Download Chronic Diseases

Chapter 11
Other Chronic Diseases
and Conditions
Chronic Diseases: What Are They,
and Why Are They Important?
• Diseases that persist for a long time
• Rarely cured completely
• Chronic diseases (including heart disease and
cancer) cause more than half of deaths around
the world.
• Almost all women will be affected by at least
one chronic disease.
Chronic diseases are common, and they
also affect women more than men.
Chronic diseases are responsible for 70% of deaths in
the U.S. (men and women).
Women have greater rates of arthritis, immune diseases,
Alzheimer’s disease, as well as:
– Osteoporosis (4x more common)
– Lupus (9x more common)
– Hypothyroidism (50x more common)
– Fibromyalgia (7x more common)
Women are also more likely to be caretakers for
other people with chronic diseases.
Racial/Ethnic and Socioeconomic
Dimensions
• White and Asian women have osteoporosis
more often than African American women
• African American women are more likely than
white women to die following a hip fracture
• American Indians and Alaskan Natives have the
highest prevalence rates of diabetes
• Blacks and whites have somewhat equal rates of
arthritis, but blacks have a higher rate of activity
limitations due to arthritis and a higher
prevalence of severe pain.
Economic Dimensions
Estimated Annual Costs
Conditions
Costs
Arthritis
$130 billion
Diabetes
$180 billion
Alzheimer’s disease $180 billion
and dementia
Cardiovascular
disease
$300 billion
Bone fractures
$12–18 billion
Osteoporosis
• Literally “porous bone”
• Caused by gradual loss of calcium that weakens bone
structure
• Usually occurs without symptoms
Osteoporosis, Cont.
Nonmodifiable Risk Factors
for Osteoporosis
• Being female
• Increased age/postmenopausal
• Small frame and thin-boned
• White or Asian
• Family history of osteoporosis or fractures
Modifiable Risk Factors
for Osteoporosis
•
•
•
•
•
•
Diet low in calcium and vitamin D
Sedentary lifestyle
Cigarette smoking
Estrogen deficiency
Low weight and body mass index
Certain medications
– Glucocorticoids, anticonvulsants
• Amenorrhea
• Anorexia nervosa or bulimia
Screening and Diagnosis
for Osteoporosis
Women who should be tested:
• All postmenopausal women younger than age 65 who
have one or more additional risk factors for
osteoporosis besides menopause
• All women age 65 and older
• Postmenopausal women with fractures
• Women who are considering therapy for osteoporosis
or who want to monitor the effectiveness of certain
osteoporosis treatments
Treatment and Prevention
of Osteoporosis
• Adequate supply of calcium (ideally from food)
• Vitamin D
• Participate in weight-bearing and musclestrengthening exercises
• Estrogen replacement therapy
• Drugs: alendronate (Fosamax), risedronate
(Actonel), raloxifene (Evista), teriparatide (Forteo),
nasal calcitonin spray
• Fall-prevention strategies
Arthritis
Arthritis—inflammation of the joints—affects an
estimated 50 million Americans (1 in 5 adults)
– Osteoarthritis: degenerative joint disease
– Rheumatoid: chronic inflammatory disease
– Gout: excess uric acid in the body
Arthritis, Cont.
Arthritis is most common in the south and midwest
Healthy Joint vs. Osteoarthritic
Joint vs. Rheumatoid Arthritis
Risk Factors for Arthritis
Symptoms of Arthritis
• Achy, stiff joints
• Small bony knobs on fingers (osteoarthritis)
Diagnosis of Arthritis
• No single test can diagnose arthritis
• Family history and physical exam to check joints,
reflexes, and muscle strength
• Radiographs
• Blood tests
• Joint aspiration
Prevention and Treatment
of Arthritis
• Maintaining weight through diet and exercise
• Avoiding contact sports and repetitive joint motion
• Preventing Lyme disease (vaccine, insect
repellent)
•
Treatment may consist of
drugs (NSAIDs, topical pain
relievers, corticosteroids,
immunosuppressants) or
surgery
Diabetes Mellitus
• 18.6 million cases of diabetes—half of the cases
are women
Types of diabetes
• Type 1: Usually appears during childhood
• Type 2: Most cases of diabetes
• Gestational diabetes: Develops in 2% to 5% of
pregnant women
Risk Factors for Diabetes
• Having a first-degree relative with diabetes
• Being overweight
• Not getting regular exercise
• Unhealthful diet
• Having hypertension, abnormal high-density
lipoprotein (HDL) or triglyceride levels
• Racial groups: African American, Hispanics,
American Indians/Alaskan Natives
Symptoms of Diabetes
Type 1
Type 2
• Frequent urination
• Any type 1 symptoms
• Unusual thirst
• Frequent infections
• Extreme hunger
• Cuts/bruises that are
hard to heal
• Unusual weight
• Extreme fatigue
• Blurred vision
Complications of Diabetes
 If poorly managed, diabetes
can damage nearly every
organ in the body, greatly
reduce quality of life, and
cause early death.
