The Effects of Chronic Illness On Middle Aged Adults

THE EFFECTS OF CHRONIC ILLNESS ON MIDDLE AGED
The Effects of Chronic Illness on Middle Aged Adults

Stephanie Bannerman, Carol Fortner and Emily Hogan
Missouri State University
Mara Barba Ramrez
Satakunta University of Applied Sciences
University of Cdiz
The Effects of Chronic Illness on Middle Aged Adults

According to the World Health Organization (WHO), health is defined as a state of
complete physical, mental and social well-being and not merely the absence of disease or
infirmity. Comparatively, the group discussed and agreed upon the following variation as the
definition of health: a state of being holistically and perceptually well according to one's own
subjective ideas based on one's own genetics, attitude, prior experiences and understanding of
their body.
The group has chosen the focus of this paper to be, the effects of chronic illness on
middle aged adults. Middle age is defined as the period in a person's life from about age 40 to
age 60. The purpose of this paper is to examine how middle-aged adults cope with chronic
illness. WHO includes cardiovascular disease, cancer, chronic respiratory disease, diabetes,
mental disorders, and coronary artery disease as chronic health issues. The effects of these
diseases are multifactorial and depend on the determinants of health affecting the individual.
This paper will address chronic illnesses, nursing concerns, rehabilitation and other issues
pertinent to chronic illnesses and middle aged individuals in the United States, Spain and
Finland. Additionally, the structure of the different countrys healthcare systems will be
discussed along with which health organizations are helping chronic illnesses in the middle-aged
and how they are meeting the publics needs.
Chronic illnesses encompass conditions such as, heart disease, stroke, cancer, chronic
respiratory disease, kidney disease, osteoporosis, depression, arthritis, and diabetes. Most chronic
illnesses do not fix themselves and usually cannot be cured. Consequently, there are many areas
of concern that nurses needed to address when considering the health promotion and disease
prevention strategies in middle aged adults who have chronic illnesses (Better Health Channel,
2012). One area of concern that a nurse must address is the complex causes and multiple risk
factors that accompany chronic illnesses and have a drastic effect on middle aged adults lives.
There are many chronic illnesses that become a problem in an individuals life because of an
unhealthy way of living, such as hypertension and diabetes, or some can be passed on
genetically, with breast cancer being an example. Sometimes, it is hard to know the exact cause
of a chronic illness which can make health care planning, education, and motivation toward
healthy living difficult for health care providers (Better Health Channel, 2012). Along with many
causes and risk factors, some chronic illnesses have long latency periods which mean the time
between exposure and the onset of the illness and symptoms can be lengthy. Doctors say that
rheumatoid arthritis predominantly affects middle aged adults and can start as early as late
twenties, but some people do not realize they have it until they are middle aged and experience
the pain involved with a chronic illness (HealthStatus, 2015). It is important that nurses
encourage screening at an early age for people with many risk factors of certain chronic illnesses
because by the time someone is diagnosed with a chronic illness at the middle age stage of their
life, it might be too late for screening and prevention strategies.
Another area for concern is the patient and their familys mental health and quality of life.
Some chronic illnesses can be life-threatening, like strokes and heart attacks, and affect the
patients life in a more drastic way. At this point in their lives, middle aged adults usually have
families and careers set in motion, so chronic illnesses can negatively affect their mental health,
leading to depression, anxiety, and low-self-esteem, which also affects the quality of life of the
persons family and friends (IRISS, 2015). Middle aged adults who have already settled down in
life have to adjust to the demands of the illness and therapy used to treat their condition. Since
the middle aged adult may become depressed and have low self-esteem, the nurse would need to
suggest some support groups for their psychosocial health. Depression and low self-esteem may
also affect the patients will to work on activities involving health promotion and disease
prevention, so the nurse must keep encouraging patients with chronic illnesses to not give up and
remember the importance of the care they are receiving.
Nurses must also consider health promotion and disease prevention strategies with
middle aged adults with chronic illnesses because an important concern is the patients confusion
of trying to understand their condition along with their treatment regimen, while trying to
maintain an emotional balance to cope with negative feelings and low self-esteem. As a result
their emotional imbalance, some individuals find it hard to maintain their trust and confidence in
health care providers when recovery is not possible. This can make it difficult for nurses to help
their patients understand that they should be eating nutritiously, taking their medications a
certain way, or receiving regular checkups (like checking blood pressure with hypertension, or
blood sugar monitoring for diabetes) (Better Health Channel, 2012).
