The Role of Chronic Ilnesses in Socially Active Aging Adults

R o l e o f C h r o n i c I l l n e s s P a g e | 1

Running Head: ROLE OF ILLNESS AMONG AGING ADULTS

The Role of Chronic Illness Among SociallyActive Aging Adults Benjamin A. Lerario West Chester University of Pennsylvania


Abstract

This review of research is to identify the chronic illness conditions effecting

socially active aging adults. Chronic illness conditions include: mental state, physical

health and environmental conditions. Research was taken from journals and academic

articles that pertained to chronic illness effecting adults as well as preventive care.

Significance in level of health in those adults that kept active did not have trouble with

chronic illnesses. Research suggest that all aging adults suffer chronic illnesses at

different levels and ages. Preventive care, use of medicine,and use of technology can


help aging adults maintain activity even though they may have a chronic illness or

disability.

Introduction

The Role of Chronic Illnesses Among Socially Active Aging Adults

The purpose of this review of research paper is


to review the increasing role of

chronic illness conditions effecting socially active aging adults and intervening variables

that promote well-being. Adults who are trying to maintain daily social activity are

facing positive and negative consequences concerning the level of physical ability among

aging adults. Chronic illness conditions include: mental state, physical health and

environmental conditions. Older adults have many different levels of ability according to

age and health status. For instance a female adult 60-years-old may have mobility issues from the

effects of osteoporosis but a male adult 80-years old can walk 1/4 of a mile a day just

because he had maintained a healthy lifestyle as a younger person. Present statistics from

the government show problems with physical functioning were more frequent at older

ages. Among men 65-74 % were reported they were unable to perform at least one of

five daily activities compared with 40 % of men aged 85 and over. (p. 5) Among women

19% of those 65-74 were unable to perform at least one


activity, compared with

53% of those over 85% and over. (p.5) Positive consequenceof socially active adults

may concern those older adults 60 years or older who have a good health status and have

maintained a healthy lifestyle throughout their life; they would have no problems with

mobility, mental & physical health, or isolations issues which would keep them from-

-maintaining a healthy lifestyle. In 2009 , about 41% of people age 65 and over enrolled

in Medicare reported a functional limitation. (p. 6) Twelve percent had difficulty


performing one or more instrumental activities of daily living but had no activity of daily

living limitation. (p.6) Approximately 25% had difficulty with at least one ADL

and 4% in a facility. (Aging Statistics, 2012) Negative consequence of socially active

aging adults concern those older adults, 60 years or older with chronic health issues who

may not be able to achieve a healthy level of social activity as the result of health status.

Another condition facing older adults is level of mental health. Things like neuroticism,

loneliness, and dementia are some mental health issues facing many older adults.

According the world health organization 2013, 6.6% of older adult populace suffer with

neuropsychiatry disorders. Social isolation is another majorcondition facing those older

adults who have no relatives, spouses or friends to talk to;social isolation can lead to Chronic Illnesses

loneliness, depression and anxiety among older adults livingin nursing homes, hospitals,

and private settings. The level of cognitive decline is a chronic illness condition that


arises when older adults lack ability to be socially active.

One and a half-million adults over the age of 60suffer with Alzheimer's disease

which contributes to cognitive decline; symptoms include word finding, judgment and

vision impairments. (National Institute on Aging, 2013) Mobility is another chronic

illness condition which effects the ability of an older adult to maintain social activity and

can be leaving behind many older adults who may need to socialize more. Frailty

conditions include osteoporosis, inflammatory conditions like arthritis, chronic back pain,

fatigue, chronic pneumonia, and paralysis. There are countless chronic illnesses that

effect the abilities for an older adult to maintain a healthy lifestyle. In a statistical survey

issued by the federal government, the leading cause of deathfor older Americans ages 65

to 85 are heart disease, cancer, stroke, lower respiratory disease, pneumonia, diabetes and

Alzheimer’s disease. The statistical survey stated that chronic illnesses effected the their

quality of life. (Aging statistics, 2012) In another statistical survey, 84% of older adults


ages 65-85 are more likely to have one or more chronic illness.

