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Chronic Disease in Long Term Care

  • abissett22
  • Jul 24, 2022
  • 3 min read


About halfway through the Athabasca University course on Critical Foundations in Health Disciplines, we turned our attention to chronic disease prevention and management, which are essential for overall health and wellbeing. Before looking into the literature, I took a guess at which conditions would be most common in long term care. The first conditions that came to my mind were dementia, stroke, multiple sclerosis, Parkinson's Disease, and spinal cord injury.

My next step was to review the Alberta "Long-Term Care Resident Profile" to discover which chronic diseases are most prevalent in the population I serve. I found that the top three are dementia, hypertension, and arthritis (Government of Alberta, 2018). I was not surprised to learn that dementia was the most common condition, as the debilitating nature of dementia can be a common reason for admission to long term care. The data on hypertension and arthritis also seemed consistent with my experience, although these conditions had not been at the top of my mind. It was interesting to consider why these conditions had not immediately come to mind for me, despite their high rates in long term care. I realized that the conditions I thought of first tended to be neurological and are often seen as primary reasons for admission to care facilities. Hypertension and arthritis are often seen as comorbidities or secondary conditions, which may lead to health care providers underestimating their impact.

The next topics I examined were the primary determinants of each of these conditions, and the contributing factors that could lead to long term care admission, as summarized in the following table:

​

Dementia

Hypertension

Arthritis

Long Term Care in Alberta

59%

(Government of Alberta, 2018)

54%

(Government of Alberta, 2018)

36%

(Government of Alberta, 2018)

Primary Determinants of Disease

  • Low socioeconomic status

  • Low education

  • High BMI in mid-life with decreasing BMI in later life

  • Low food security

  • Neighbourhood with few physical resources

  • High levels of stress

  • Early life adversity

(Majoka & Schimming, 2021)

  • Low education

  • Low family income

  • High body weight

  • Psychological stress

  • Social stress

(Basharic et al, 2020)

  • Low education

  • Non-professional occupation

  • Neighbourhood level of poverty (Luong et al., 2012)

Factors Contributing to Long Term Care Admission

Admission to long term care can be triggered by advancing disease, safety concerns, and caregiver burnout (Alzheimer Society of Canada, 2016).

Hypertension increases risk of heart attack, heart failure, and stroke (CDC, 2021). These significant medical events can lead to long term care admission.

Symptoms such as joint pain and stiffness can lead to difficulty with independence in activities of daily living (Arthritis society, 2022).

Upon examination of the primary determinants of these conditions, common themes arise: socioeconomic status, education level, BMI, neighbourhood resources, and stress. There are also common themes in how these conditions can contribute to long term care admissions; advancing disease, significant medical events, and decreasing independence. These correlate with known determinants of long term care admission in general, which include advanced age, living alone, physical and cognitive limitations, assistance for instrumental activities of daily living, loss of a spouse, acute health events, chronic health conditions, education level, gender, and preceding hospitalizations (Branch & Jette, 1984, Garner et al., 2018, Hedinger et al, 2015).

Awareness of the relationships between chronic illness, long term care admissions, and social determinants of health can guide us as a society to develop strategies at multiple levels of intervention. We have the opportunity to take this knowledge and implement plans that will improve overall health and well-being of our population. These strategies can range from social changes outside of the health care field to public health initiatives to interventions for specific groups (such as long term care residents) to individual medical management and care plans.

References


Alzheimer Society of Canada (2016). Considering the move to a long-term care home. Long

Arthritis Society (2022). The truth about arthritis. https://arthritis.ca/about-arthritis/what-is

Basharic, F.Q., Janati, A., Pezeshki, M.Z., Khodayari-Zarnaq, R., Sadeghi-Gyhassi, F., &

Gholizadeh, M. (2020). Country-level interventions for the prevention and management of hypertension through the modification of social determinants of health: a systematic review protocol. Systematic Reviews. 152. https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-020-01392-9

Centers for Disease Control and Prevention (2021). High blood pressure symptoms and

Garner, R., Tanuseputro, P, Manuel, D.G., & Sanmartin, C. (2018). Transitions to long-term

and residential care among older Canadians. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/82-003-x/2018005/article/54966-eng.htm

Government of Alberta (2018). Long-term care resident profile.

Hedinger, D., Hämmig, O., Bopp, M. (2015). Social determinants of duration of last nursing

home stay at the end of life in Switzerland: a retrospective cohort study. BMC Geriatr 15, 114. https://doi.org/10.1186/s12877-015-0111-3

Luong, M.N., Cleveland, R.J., Nyrop, K.A. & Callaghan, L.F. (2012). Social determinants and

osteoarthritis outcomes. Aging Health. 8(4): 413-437. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3519433/

Majoka & Schimming (2021). Effect of social determinants of health on cognition and risk of

Alzheimers disease and related dementias. Clinical Therapeutics. 43(6), 922-929. https://pubmed.ncbi.nlm.nih.gov/34103175/



 
 
 

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