 If managed well (healthful diet
with balanced amounts of
carbohydrate, blood sugar
monitored regularly, and with
regular exercise, people with
diabetes can live long, healthy
lives.
Diagnosis of Diabetes
Routine tests
• Fasting plasma glucose test/oral glucose tolerance
test
• Normal sugar level = 70–110 mg/DL; blood sugar
level above 126 mg/dL on at least two occasions
Treatment and prevention of diabetes
• Daily insulin injections
• Diet control
• Physical activity
• Home blood glucose testing several times a day
Fibromyalgia
• Disease characterized by constant,
widespread pain
• Still poorly understood
• Treatment focuses on improving quality of life
and reducing symptoms (regular exercise,
therapy to cope with pain and adjust,
antidepressants)
• Most likely to appear in women and during
middle age
Autoimmune Diseases
• Diseases in which the body’s immune
system turns inward rather than outward.
• More than 80 different illnesses, usually
occurring among women.
• Hormone related?
Autoimmune Diseases
Lupus: A Poorly Understood Disease
• Immune system forms antibodies that target healthy
tissues and organs
• Primarily a disease of young women of childbearing
age (affects women 10 to 15 times more often than
men), more likely to affect African American women
• Symptoms can go away and then return
• Types
– Discoid (cutaneous) lupus
– Systemic lupus erythematosus (SLE)
– Drug-induced lupus
Lupus, Cont.
Exact cause(s) is unknown. Genetic, hormonal, and
environmental factors appear to be involved.
Symptoms:
• Painful, swollen joints or arthritis
• Skin rash
– Butterfly-shaped across
face
– Triggered by sun exposure
• Frequent fevers
• Prolonged or extreme fatigue
• Anemia
• Kidney involvement
Lupus, Cont.
Diagnosis of lupus
• Take note of symptoms
–Skin rash, joint pain, chest pain, seizures,
photosensitivity, review of history of
medications
• Complete blood count
• Antinuclear antibody test (ANA)
• Urinalysis
Lupus, Cont.
Treatment and prevention of lupus
• Avoid sun exposure and use sunscreen
• Exercise
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Antimalarial agents
• Immunosuppressant drugs
• Steroids
Thyroid Disease
Thyroiditis: inflammation of the thyroid, the gland
controlling the body’s metabolism
Two forms:
• Hypothyroidism:
underactive thyroid—
body burns energy too
quickly
• Hyperthyroidism:
overactive thyroid—
body burns energy too
slowly
Risk Factors for Thyroid Disease
• Age and gender (women over age 20)
• Family history of a family member with
thyroid disease
• Previous thyroid concerns or conditions
Symptoms of Hashimoto’s
Disease and Graves’ Disease
Hashimoto’s Disease (Hypo)
Graves’ Disease (Hyper)
• Weight gain
• Weight loss
• Fatigue and listlessness
• Increased energy expenditure
• Difficulty concentrating
• Nervousness and irritability
• Dry skin
• Sweating more than normal
• Sensitivity to cold
• Heat intolerance
• Constipation
• Diarrhea
• Goiter
• Bulging of the eyes
Diagnosing and Treating Thyroid Disease
Diagnosis of thyroid disease
• Thyroid-stimulating hormone (TSH) test
• Blood tests measuring levels of thyroxine (T4)
can confirm presence of disease
Treatment and prevention of thyroid disease
• Annual checkups
• Thyroxine for Hashimoto’s disease
• Antithyroid drugs for Graves’ disease
Alzheimer’s Disease
Alzheimer’s Disease, Cont.
Risk factors for Alzheimer’s disease
• Age
• Female gender (related to women living longer?)
• Genetic background
– Familial Alzheimer’s disease (FAD)
• Other possible factors
– Lifestyle
– Severe or repeated head injuries
– Lower education levels
– Environmental agents
Alzheimer’s Disease, Cont.
Symptoms of Alzheimer’s disease
• Memory loss
• Decline in ability to perform simple tasks
• Less clear thinking and forgetfulness
• Affected language and reasoning skills
• Lack of ability to make judgments
• Personality changes
• Emotional outbursts
• Wandering and agitation
Alzheimer’s Disease, Cont.
Diagnosis of Alzheimer’s disease
• Person’s history, complete physical exam;
various laboratory tests; brain scans; tests for
measuring memory, language skills, and other
brain activities
Treatment of Alzheimer’s disease
• Controlling symptoms and delaying memory
loss with drugs
• Maintaining a calm, safe, structured
environment
Discussion: Informed Decision Making
• Prevention, when possible
• If prevention isn't possible, find the disease
early, and manage it to reduce symptoms and
promote healthier living
• Examples?
• Does anyone know anyone living with a
chronic condition? What strategies do they
use?