These chronic conditions can reduce the chance of mobility for an adult to stay

active and healthy. Osteoporosis is a disease that can mainly affect the ability of an older

adult to stay active. Risks of being active with osteoporosis include fractures, fall risks

and all frailty in bones structure. (Nyman et al., 2007) Cardiovascular disease is another

condition facing older adults and the risk of being active with cardiovascular disease are

heart attack, stroke, and even death. (Berry et al., 2012) Inflammatory disease is disease

Chronic Illnesses

which constant pain is produced in the upper arms, knees, neck and joints.

(Beavers et al., 2011) Chronic back pain can cause sleep deprivation and mobility

difficulty. (Rudy,Lieber, Slaboda, & Boston, 2007) Respiratory illness can cause asthma

and lung cancer in which many aging adults could not be active as a result.

(Garantziotis & Schwartz, 2012) One statistic indicated that frailty is common in 32% of


older adults in their 90s and 16% of older people at the ages of 65-75. (p. 269) The

effects of aging like frailty and dementia later in life are inked to smoking, obesity, and

lack of physical activity ( p.347 ) This research implied that social interaction is not for

everybody who is aging, in fact for many frail individuals it is harder to socialize than

other adults. Frailty in aging adults seems to affect only those individuals

who did not take care of themselves at an earlier age and those who allowed their bodies

to become overweight, smokers and those who were non athletic people.

This may be upsetting news to those aging adults who were not able to stay active

early due to an unhealthy lifestyle before they age. (Sampson, 2012) One report on a self-

view of health by, Jahn & Cukrowicz (2012), noted as merely psychological and those

who felt healthy enough to do daily activity also reported that they felt healthy rather then

those who were functionally impaired reported to have depression and a negative view of

health. (p.281) So being active socially does have a great


impact on one’s psychological

health and readily effects the individual both positively and negatively. In the same study researchers linked depression to motivation for self-care

which contributed to the general maintenance of keeping a healthy lifestyle. (p.281) The

study was also noted for having a broad range of participants from age, race, gender and Cognitive Decline

marital status and this study was designed to help diagnose depression for adults living in

a nursing home environment. Another known chronic condition among aging adults, Jahn

& Cukrowicz, talks about in their research in known as cognitive decline and is a

condition in which older adults lose their ability to communicate, speak, maintain

intelligence and awareness. Chronic conditions like cognitive decline can really impair

the process of social activity for aging adults and keeps them isolated from

communicating socially.

Cognitive decline is a chronic condition that effects aging adults and can impact


their daily social activities. Two common diseases linked tocognitive decline are

Parkinson’s and Alzheimer symptoms and they can have a negative effect on the abilities

of older adults when they are trying to keep a socially active lifestyle. As a person get's

older there are many conditions effecting the ability to maintain a healthy level of social

activity. When aging happens throughout a human being development there can be more

of a chance of developing an impairment like cognitive decline. Older adults may have

trouble with areas of the brain where we communicate language abilities. One example of

this relates to an article from the encyclopedia of the human brain (2002) stated that,

older adults may have difficulty in recruiting cortical resources for processing novel

pseudo-linguistic stimuli.” Many other conditions which are linked to cognitive decline

can also be a psychological conditions such as loneliness, depression and anxiety. Loneliness can have an important role concerning the physical and psychological

abilities of older adults to maintain social activity and itis linked to many negative


implications such as poor subjective health, hearing impairments, and lung disease.

Loneliness

(p.336) Loneliness has a greater impact on older adults suffering from various diseases

for instance, the risk of Alzheimer’s disease is doubled in those who reported loneliness

when compared to those who were not lonely. (p. 336) We might ask how does a

condition like loneliness effect the ability of older adultsto maintain a healthy lifestyle?

