Chapter 5: Chronic Illness & Care of Older Adults

Chronic illness, defined as persistent health conditions requiring ongoing management, affects the majority of older adults and follows predictable patterns described by the Corbin and Strauss Chronic Illness Trajectory, which includes phases from onset through crisis, recovery, and end-of-life transitions. The chapter emphasizes evidence-based prevention strategies across primary, secondary, and tertiary levels, including immunization protocols, screening programs, and rehabilitation interventions designed to maintain functional capacity and independence. Gerontologic nursing principles focus on comprehensive assessment of activities of daily living and instrumental activities of daily living to identify functional decline and implement targeted interventions. The demographic shift toward an aging population, particularly the rapid growth of adults over 85, presents unique challenges including frailty, cognitive impairment, polypharmacy, and increased vulnerability to elder mistreatment. The Age-Friendly Health Systems framework provides a structured approach through the 4Ms model, addressing what matters to patients, medication optimization, mentation preservation, and mobility maintenance. Care delivery systems encompass diverse settings from community-based programs to long-term care facilities, with emphasis on transitional care models to prevent hospital readmissions and promote continuity. Special attention is given to vulnerable populations including rural, homeless, and ethnically diverse older adults, requiring culturally competent care approaches. The chapter addresses critical safety issues such as fall prevention, medication management using tools like the Beers Criteria, and the legal and ethical responsibilities surrounding elder abuse reporting and advance directive implementation.