are living with Parkinson’s disease (PD) and approximately 60,000 Americans are diagnosed with PD each year. Incidence of Parkinson’s disease increases with age, but an estimated four percent of people with PD are diagnosed before age 50.
Men are 1.5 times more likely to have Parkinson’s disease than women. There is no cure but symptoms can be treated with medication. Surgery may reduce tremors and rigidity. To learn more visit the Parkinson’s Foundation website

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

Resources for Caregivers

Visit our Resource Directory for a comprehensive and searchable list of organizations and agencies which provide services for both care givers and receivers.

•  2-1-1 throughout Texas. Provides information and access to health and human service information for all ages
•  Health and Human Services Commission: 1-800-252-9240 to find your local Texas Area Agency on Aging
•  Elder Care Locator 1-800-677-1116  a public service of the U.S. Administration on Aging connecting you to services for older adults and their families.
•  Benefits Check-up – an online way to determine benefits for which someone qualifies.

Assistance available through the Area Agency on Aging for caregivers:
•  Information and referral
•  Benefits Counseling
•  Caregiver respite

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

References:
Written by:  Zanda Hilger, M. Ed., LPC, Family Caregiver Education, Area Agency on Aging, Revised 2021
Includes materials adapted from As People Grow Older, Jane Oderberg and Sue Smith, 1995 and as cited in the materials