In a study by, R.I.B Schnittger et. al. (2012), indicates that functional

incapacitation may influence an individual’s ability to maintain and develop new social

relationships and may also affect the desire to engage in outside activity due to insecurity

over ailment or fear of injury. (P. 347) Loneliness can alsocause mobility problems

and it is a chronic condition in which older adults can become shut-inns as a

result. (Schnittger et. al. , 2011) The ability to maintain a social network is an

important key for social activity for an older adult and many adults that do not have the


capacities to maintain a social network loneliness happens. When there aren't any social networks available to older adults when those

adults cannot interact socially their health seems to decline. According to Schnittger et.

al. ,(2011) , the environment aging adults lived in was a predictor of loneliness as well

as the social support networks that were available effected the health in many of the

subjects. The fact that loneliness affects the physical health of older adults who do not

interact explains that being social has a major role in staying physically active.

Neuroticism is another chronic condition which concerns manyolder adults who suffer

with this disorder and can be very debilitating. Older adults experience increasingly

frequent reminders of mortality due to their own declining health and the deaths of

friends and family members. (p. 149)

Neuroticism & Depression

The role of neuroticism in terror management processes, this personality trait has

also been associated with poorer perceived health among


older adults ; it was therefore

hypothesized that neuroticism would be related to older individuals' subjective life

expectancy estimates and responses to increased awareness ofmortality.

(Maxfield et al. 2010) Neuroticism can immobilize older adults and can render them

helpless, insecure and debilitated. Stress is a great inducer of neuroticism and those adults

dealing with high stress will eventually suffer of a form ofdepression. In a statistical

study in 2008 proportion of people ranging from 65 and over were clinically relative

symptoms of depression was higher for people age 85 and over(18%) than for people in

any younger groups (12-15%) .

Depression and anxiety has a high mortality rate with older adults and linked to

functional impairment which is measured through the ability to perform instrumental

activity of daily life which includes taking medication, handle finance, and doing house

work. (p. 281) Those reported with a functional impairment more severe depressive

symptoms and those with greater impairment reported having a


negative view of their

health; contrastingly the good news is that those adults with substantial functioning

reported, were less likely to experience severe depression .(p.283) Those adults who had

self-rated health reports may diminish or intensify with the effects of functional

impairment with depression. ( Jahn, & Cukrowicz 2011)

According to a team of researchers, Luanaigh et al. (2012), the psycho-pathology of

older adults implies those suffering from the effects of social isolation include the

symptom of depression, neuroticism, anxiety and stress.

Social Isolation

Another condition of social isolation among olderadults is relationships and

learning how to depend on them to help each other to maintain a social support network.

Women in one particular study lived in a nursing home environment and were have

said to be suffering from a negative psychological effect of self-competence; which was

continuously eroded by decreasing mental and physical skillsand the loss of meaningful


relationships. Clarie Brodie (1990), mentioned that the study of the institutionalized

women living in a nursing home was to explore feelings and provide emotional catharsis

in a population stereotyped largely by hopeless affect andlack of meaning in their lives.

(p579) The health status of the women who were studied varied from cognitive ability,

hearing impairments and confusion. Clarie Brodie (1990), as a therapist, took a stance on

her treatment which was geared towards a “feminist” orientation which was designed to

boost the women’s morale and connect them socially.

Because the women had been removed from family relationships for varying

lengths of time the process of creating new, meaningful social networking through the

group was a slow one. Clarie Brodie (1990) had to help develop a trust factor which she

continuously prodded them to keep the group's morale.Clarie Brodie (1990)was there as a

therapist to facilitate meaningful intra-group communication. Although it took the

women several weeks they began to mesh well together. (P.582) As the group


progressed so did social interaction between them, Brody, noted in the research that they

were told to hold each other’s hands as a way of getting over things that they thought

they didn't like about each other as a symbol of connectedness. (p. 582 ) She utilized

memory skills that the group of women could obtain like remembering each other’s

Social Isolation

names, recalling old memories and remembering pets. (p.584)