When talking about vulnerable groups of people in general and rehabilitation, it is
important, as nurses, to assist individuals in regaining a sense of control over their situation
through information and shared decision making, which reduces anxiety and helps the patients
motivation to participate in rehabilitation. Some people with chronic illnesses are very angry at
themselves and are dissatisfied with their current lifestyle, so certain kinds of activities can help
them channel their anger into progress in their rehabilitation, like vigorous exercises and sports.
Successful rehabilitation in these vulnerable groups does not just mean assisting individuals to
reach their highest functional abilities; it could also mean assisting them in achieving and
enhancing their quality of life and to maintain that quality of life. Vulnerable groups, in general,
may struggle to adhere to prescribed treatment and recommendations because they are struggling
from low self-esteem, depression, or anxiety. Some vulnerable groups, like people with chronic
illnesses, may have disabling conditions and require ongoing treatment, medical supervision, or
restrictions on activity to control their condition or to prevent complications, which can make it
very hard for them to stick to such a strict life-style (Falvo, 2014). Therefore, rehabilitation is
very important in middle aged adults with chronic illnesses because it allows these individuals to
maintain their functional ability and help them learn how to prevent exacerbations. In general,
rehabilitation allows people to grow stronger and have a better quality of life, along with helping
people become more confident in their own abilities. Without rehabilitation, individuals may not
have a way to fully heal from their surgeries or injuries and may not be able to reach the level of
health they had achieved before their injury/surgery which could negatively affect them for the
rest of their lives. Consequently, rehabilitation is an extremely important piece of healthcare in
the care of those with chronic illnesses.
The best rehabilitation plan set in action for this group of individuals holds little value if
the individuals do not follow the treatments and recommendations made to manage their
problems to prevent complications in their lives. Some individuals in vulnerable groups, like
people with chronic illness, may be reluctant to return to their former roles and obligations that
they had before their struggles and may try to retain their vulnerable roles because they find that
they enjoy the attention they receive. When this happens, rehabilitation progress is hindered.
Effective rehabilitation enables individuals in vulnerability groups to strive to be the best they
can be and be able to function effectively in their lives and maintain a good quality of life. This
involves interdisciplinary efforts of many types of medical and nonmedical professionals (Falvo,
2014).
Rehabilitation in the U.S. includes a mixture of different types of therapy: occupational

therapy, physical therapy, speech therapy, and any therapy nurses might include in their
treatments, such as massage therapy. American rehabilitation services hire registered nurses,
licensed practical nurses, occupational therapists, certified occupational therapist assistants,
physical therapists, physical therapist assistants, and speech-language pathologists. In the U.S.,
rehabilitation is all about recuperating and getting back to normal as quickly as possible so
individuals can get back to their busy schedules and not miss out on anything. Americans expect
the process of rehabilitation to be quick, which can make some people angry or depressed when
they do not progress as quickly as they wish too. The U.S. has both inpatient and outpatient
rehabilitation services. Rehabilitation services in the U.S. focus on the fact that everyone is
different, so everyone needs different types of therapy, and they focus on creating attainable
goals before beginning therapy (Life Care Centers of America, 2015). When looking at problems
the U.S. has with rehabilitation, surveys state considerable unmet rehabilitation needs that are
often caused by funding problems for assistive technologies (WHO, 2011).
MARIA
In Spain rehabilitation of diseases is of great importance. It is a global and continuous
process of limited duration and aimed at promoting and achieving optimum levels of physical
independence and functional abilities, as well as psychological, social, vocational and economic
adjustment to enable the individual to become independent in his own life. The objectives of
rehabilitation in Spain include: treat the disease and prevent complications, deal with possible
disabilities, and improve function, and teach the patient and family to adapt to a healthy lifestyle.
This rehabilitation depends on several factors: the type and severity of the disease, disorder or
injury, the type and degree of any resulting impairments and disabilities, the overall health of the
patient and family support.

Rehabilitation, all over the world, targets body functions and structures, environmental
factors, activities and participation, and personal factors. Rehabilitation includes identification of
an individuals problems and needs, defining rehabilitation goals, relating the problems to
relevant factors of the person and their environment, planning and implementing the measures
needed, and assessing the effects of rehabilitation. According to Article 26 that the United
Nations Convention on the Rights of Persons with Disabilities (CRPD) created, and when
looking collectively at the global population of the world, rehabilitation means
appropriate measures, indulging through peer support, to enable persons with
disabilities to attain and maintain their maximum independence, full physical, mental,
social and vocational ability, and full inclusion and participation in all aspects of life
(World Health Organization, 2011, p. 95).
