Managing Chronic Conditions

Individuals with chronic conditions are being encouraged to take control of their health and condition(s) through health lifestyle practices and self-management/self-care actions. Self-management has been defined as the "actions an individual and family must undertake to live well with one or more chronic conditions" (Adams, Greiner, & Corrigan, 2004).
Research demonstrates that individuals who engage in self-management/care actions can stabilize and improve their condition(s) and prevent and reduce risk of complications and other chronic conditions. Having support and involvement of a caregiver, family and friends can result in even better outcomes!

As well as general resources directed at 'living well' with chronic conditions, we specifically cover the following guidelines for healthy living and active self-management:

• Healthy Eating



• Being Active



• Monitoring Common Symptoms



• Proactive Problem-Solving



• Managing and Taking Medications



• Healthy Coping



• Reducing Risks for Complications/Other Chronic Conditions through Healthy Eating, Being Active, Quit Smoking and Low –Risk Alcohol Intake

These are general guidelines only. Please consult with your doctor or health care provider for disease-specific guidelines and follow treatments that have been specifically prescribed for your loved one.

Chronic Disease Self-Management Program

Stanford University developed a Chronic Disease Self-Management Program that incorporates healthy lifestyle practices and self-management actions based on five years of research. This program is promoted and funded by many regional health authorities and provinces for residents with chronic illnesses and their caregivers under various names. Caregivers are encouraged to participate.

The program includes 6 2.5 hour sessions delivered by volunteers with chronic illnesses and/or health care professionals. A book was developed to support the program. A Canadian edition if available:  Living a Healthy Life with Chronic Conditions, Canadian Edition, 3rd Edition | Bull Publishing, 2007, Lorig and others. The program is also on-line in some areas.

Written and compiled by: C. Goetz-Perry, RN, MN, PhD, Director, Caregiver Connect, VON Canada

References:
Fisher, et al. (2007). Perspectives on self-management from the Diabetes Initiative of
the Robert Wood Johnson Foundation, The Diabetes Educator, 33 (S 6), 216S-        224S.
Lorig, K. R., & Hollman, H. (2003). Self-management education: History, definitions, outcomes, and mechanisms. Annals of Behavioral Medicine, 26, 1-7.
Lorig, et al. (2007). Living a Healthy Life with Chronic Conditions, Canadian Edition, (3rd Ed.). Bull Publishing.

Information for caregivers :

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Healthy Eating

General guidelines to improve your eating:

• Choose the following more often: vegetables, fruit, low-fat dairy products, foods low in saturated and trans fat and salt, whole grains and fish, poultry and lean meat.



• Limit fast foods, canned or prepared foods, as they usually contain high levels of sodium.

These guidelines are provided as information only. Please consult with your doctor or health care provider for disease-specific guidelines and follow diets that have been specifically prescribed for your loved one.

Canada-wide

Aboriginal

Eating Well with Canada's Food Guide - First Nations, Inuit and Métis, Health Canada, 2010

Diabetes

Diabetes and You - Nutrition, Canadian Diabetes Association, 2011. Includes "Just the Basics" pdf in English and French and multicultural adaptations for Aboriginal, South Asian – Hindi, Punjabi, Tamil, and vegetarian menus

General

Eat Better - More Than Medication, Pfizer Canada, 2011

Eating Well with Canada's Food Guide, Health Canada, 2010

Healthy Eating, Ontario Ministry of Health Promotion and Sport, 2011

Fr: manger sainement

Healthy Living - Health Eating, Health Canada, 2007

Heart Disease

Heart Healthy Action Plan, Heart and Stroke Foundation, 2011

Eating Well with Canada's Food Guide

By following the recommendations in Canada's Food Guide, you can be assured you and your loved one will meet your daily requirements for vitamins, minerals and other nutrients, helping you to achieve overall health and vitality. You both will also reduce your risk of chronic diseases such as heart disease. People, who make small changes in their diet over a longer period of time, rather than a dramatic change all at once, are more likely to stay committed to a healthier diet. If you are overweight, talk to your doctor or health care provider before taking on a weight reduction program.
The new Food Guide recommends:

• Eating plenty of vegetables and fruit. Every day, include a dark green (such as broccoli, asparagus and romaine lettuce) and an orange (such as carrots and sweet potato) vegetable.



• Making half of your grain products whole grain (such as brown and wild rice, bulgur, quinoa and oatmeal) each day.



• Serving fish twice a week (such as rainbow trout, salmon and sardines).



• Including beans, lentils and tofu (meat alternatives) more often in your diet.



• Drinking lower fat milk and milk alternatives such as fortified soy beverages. Be aware that other fortified drinks such as orange juice, rice, almond and potato do not contain the same level of protein found in milk or soy.



• Using unsaturated oils such as canola, olive, and soybean as well as non-hydrogenated margarines (no more than 30 to 45 mL/2 to 3 tbsp a day).