This type of therapy treatment helped cognition and help gain some independent

socializing that lasted beyond the therapy. Although this therapy wasn't a cure-all it did

however strengthen friendships and gave hope to those bound to a life in a nursing home

in which many women are rendered helpless from disability. (Brody, 1990) Another

therapist, Julie McLaughlin-Gray, helped older adults gain independence with her study

named, "Well older Study". The program was to help older adults alter their approach to

everyday activity such as shopping, exercise and grooming inorder to maximize


function, productivity and vitality. (p.1) The social control group went on community

outings, worked on crafts, viewed films, played games which were conducted without

supervision and which emphasized diversion and social interaction only. (p.2) No

activities were conducted for the non-treatment control group. The findings indicate the

seniors who received occupational therapy experienced more gains and fewer declines in

many important health related areas of their lives.(p.2) Senior’s showed a 14% advantage

over their control group counter parts in a positive change over a range of measure,

including better physical and mental health, greater vitality , higher quality social

interaction, greater life satisfaction fewer role model limitation and less bodily pain.

Occupational therapy was used in this study as an attempt for a new approach to

help prevent disease and maintain health in general public. ( p.1) A researcher in the

study, Professor Clark, noted in the article stated that what we do every day over a

lifetime, has powerful effects on our health and eventually determines whether we could


live alone in old age or whether we become dependent. (p.2) Professor Clark also states

Social Isolation

that keeping the body engaged in an active lifestyle is healthy and it is important to keep

your mental capacity health by playing cards or reading. One woman in the study had a

fear of falling off of her bus the therapist invented an activity she could do at home, the

bus step. After a while the therapist went along with the woman and she began to be

relieved from depression. (Anderson, 1997) With disabilities like Alzheimer’s,

cognitive disorders, dementia and frailty it is not uncommonfor an aging adult not to be

able to socialize. One of the negative effects on socializing is frailty with aging adults and

health risks. Frailty keeps some aging adults from socializing by the symptom of

physical pain issues and the threat of falling or collapsing while maintaining social

activity.

In an editorial one research statistic indicatedthat frailty is common in 32% of


older adults in their 90s and 16% of older people at the ages of 65-75. (p. 269) The

effects of aging like frailty and dementia which can happen later in life are linked to

smoking, obesity, and lack of physical activity ( Sampson, 2012 ) In Clarie Brodie’s

research she examined the role of relationships among womenwho were unable to be

socially active and how she changed their lives by encouraging social interaction by

boosting morale. This review of Clarie Brodie’s research revealed that aging adults need

common interaction and reassurance which contributes to their physical abilities to

maintain an active lifestyle .

Older adults who cannot maintain an active lifestyle will most likely need a form

of a relationship to keep active and safe. A study from Osaka University, Japan, stated

that the national institute of population and social security research has predicted that

Role in Relationships

elderly people living alone will increase 15.1% in the next 10 year. (p. 112) The results of

the study in Japan noted that in his t-test sample of 720


males (54%) and 613 females

(46%) elderly people living with families and 23 males (12%)169 female (88%) elderly

living alone indicated that elderly living alone were older and in worse economic

condition than elderly living with families. (p.115) Nakahara also noted that elderly

people living alone have little family roles and positive role identity, which need to have

some interactions with their family members. In order to maintain their subjective well –

being at the level of elderly living with family as previous study showed they may have

to acquires social roles outside and positive role identities through contact with non-

family members outside their homes. (p.113) Nakahara’s research explains that elderly

adults benefit from not only their role in families but non-family as well and improves

their health by contributing something from who they are as a role model.

Nakahara (2013) explains what older adults gain more independence by being

social outside of their familial environment however many adult still suffer


psychologically and financially from being alone. (Nakahara2013) A major condition

facing aging adults is the risk due to inactivity in capableadults. Not only does an older

adults face the effects of loneliness they also face effectsof inactivity. The conditions of

inactivity include obesity, cardiovascular disease, respiratory, immune deficiency and

frailty.

In a study of community living disabled adults who could not officially maintain

mobility and an keep an active lifestyle; they were confinedto a sedentary life maintained

an undesirable lifestyle including unhealthy diet, physical inactivity and obesity.