This article calls on countries to organize, strengthen, and extend comprehensive rehabilitation
services and programs, as soon as possible, based on multidisciplinary assessment of individual
strengths and needs, and should include the use of assistive technologies and devices. Vulnerable
people experience health disparities and greater unmet needs in comparison to the general
population in all countries. Every country needs to work towards removing the barriers blocking
vulnerable people from getting health care such as rehabilitation and make existing health care
systems more inclusive and accessible to vulnerable people. A study done in 2007 on
rehabilitation needs in China found that about 40% of vulnerable people who needed
rehabilitation services and assistance received no help. Along with this, the unmet need for
rehabilitation services was high for aids and equipment, rehabilitation therapy, and financial
support for poor individuals. A survey of physical rehabilitation in Slovenia, Czech Republic,
Slovakia, Hungary, and Croatia found a general lack of access to rehabilitation services. Also,
facilities for prosthetic and orthotic professionals and other health care providers of rehabilitation
services are deeply inadequate in relation to need worldwide (WHO, 2011).
Rehabilitation services take place in different settings across the nation, but medical
rehabilitation is typically provided in acute care hospitals for conditions with acute onset. Follow
up rehabilitation, though, can be provided in a wide range of settings like specialized
rehabilitation wards or hospitals, rehabilitation centers, institutions such as residential mental and
nursing homes, hospices, respite care centers, military residential settings, or single or multiprofessional practices. Long-term rehabilitation may be provided within community settings,
such as schools, work places, or home-care therapy services. Since the 1970s, community-based
rehabilitation has been a major strategy to respond to the needs of vulnerable people, particularly
in developing countries. Community-based rehabilitation was originally promoted to give
rehabilitation services in countries with limited resources and field manuals gave family
members and community workers practical information about how to implement basic
rehabilitation interventions. More than 90 countries around the world continue to develop and
strengthen their community-based rehabilitation programs. The Rehabilitation Council of India
created a national program (1999-2004) that aimed to educate medical officers working in
primary health care facilities about vulnerable populations and about the need to spread
knowledge about rehabilitation, along with other things like health promotion and early
identification of diseases. This raised awareness about services for vulnerable people. Conclusion
of the program ended with 18,657 medical officers receiving training out of 25,506 (WHO,
2011).
Overall, patients in other countries suffer from many of the same health problems the
U.S., but because of geographic location and economic situation, these patients do not have
access to rehabilitation medicine. Even though rehabilitation is become more widespread, it still
does not exist in many countries (UNC School of Medicine, 2015). Therefore, countries around
the world are realizing the importance of rehabilitation needs of vulnerable populations and some
countries are starting to do something about it. It is important to remember when looking at
different vulnerable groups around the world; each type of vulnerability does not have specific
health, education, rehabilitation, social, and support needs. Diverse responses are always
required for each individual. Countries need to promote community-based rehabilitation,
especially in less-resourced areas, to help vulnerable people receive rehabilitation care.
Rehabilitation, no matter where the individual is from, is always voluntary, and some people may
need support with decision-making about rehabilitation choices. For some vulnerable people,
rehabilitation is of the upmost importance to be able to even participate in education, the labor
market, and civic life. No matter where someone is from, rehabilitation should help to empower
vulnerable population groups and their families (WHO, 2011). An important factor in the support
of providing health promotion, rehabilitation and care for the middle-aged with chronic diseases
is the health care system of the country and the support it provides to the different aspects of
health involved in the care of individuals with chronic illnesses.
