By: Meredith Brunk, MS, OTR/L, CDP

Director of Occupational Therapy Clinical Services

The statistics are startling—80% of adults 65 and older have at least one chronic disease condition. The costs are steep. It’s estimated that 86% of America’s 4 trillion dollars in healthcare costs are attributed to chronic disease. The good news is that often, chronic conditions can be well managed so that these adults can continue living a full, meaningful, active life. Additionally, physical, occupational, and speech therapists are well-positioned to impact both patient outcomes and costs. Rehab therapy professionals can work with the patient and ensure that prescribed medical and lifestyle changes are implemented in an individualized way to ensure that the results are long-lasting.

The National Council on Aging indicates the following as the top 10 chronic diseases that people over the age of 65 experience chronic obstructive pulmonary disease (COPD), Alzheimer’s disease and dementia, depression, heart failure, chronic kidney disease (CKD), diabetes, ischemic heart disease (or coronary heart disease), arthritis, high cholesterol, and hypertension (high blood pressure).

Research shows that focusing on a few main health strategies will significantly impact every disease process to prevent progression and support wellness. These strategies include:

  • Exercising daily – including cardio exercise, strengthening, and stretching
  • Getting enough sleep – 7-9 hours daily
  • Keeping stress levels in check – avoiding stressful situations, doing purposeful activities, staying engaged socially with friends and family
  • Maintaining medical recommendations – following medication regimen and staying up to date on appointments and vaccines
  • Eating healthy – avoiding excess alcohol, minimizing trans fats and sugars, consuming foods rich in nutrients

Putting the Strategies to Practice

The strategies sound simple, but let’s put them in a scenario. Consider a typical 80-year-old—we will call her “Linda”—who has been diagnosed with diabetes. Linda sees her physician for a checkup and receives a list of prescribed recommendations: taking medication, checking blood sugar levels daily, exercising, and limiting carbohydrate intake. Linda may have been trained once by a nurse on how to check blood sugar levels and what those levels mean but has otherwise been left to follow the commendations on her own.

Linda wants to take care of herself but has limited nutritional literacy and currently lives in an independent living community with little control over what meals are being served.  Linda also has poor vision and some memory deficits, which make it difficult for her to organize her medications, remember when to check her blood sugar levels, and read her glucometer when she does check her blood sugar. Finally, she has a history of a sedentary lifestyle with limited interest in “exercising.”  Linda is very likely to have difficulty following the recommendations and may end up with repeated visits to the ER due to uncontrolled diabetes.

What’s the answer to this scenario? How can the gap between education and lifestyle behavior changes be bridged for a typical older adult like Linda, to improve her outcomes while also reducing overall healthcare costs? 

How Legacy Can Help

Although education is important, it usually takes more than that to impact behavior among the older adult population, given the complexities they are facing. Legacy’s therapists specialize in working with older adults and are skilled at assessing each patient’s routines, motivators, skills, cognition, and environments—all of which influence whether chronic condition management recommendations may be followed by the patient.

Legacy therapists also collaborate closely with other health practitioners (such as physicians, pharmacists, nursing, registered dieticians, and social workers) to maximize the outcomes for each patient. Working within that patient’s apartment during one-on-one treatments, therapists can actively identify challenges and create individualized solutions to ensure self-management carryover. In the case of Linda, a therapist’s intervention might focus on the following:

  • Train Linda on the use of individualized adaptations such as a daily alarm for reminders, improved lighting and magnification, and a talking glucometer to support her ability to manage medications and blood sugar levels effectively. 
  • Introduce Linda to the independent living facility’s pool since she reported enjoying swimming when she was younger.   Then, create a swimming routine that is interesting and feasible for Linda, making sure that she is able and motivated to follow her swimming routine.  Also, identify and schedule some additional activities that Linda enjoys, such as walking with friends, to incorporate into her weekly exercise routine.
  • Coordinate with a registered dietician for a comprehensive recommendation of foods to consume and avoid.   Collaborate with dining staff to receive menus ahead of time.  Assist Linda with understanding how to read the menus and select items from the menu that would support healthier diet choices based on the diet her dietician recommended.

Therapists are an essential solution to bridge this gap in chronic disease management.  Let’s work together to ensure that older adults receive this necessary and individualized care so that they can effectively manage conditions and continue living lives full of purpose, safety, and dignity.

References:

Grady, P. A., & Gough, L. L. (2014). Self-management: a comprehensive approach to management of chronic conditions. American journal of public health, 104(8), e25–e31. https://doi.org/10.2105/AJPH.2014.302041

Holman H. R. (2020). The Relation of the Chronic Disease Epidemic to the Health Care Crisis. ACR open rheumatology, 2(3), 167–173. https://doi.org/10.1002/acr2.11114

The Top 10 Most Common Chronic Diseases. (n.d.) National Council on Aging.  https://www.ncoa.org/article/the-top-10-most-common-chronic-conditions-in-older-adults

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