Lifestyle

(p. 444) Prevalence of disability 14.6 % and as the disability increased the participants

with unhealthy diet physical inactivity and obesity became more prevalent. (p. 440) The

study also indicated that the adults needed preventative services like screening and

medical checkups were less likely to receive the medical treatment as a result of

disability and mobility issues. Inactive adults are more


at risk to get infection -related

complications, cancer and cardiovascular disease. (p 440) The researcher indicated that

the disabledadults did not take advantage of the health services as result of lifestyle.

(p.441) Risk factors for inactive and disabled adults included diet of fast food or

inadequate fruit and vegetables and smoking which contributed to their mortality rates.

(Kim, Sagar, Adams & Whellan 2009 ) There are innumerable conditions that are

blocking the road to healthy and active lifestyle among older adults and it appears that

conditions will get worse if an adult had not maintained a healthy life as they aged.

Unfortunately , there are limited ways for disabled adults to maintain a healthy and active

lifestyle if they had not done so before. However in another study which noted that adults who performed a high level of

physical activity reduced the likelihood of mortality and reduced the development of

limitation in functioning. The group of researchers from the physical activity of adults


with various risk factors, indicated that those who were older athlete continued physical

training had lean body mass, bone density, muscle strength and work capacity.

(p.1443) Endurance and strength training studies of sedentary older adults demonstrated

that regular exercise can improve work capacity, strength and flexibility. (p1443) A

Lifestyle

relationship between physical activity and physical impairment has been found in

healthy elderly people aged 70-74 who were inactive experienced 1.5 times the rate of

disability over 2 years of person who reported regular exercise or walked 1 mile (p.1446)

The research also found that “slowing down” of activity among non-disabled persons 65

years of age and older predicted incident disability over 15months. (p. 1447) This report

implied once you have been active for a longer period of time it is not good to stop or

slow down because there is a great risk of disability that may happen as a result of

Inactivity and more vigorous activity increase protection from impairment and disability.


(Simonsick et al. , 1991) Physical activity and past lifestyles may determine the future

projection of health in many aging adults.

Unhealthy habits like smoking, drugs, alcohol use can greatly affect the future

health of an individual. Smoking for one instance can contribute to many chronic

illnesses such as lung cancer, respiratory illness, and other health related issues.

According to a journal article smoking, body mass index, andexercise patterns in mid-

late adulthood are predictors of subsequent disability. The study also noted that adults

with a lower health risks tend to live longer than those with higher health risks. (p.1035)

An unhealthy lifestyle in this study was considered a healthrisk and when comparing

body mass index, smoking and exercise those who had poor lifestyles seem to have

chances of future disability Preventative measures to reduce an unhealthy lifestyle may

help with reducing long term disability. By diet and exercise and reducing certain

pleasures like smoking or drink one might be able to maintain a healthy lifestyle and


reduce the risk of chronic illness.

Lifestyle

Smoking attributes to chronic health conditions in aging adults and can reduce the

chance of social activity and increase the chance of disability. Preventative measures to

stop smoking and promote exercise habits can increase socialactivity and longer health

among aging adults. Contrastingly, recent studies indicated that the role of

socioeconomic status , a higher educational labels and thosewho engage in aerobic

exercise have substantially better health. (Vita, Terry, Hubert & Fries, 2003) Another

unhealthy habit that contributes to chronic illness is the irresponsible use of alcohol and

drugs.

Alcohol consumption and drugs can affect the longterm health of aging adults.

Alcohol consumption contributes to many forms illnesses suchas liver disease, cancer,

blood pressure, stroke and cardiovascular disease. 54% of Americans partake in binge


drinking at least once a week are alcohol dependent. It hasbeen estimated that by 2020,

the number of substance dependence and abusing adults age 50and older will have

grown to 4.4 million from 1.7 million in 2001. (p.1) In the relation between binge

drinking and psychological distress among older adults, the study discussed that binge

drinking may have been related to psychological stress amongolder adults.