The U.S.s healthcare system is unlike any other developed nation because it is extremely
expensive and it doesnt have a universal delivery system; instead it has many different sectors
that provide care for a variety of individuals throughout the population. The U.S government
does not centrally control the healthcare system which means financing of health care comes
from a mix of private and public companies. The majority of Americans have private insurance,
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but those who do not may be enrolled in Medicare, Medicaid, SCHIP, TRICARE, or managed
care which includes HMOs and PPOs. Medicare is for individuals age 65 and older, disabled
individuals or those who have end stage renal disease, while Medicaid covers children, lowincome individuals at any age and individuals with disabilities. SCHIP is for children in
uninsured families households who do not qualify for Medicaid and TRICARE is health
insurance that is financed by the military for active-duty military personnel. Managed care is
financed by an employer or the government and the prices for services and the salary of the
health professionals are pre-determined. Individuals in the managed care system have limited
choices for healthcare providers. In short, the U.S. healthcare system essentially provides
freedom of choice to individuals on their healthcare coverage and access to care is based on the
coverage they receive. The government fills the gaps in the private sector including gaps in
coverage for vulnerable populations (Shi & Singh, 2005).
There are four models of healthcare and the U.S. is a mixture of all of them. The
Beveridge model is a system of healthcare that is financed by the government via taxes which is
similar to coverage for American veterans. The Bismarck Model is a network of insurance
companies in conjunction with employers that dont make a profit, but provide insurance to
everyone; this is similar to the working class in the U.S. who usually get their insurance from
their employer. The National Health Insurance Model is a universal insurance program run by the
government with private health care providers and a good example of this in the U.S system of
healthcare is Medicaid and Medicare. And in the Out-of-Pocket model the individual is
responsible for paying for healthcare services if they are not covered by insurance. This model is
demonstrated in the U.S. by the part of the population with no insurance at all (Physicians for a
National Health Program, 2010).
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Due to the disorganization of the healthcare system, the cost of healthcare in the U.S. is
skyrocketing. Therefore, until sufficient reorganization of health services is achieved costs will
continue to rise and cause more problems. One challenge to reorganization of the U.Ss
healthcare system is the idea of choosing collaboration and interdisciplinary teams over focusing
on the individual health care provider. The continuum of care idea is important in preventing
fragmentation of health care and the patient will be the center of care. A barrier to collaboration
is also the current financial model of healthcare which is the fee-for-service system. The fee-forservice system draws more attention to the volume of services compared to the quality of the
service and focus on the individual and what is in their best interest. An important player in
reorganization of healthcare is professional organizations that need to back changes in the
payment system and model of care.
On the other hand, the organizational structure of the health system in Finland is a health
system based on compulsory levies, with universal coverage covering the entire resident
population officially. It jointly involved the central government and municipalities. Therefore,
Finland follows the Beveridge Model of health care because all patients have access to care and
medical care is paid via taxes. Finland has a public health care model, as well. According to an
article entitled, Integrated primary health care: Finnish solutions and experiences, criticism of
the model is centered on the lack of equal availability to all localities because access is limited to
rural areas. Finlands National Institute for Health and Welfare is a research and development
institution. Kehitysyhteistyn palvelukeskus (Service Centre for Development Cooperation) is a
service in Finland working on the development of work in global issues. Nationally, the Ministry
of Social Affairs and Health is in charge of making legislation and monitor compliance. Locally,
they are responsible for organizing health through Municipal Health Committees and by the
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Councils. The existing 444 municipalities are responsible for the promotion and prevention of
health, primary care, rehabilitation and dental services.
One of the many objectives of Finlands health system is to provide quality care and continue
with cost control measures for the existing increase in pharmaceutical spending. Also, another
goal is to maintain Quality Guidelines Mental Health put in place in 2001; improvements in
access; to respond to patient preferences; and run the free choice of general practitioner and
hospital choice as well as better coordination between primary care (GP) and specialist care
(medical specialists and hospitals).
According to the law, health services in Spain are public, universal and free at the time of
delivery, so it provides great benefits to society as a whole, such as improved equity and social
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cohesion. Moreover, the quality and safety of health care has improved health indicators so the
SNS is one of the best in the world. Within the European Union, we find that Spain has a high
life expectancy and very good clinical results. Each of the healthcare systems in the different
countries vary in ideas and government involvement, but each country is striving toward creating
useful organizations that will benefit the health of individuals, including those with chronic
diseases.
