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Chronic Ailments Called 'Invisible' Epidemic

Medicine: Illnesses such as arthritis, diabetes and high blood pressure afflict 99 million Americans and seriously strain caregivers and health care system, report says.


WASHINGTON — A vast army of 99 million Americans suffer from chronic ailments such as arthritis and diabetes, which impose great hardship not only on the sufferers but also on their family members and the nation's health care system, according to a comprehensive study issued Tuesday.

The strains from this largely "invisible" epidemic will only grow as the population ages and those with the ailments become increasingly frail and disabled, the Robert Wood Johnson Foundation warned.

The chronic ailments, which also include heart disease, high blood pressure, cancer and mental retardation, cost $470 billion a year in direct health costs, according to the study, the first comprehensive survey of the issue in 30 years. Indirectly, they cost $234 billion in lost productivity from those who are disabled or die prematurely.

The report, called "Chronic Care in America: A 21st Century Challenge," was prepared by Catherine Hoffman and Dorothy P. Rice of the Institute for Health and Aging at UC San Francisco.

The nation's health system is skilled at dealing with acute conditions such as infections and broken bones, the study found, but it does little to help the chronically ill and their families manage their daily lives.

Many of the chronically ill need "low-tech" help--assistance with such tasks as bathing and preparing meals, home repairs such as the installation of "grab rails" in bathtubs and showers--but health insurance usually does not cover such help.

"When we think of health care, we often think of ambulances blaring and someone rushing to the emergency room with a heart attack," said Dr. Lewis Sandy of the foundation. "But the real face of health care is chronic illness."

Those with chronic ailments represent 46% of the patients seeking medical care each year but account for 76% of the nation's health care budget, the report said.

The study by the foundation, which is based in Princeton, N.J., dispels the belief that chronic ailments are restricted to the elderly: Only 26% of people with these conditions are 65 or older. However, chronic conditions become more common with old age and the elderly are more likely to have multiple problems.

"The golden years can be less of a blessing and more of a curse," said Bruce Scott, executive director of SeniorLink, a Kansas City organization. "Retrace your steps this morning. Imagine what it would have felt like to take 15 minutes versus 5 seconds to jump out of bed. Imagine not being able to dress or bathe yourself. Imagine reaching for your coffee mug and [being] unable to grasp the handle."

Family members dealing with chronic ailments of a loved one talked about the strains of care-giving and the difficulty of finding community help.

Cameron Pease, whose son Sean suffered a crippling brain injury in a car accident seven years ago and spent five years in a rehabilitation center, said: "Sean is still dependent on 24-hour care, but he has it with dignity." With the help of a local program in Keene, N.H., Sean lives in his own apartment.

"There is a track over his bed with a lift to get him into his wheelchair," Pease said. "And also he can take baths each day instead of being sprayed down in a gurney as he had been for the previous five years [in a rehabilitation center]," Pease said.

"Helping your loved one becomes a crusade, often at the cost of your health," said Devara Berger of Sacramento, who took a leave of absence from her work to become a full-time caregiver for her late husband, Derek, who had Parkinson's disease and associated dementia.

The most common chronic conditions are arthritis (32.6 million patients), high blood pressure (27.5 million), heart disease (21.3 million), asthma (13.1 million), diabetes (7.8 million), back ailments (4.3 million), Alzheimer's disease (4 million), mental illness (3.3 million), emphysema (1.9 million), mental retardation (1.5 million), paralysis of the extremities (1.4 million), Parkinson's disease (1 million), blindness (600,000), multiple sclerosis (200,000) and AIDS (190,000).

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