(Bryant & Kim, 2013) Psychological Stress in a major impairment among aging adults

which can lead to many bad lifestyle decision such as binge drinking and alcohol

and these bad habits can decrease the social activity among aging adults. The use of

alcohol has risen as a result of psychological distress which reflects the conditions of

many aging adults and their choice of lifestyle. Many these type of chronic illnesses need

Preventative Care

preventive care to help aging adults to achieve and active lifestyle again. If not mortality

will increase as reduce the chance at living longer. There are preventative measures that


can help those aging adults with chronic illnesses that effect their physical health,

psychological health and well-being. Preventive measure mayinclude the use of present

technologies, proper use of medical care and medicines, and the use of different type of

companionships and social groups. Since there are no immediate cures for chronic

illnesses and the need for aging adults to maintain a healthy and active lifestyle the

use of medical technologies are very important tool in beingmobile.

The use of medical walkers, canes and wheel chairs canincrease mobility and help an

aging adult stay active socially in spite of a chronic illness. Frail adults Have trouble

with falling down. Falls contribute to the negative perception of aging adults, reducing

self-confidence, physical activity and independence . Walkercan help improve

ambulation and reduce the risk of falls. Honeyman and colleagues (1996) reported that

the use of a wheeled walker resulted in a significant increase in 6 minute walking

distance, a significant reduction in hypoxemia with walking,


And a significant reduction

in breathlessness, during a walk test. (p. 7) Walkers can improve the quality of life in

those disabled adults with severe impairments by reducing disability an breathlessness.

As result of the test of wheeled walker, auxiliary crutches,and standard walkers reduced

use of oxygen for breathlessness in severely disabled adults. (Anderson, et al. 2007)

Disabled adults can also benefit from social activity by having a pet companion. Many

adults have pets for a companion when there are no social networks available to them.

The therapeutic use of animals has increased in recent yearsas different Professional and

Companionship

volunteer groups increasingly incorporate animals into therapy. In one study which included residents were given scores on how they felt after a

dog visited them in their home, mostly all participants mentioned that they enjoyed the

dog visit and would have another visit in the future. (Phelps et al 2008) Although pets


were used in this study to reveal the effects of pets on mood, the research implied that

animals effects well-being of aging adults. Proper use of medication and preventive

measures of non-adherence can also improve the quality of life in socially active aging

adults. Older Adults are the biggest users of prescription medications and in advancing

age many aging adults are vulnerable to adverse reaction tomedication they are taken.

Approximately 30% of hospital admissions of older adults aredrug related, with more

than 11% attributed to medication non-adherence and 10%- 17%related to adverse drug

reactions. (p. 1) Ages 66-74 have been found more adherent to medication regimens than

middle age adults but after 74 , older adults present decreased comprehension of

medication instruction and adherence. ( Doman & Antle , 2008) In this study the quality

of life improve in those adults who were actually able to take their medication on time.


Case Study Consider, Mr. Roth, whom had a kidney remove in 2006 and chose a method of

peritoneal dialysis. Mr. Roth had to perform this dialysis four times a day in order to

maintain social activity as an aging adult. Mr. Roth has towork at full time job with

dialysis pouch. He even maintains social activity outside ofwork with the dialysis pouch.

Whenever he was on a road trip or vacationing he had to wearhis dialysis machine. Mr.

Roth has continues to worry about infections while maintaining a socially active lifestyle.

Mr. Roth has been subject to secrecy over his ailment and had to fix his dialysis pouch

around his busy schedule and strained him physically and psychologically. This chronic

disability did not keep him from a daily activity and continued to use the dialysis method


for two years by maintaining his lifestyle. In conclusion, there are many aging adults suffering from chronic illness playing a

role in their socially active lifestyles and many are effected by past lifestyle choices

including diet, and exercise. Since the aging population is doubling there will need to be

more ways to help the aging population to gain their independence from chronic illness.

although there is no quick cure for disabled adults to give them the full benefit of social

interaction there are still many way to achieve social activity as an aging adult regardless

of chronic illness which include new technology, medicines and ways to exercise & diet.

Many aging adults who may have chronic-illnesses or some types of disabilities still may

be able to partake in functional fitness which merely movingthe body around whatever

daily activity you are doing, lifting, raking, pulling walking etc.

(Volkwein & McConantha, 2012)


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The Role of Chronic Ilnesses in Socially Active Aging Adults

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