The U.S. has many government and non-government organizations that are in place to aid
middle aged individuals with chronic illnesses; however, I will be focusing on those
organizations that can be found in the state of Missouri. The Missouri Department of Health and
Senior Services and the Missouri Department of Social Services provide information, support
and resources for individuals with chronic illnesses. The Missouri Department of Health and
Senior Services website has a home page specific to chronic diseases that provides links to
information on risk factors and prevention strategies, statistics, and resources for the public, the
community, and the health provider. A huge new opportunity in managing chronic illnesses in
Missouri is health homes for those on Medicaid which come out of the Patient Protection and
Affordable Care Act (ACA). Missouri is one of the first states to initiate this new optional
benefit of the ACA which provides federal funds for a two year stay in a health home for those
with chronic conditions on Medicaid. Missouri may decide to open this service to specific
chronic conditions or all of them. The goals of the houses are to provide continuity in the care of
these individuals and present a holistic method of supporting the individual so they are not solely
defined by their chronic illness (Silow-Carroll & Rodin, 2011). Another government organization
that is funded by the CDC is the Chronic Disease Self-Management Program (CDSMP). The
CDSMP equips individuals with chronic health conditions through education and the
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development of skill related to the self-management of disease through workshops that usually
last around 6 weeks. The CDSMP is a national program, however Missouri is home to many
regional arthritis centers that offer classes specifically to those with arthritis, but they also offer
other self-management programs for those with other chronic conditions (Center for Disease
Control and Prevention, 2012).
Non-government agencies, or NGOs, benefiting those with chronic illnesses are very
prominent in Missouri and one example is the Missouri Foundation for Health. The Missouri
Foundation for Health works with a variety of organizations in regional communities to provide
support to activities and programs that are striving to improve health issues for all Missourians.
The foundation provides funding for a program called ACCESS which stands for Advancing
Chronic Care through Excellence in Systems and Support. The ACESS program provides
support for a holistic framework of health care that will enable health providers to manage
individuals with chronic illnesses and all aspects of their lives that their condition effects
(Missouri Foundation of Health, 2015). The Center for Health Care Strategies (CHCS) is a nonprofit NGO that partners with states, such as Missouri, to aid health care advances related to
those with complex needs. Those with complex needs include individuals on Medicaid and
Medicare, children in foster home situations, high-cost populations and those with complex
medical needs such as middle-aged adults with chronic health conditions. The CHCS works in
healthcare policy to improve access, quality, and cost of public healthcare in the U.S. In
Missouri, the CHCS works closely with the Missouri Department of Social Services and reports
to the department on advances in care for the vulnerable citizens of Missouri. Another NGO is
the Chronic Disease State Plan Workgroup of Missouri that produced a publication called On
Common Ground. The workgroups publication is a comprehensive plan to prevent and manage
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chronic disease in the state of Missouri. The publication provides background information on the
burden of disease in Missouri, risk factors, disparities in care, and self-care management
strategies. It goes on to list a number of strategy areas that should be addressed and objectives
that should be met when planning the management of chronic illnesses.
Nation-wide government organizations benefiting chronic diseases in the U.S include the
Centers for Disease Control (CDC), National Institute of Health (NIH), the Food and Drug
Administration (FDA), and the Health Resources and Services Administration (HRSA). The
CDC is an excellent resource for information related to current health situation involving the
population of the United States. Additionally, statistics related to morbidity and mortality,
disease rates, prevalence and transmission can be found on this site. The Mission of the CDC is
stated as, to protect America from health, safety and security threats, both foreign and in the
U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable,
human error or deliberate attack, CDC fights disease and supports communities and citizens to
do the same (CDC, 2015). NIH is referred to as the nations medical research agency and
provides Information related to clinical trials. Their mission is, to seek fundamental knowledge
about the nature and behavior of living systems and the application of that knowledge to enhance
health, lengthen life, and reduce illness and disability (NIH, 2015). HRSA is a division of the
Department of Health and Human Services. This site is an excellent resource for information
about the Affordable Health Care Act, drug pricing programs, rural health, and a myriad of other
services.
There are also many national NGOs in the U.S. which provide support to individuals with
chronic illnesses, such as the Joint Commission, the Bill and Melinda Gates Foundation, the
Kaiser Family Foundation, and the Global Alliance for Chronic Disease (GACD). The Joint
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Commission is an independent non-profit organization in charge of accrediting health

institutions. According to their website, Guided by the belief that every life has equal value, the
Bill & Melinda Gates Foundation works to help all people lead healthy, productive lives. I
think there should be a reference in this paragraph. This site is a great way to access different
helps works the foundation is working on. Their focus is on underserved populations. The
Kaiser Family Foundations website has a wealth of information about Medicare, Medicaid,
HIV/AIDS, private insurance and other health reform issues pertinent to todays chronically ill
individuals. The GACD is composed of many health institutions from different countries that
invest in global research studies that benefit health plans regarding chronic non-communicable
diseases. Their focus is on meeting the needs of those with chronic illnesses in low to middle
income countries through an interdisciplinary approach.
