Managing Chronic Disease and Chronic Pain as You Age

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As they age, millions of Americans develop health conditions, including chronic pain. For an expert’s view on prevention and treatment, HealthCentral interviewed Kenneth Thorpe, Ph.D., via email. Dr. Thorpe is the Robert W. Woodruff Professor of Health Policy at the Rollins School of Public Health at Emory University. He is also the chairman of the Partnership to Fight Chronic Disease, an organization that has made several public-policy recommendations to address chronic disease, encouraging ways to improve patient access to care and invest in medical innovation. Read on to become part of the conversation.

HealthCentral (HC): Chronic illness can affect people from childhood onward but individuals tend to begin to have problems in middle age. What can people do to avoid chronic illness?

Dr. Thorpe: They must be proactive about their health and maintain a healthy lifestyle. Eating right, not smoking or drinking to excess, exercising often, and sleeping well can all help ward off chronic disease.

For instance, one Harvard study showed that those who had eight or more servings of fruits and vegetables every day were 30 percent less likely to have had a heart attack or stroke than those who ate less than 1.5 servings.

Exercising can reduce one's risk of developing major chronic diseases, including heart disease, stroke, and type 2 diabetes. The Office of Disease Prevention and Health Promotion recommends that adult Americans exercise between 150 and 300 minutes every week to improve health. For those with pre-diabetes or hypertension, enrolling in the diabetes prevention program, a benefit that will be covered by Medicare starting in 2018, is one approach to keeping healthy.

A good night's sleep also is key. According to the National Sleep Foundation, adults who sleep less than the recommended 7 to 9 hours per night can weaken their body's ability to process glucose, which puts a person at risk for type 2 diabetes. Insufficient sleep also can cause weight gain, which increases the risk of chronic disease.

Visiting a doctor regularly also can help people monitor their health and make changes when necessary. Policymakers can help people see doctors by ensuring that care is accessible and attainable.

HC: What if a middle-aged person is already struggling with chronic pain that is hampering his or her ability to live life fully?

Dr. Thorpe: I recommend staying as active as possible. This can be a challenge for those struggling with chronic pain, but exercising moderately a few days a week can do a lot to prevent chronic conditions from worsening, while also alleviating existing symptoms. For instance, maintaining or building muscle mass through moderate strength training can counter conditions like arthritis, which can lead to muscle deterioration. Exercise can prevent weight gain or even facilitate weight loss, both of which help prevent people with a chronic disease from developing new chronic diseases.

Not only will exercise make the person feel better, but it also will reduce healthcare costs in the long run. A 2016 study by the American Heart Association showed that participants who complied with its exercise recommendations faced $2,500 less in healthcare costs annually, compared to those who did not. Reducing the cost burden of chronic disease is crucial. Right now, America is poised to spend $42 trillion on these conditions by 2030.

HC: How would you advise people in their 60s, 70s, and beyond to approach living their lives fully when they know they are unlikely to benefit from potential cures that are years down the road?

Dr. Thorpe: First, I would advise them to stay as active as possible for the reasons discussed above. Not only can physical activity help to manage chronic conditions, but it has been proven to improve people's mood and overall disposition. This can make a huge difference for someone dealing with the day-to-day mental strain of having a chronic condition. As noted above, for seniors with pre-diabetes or hypertension, enrolling in the diabetes prevention program is one option.

Next, I would assemble the best care team possible. Having a doctor you know and trust, and who knows you, can make a chronic disease more manageable. It can also make coordinating your care with other specialists much easier.

I also would recommend taking an active role in your chronic-disease management. Over the past three years, there have been 77 drugs in development to treat Alzheimer's, 171 to treat diabetes, and 213 to treat heart disease and stroke. Actively managing your care can make you more aware of potentially useful medicines as soon as they come to clinical trials or to the market. Although the reality of managing a condition for the rest of your life can be daunting, taking charge and educating yourself about treatments can make it less so.

HC: As people age, they tend to become more sensitive to medications of all types. How do you approach helping people who need more than basics, such as heat, ice, and physical therapy? They will likely need some type of medication. Especially for people who are older, their stomachs may prevent certain OTC medications and prescribed anti-inflammatories from being useful. What are the options?

Dr. Thorpe: Those who need more than the basics should consult their doctors to make a personalized care plan. Making such a plan is a great way to manage chronic symptoms in the moment, while also setting wellness objectives for the future. A doctor is the only person who knows a patient well enough, and who has the medical expertise, to actually help them meet those goals.

However, many people struggle to afford the cost of care required by a personalized care plan. Forty percent of Americans say their out-of-pocket costs are going up. These costs may deter chronic-disease sufferers from seeing a doctor, which can then cause them to get sicker and increase healthcare costs in the long run. For this reason, it's imperative to enact policy that makes these visits more affordable and improves access to recommended care.

HC: Where do you stand on prescribing opioids to people of varying ages who must live with substantial pain?

Dr. Thorpe: When used correctly, opioids can help people manage their pain and go about their daily lives. Americans should talk to their doctor to see if opioids are a good option for them.

[Interview has been condensed and edited.]

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