There are many government organizations in Spain, but these do not cover all chronic
diseases in general. Moreover, these organizations are intended not only for patients, but also
their families. The most important are: Spanish Association against Cancer, Federation of
Spanish Diabetics, Spanish Federation of Rare Diseases, Association of Relatives of Alzheimers
and Spanish Confederation of Families and Persons with Mental Illness.
Non-government organizations found in Spain with the objective of benefiting middleaged individuals with chronic illnesses include: the Asociacin de enfermera comunitaria
(Community Nursing Association or AEC), the Sociedad Espaola de Salud Pblica y
Administracin Sanitaria (Spanish Society of Public Health and Health Administration or
SESPAS), and the Sociedad Espaola de Medicina de Familia y Comunitaria (Spanish Society of
Family and Community Medicine or semFYC). The AEC is a nongovernmental organization that
has several functions. On one side it is responsible for training of community health nurses. On
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the other hand it makes working sessions to promote health and prevent disease. The SESPASs
mission is to improve health and the health care services of the Spanish population. The semFYC
is composed of 17 societies of family and community medicine that are represented by 19,500
doctors. Its main functions are to promote health and prevent disease.
The challenges in providing healthcare for middle-aged individuals with chronic illnesses
will only increase as the incidence of chronic diseases in the world increase, as well as the
amount of money spent in relation to their care. The governments and organizations in both
countries must focus on prevention of chronic illnesses and providing more resources for
managing long-term care. Many organizations such as the CDC and WHO are working to shift
the healthcare focus, around the world, toward expanding prevention strategies including farreaching screening methods, follow-up care that will aid in maintaining health, and improving
education materials for leading a healthy lifestyle. The new ACA, Healthy People 2020, and
Millennial Developmental Goals (MDGs) are all ways the U.S. is addressing community health
concerns, such as chronic health conditions, and they are providing solutions and goals to
prominent gaps in community health care.
In Spain, the Community Health has the scope of primary health care. The National
Health System - Sistema Nacional de Sanidad (SNS) in Spanish - is the one who deals with the
Community Health concerns. The SNS is the set of health services of the State and the
autonomous communities and integrates all the functions and health benefits. The SNS, by law,
is run by the Spanish government. According to the Spanish constitution there is public
financing, universal coverage and free health services at the time of use. The SNS has a
multitude of strategies
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In the SNS there is a strategy proposed by the progressive development of interventions

aimed at winning health and preventing disease, injury and disability. This is the strategy of
Health Promotion and Prevention and its mission is to promote a society in which individuals,
families and communities can reach their full potential for development, health, welfare, and
autonomy because the assumption is that working toward health is a task for everyone.
One strategy in the SNS, among many, is to address chronic disease. This strategy is
governed in Spain by certain principles. People, both individual and within the social sphere, are
the focus of the SNS. The person-centered care requires health systems to be focused on the
disease and to be directed toward addressing the needs of the population whole and of each
individual.
Addressing chronicity must have a population health approach, designed to improve the
health of the entire population (healthy people and sick people) by addressing a wide range of
social determinants of health. We must recognize the human being as a biopsychosocial being
and take account of differences, diversity, equity, social justice, and multiculturalism.
Consideration of the life cycle perspective and the social determinants of health is important to
consider throughout all stages of development (prenatal, infancy , childhood, adolescence, youth,
adulthood and old age) and to promote health, disease prevention and adequate access to health
and social services, prioritizing the most vulnerable and disadvantaged groups strengthening
interdisciplinary collaboration in health in order to achieve favorable results in the health,
welfare and quality of life of people. Another principle is the consideration of all health
conditions and activity limitations in chronic illnesses. Normally, strategies for prevention and
control of chronic diseases focus on those most prevalent and cause increased mortality (cancer,
diabetes, cardiovascular disease, but we must also take into account the health conditions,
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although not very frequent, can cause a worsening of the quality of life of those affected and
their environment.
Primary care is the mainstay of patient care with health conditions and activity limitations in
chronic illnesses. All professionals in the SNS must be involved and work on improving the
integrated approach to chronic, being necessary to promote the role of primary care teams and in
particular the professional family medicine, pediatrics and nursing, as coordinators of health care
processes related to chronicity. It is now necessary to develop instruments and coordinate health
services and social services in order to achieve progressively comprehensive care for chronic
health problems.
Circuit work and patient traffic dynamics should be redirected depending upon the
objectives that must be achieved to establish effective coordination between different care
settings and within them. Such coordination requires improving the exchange of information,
agreement and setting the exercise of the powers of each professional and optimizing
intervention without duplication of services in order to maximize health outcomes. The
professionals of the SNS have to share with all citizens the responsibility for health care and the
appropriate use of health and social services. To achieve this goal it is necessary to promote
actions aimed at raising awareness among professionals and the public, ensuring that people have
adequate and sufficient information to enable them to have an active attitude and commitment to
self-care, involving them in decision-making about your health.
When comparing organizations in the United States, Spain and Finland, there are
similarities in their governmental organizations in the realm of science and research. The
differences are found in the source of funding for health. Finland has a public health model,
whereas the United States has private and publically funded sources and Spain has a primary
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care model that is universal. Access to healthcare is available in both countries; however the cost
is quite different. Finlands cost for a regular visit is 16.10 euros, which is approximately
$18.10. This is obviously quite different compared to high cost health care in the United States
and the free healthcare in Spain. Those with chronic illnesses face substantial cost either for
insurance or physician visits adding to the burden of illness. Finlands availability of services in
all locations has been criticized, therefore making it difficult for everyone to obtain access.
Those with chronic illness would face a difficulty accessing services. On the other hand, Spain
provides many strategies and objectives to meet when providing primary care to those with
chronic illnesses. Despite the differences in healthcare systems, the nurse still plays a vital role in
care of all individuals, especially those who are chronically ill.
The role of a nurse in any position or health care organization, in any country, is to
become familiar with community resources in the area, whether they are government or nongovernment organizations. Once the nurse is knowledgeable they can refer to individuals that fit
the focus of a specific organization. The nurse must learn to assess middle-aged individuals with
chronic illnesses and determine what their needs are so that they can be met by different area
programs or organizations. Nurses can also impact health care policy by giving their support to
certain reforms or taking their ideas and suggestions to individuals in the local or state
government.
An important aspect in nursing is determining primary, secondary, and tertiary health
promotion practices in order to aid the health plan for chronic illnesses. Primary health
promotion, at this point in the health of a chronically ill person, would focus on education about
preventing associated illnesses that can happen due to the progression of disease. The very word,
chronic, means the illness has progressed beyond the acute state and is therefore outside the
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realm of secondary health promotion. Secondary health promotion focusing on screening is too
late at the chronic stage of disease. The primary focus for health intervention is obviously
tertiary at this time. Managing the disease and its long term effects on an individual and family
is where the focus must be placed.
A health model is vital in a health care plan of any individual and according to the
Improving Chronic Illness Care website,
The Chronic Care Model (CCM) identifies the essential elements of a health care system
that encourage high-quality chronic disease care. These elements are the community, the
health system, self-management support, delivery system design, decision support and
clinical information systems. Evidence-based change concepts under each element, in
combination, foster productive interactions between informed patients who take an active
part in their care and providers with resources and expertise. The Model can be applied to
a variety of chronic illnesses, health care settings and target populations. The bottom line
is healthier patients, more satisfied providers, and cost savings (2015).
Interventions based on this model focus on planned visits and group visits. Planned visits serve
the purpose of keeping patients informed about the progression of their disease. The hope is,
with patient education and care; patients will not be hospitalized with such great frequency.
Patients will be more satisfied with their care and become more comfortable with care at home
without visiting the emergency room as often.
In conclusion, the state of health of middle aged adults with chronic illnesses vary
according to their subjective idea of their own well-being while taking part in health promotion
and prevention strategies or progression through the rehabilitation for their specific illness. Each
22
country, the U.S., Spain and Finland, is doing their part in supporting these individuals to ensure
they have access to healthcare and a multitude of government and non-government
organizations. Patient education is vital for individuals with chronic illnesses; therefore it is
important for an interdisciplinary team of healthcare workers to continue to care and research for
these individuals so the every middle-aged adult can achieve their own optimal state of health, no
matter the person or their chronic illness.
23
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The Effects of Chronic Illness On Middle Aged Adults

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THE EFFECTS OF CHRONIC ILLNESS ON MIDDLE AGED