• Taking a Vitamin D supplement if you are over the age of 50. If you are planning on becoming pregnant, take a multivitamin that contains folic acid. Once pregnant, your supplements should also contain iron.



• Being active for 30 to 60 minutes every day, most days of the week. Children need physical activity for 60 to 90 minutes every day.

The new Food Guide also recommends limiting:

• Foods and beverages high in calories, fat, sugar or salt



• Saturated fats from fatty meats, butter, lard, shortening and hard margarines



• Trans fats in such foods as doughnuts, cookies and other baked goods



• Salt (sodium)



• Sugar in such items as soft drinks and desserts

• Eat less salt by:

• Limiting your use of salt in cooking and at the table



• Avoiding salty foods



• Choosing fresh or frozen food



• Avoiding canned or prepared foods that are high in salt



• Reading the Nutrition Facts table on food packages for sodium content



• Using other seasonings such as herbs, spices, lemon juice and garlic during food preparation

Canada's Food Guide also outlines the number of servings you and your loved one should eat from each of the four food groups and provides guidance on portion sizes. The recommended number of serving sizes is based on age and gender. Look at the chart with the Food Guide to find your recommended number of Food Guide servings per day. Remember that it is just the average amount that people should try to eat each day.
Adapted from: Health Canada, 2007 and Heart and Stroke Foundation, 2011

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Being Active

Research shows that physical activity can prevent, help stabilize and improve chronic conditions and prevent associated complications and disability. Encourage your loved one to be active 30 to 60 minutes a day most days within his/her capacity. Your loved one should check with his/her doctor before beginning a physical activity program.
Adapted from: Health Canada, 2010.

VON Sites offering SMART Program (Seniors Maintaining Active Roles Together – seniors' group exercise sessions and/or in home exercise support program)

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Monitoring Symptoms

To be able to effectively manage chronic conditions, it's important that you and your loved one be aware of symptoms and measurements, note changes, know what changes mean and appropriate action to take.

• Check with your loved one's doctor or health care provider on what measurements may be out of normal ranges or symptoms (increasing in frequency or severity) that indicate something may be wrong and appropriate actions to take. Ask your doctor or health care provider to refer you to condition-specific group education classes or clinics that may be available in your area. Or, check under this section (Caring by Health Condition) by the specific by Health Condition.

• Help ensure your loved one's symptoms and important measurements are checked regularly (for example, for those with diabetes – blood glucose, A1C, weight, blood pressure; those with high blood pressure, heart disease and stroke – blood pressure; those with heart failure – weight, increased swelling in feet, ankles, shortness of breath).



• Set up a log or spreadsheet on which to record important symptoms or measurements and record them regularly. There are Apps being developed for specific conditions such as diabetes for those that use Smart/I-phones. Make notes of actions taken when measurements were outside of normal ranges or symptoms increased in frequency or severity.



• Review symptoms and measurements with your loved one regularly.



• Have your loved one take the record of symptoms/measurements with them when they have appointments with their doctor or health care provider or seek urgent or emergency medical treatment.



• Make sure your loved one has regular appointments with his/her doctor or health care provider scheduled to have his/her condition regularly monitored/followed-up.



• Make sure your loved on also has regular appointments to have his vision and oral health monitored.

Written by: C. Goetz-Perry, RN, MN, PhD, Director, Caregiver Connect, VON Canada

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Proactive Problem-solving

Proactive problem-solving means identifying situations that might come up in advance, planning ahead and being prepared, especially in case of emergencies.

Being Prepared Away from Home

• Talk with your loved one about what situations might come up when he/she is away from home.



• Make sure your loved one has needed equipment and sufficient amounts of medications with them for the time they will be away from home. Examples of needed equipment might include a blood glucose monitor, portable oxygen tanks, mobility aids, etc.  Examples of needed medications might include insulin, inhalers, etc.



• Help ensure your loved one is prepared if an emergency occurs away from home.

• Make sure your loved one has emergency medications with them (for example - inhalers, insulin, Epi-pen for those with severe allergies;



• Make sure your loved one has foods with them to treat urgent symptoms (for example – for those with diabetes – foods to offset low blood sugar).



• Make sure your loved one has emergency information with them that can be easily found in wallet or purse. The information should include: health conditions, medications, doctor name and contact information, steps to take in an emergency.



• Encourage your loved one to use a medical alert identification system such as Medic Alert Canada: Medical ID linked to a medical alert service. Medical identification bracelets, watches and necklaces.

Being Prepared At Home

• Talk with your loved one about what situations including emergencies that might come up at home.



• If your loved one lives alone, develop a plan with them for them to check in or someone to check in with them at least daily.



• Make sure your loved one has needed food, equipment, supplies and sufficient amounts of medications on-hand for at least 3-7 days in case of emergency. Examples of needed equipment might include a blood glucose monitor, portable or back-up oxygen tanks, mobility aids, etc.  Examples of needed medications might include insulin, inhalers, etc.



• If your loved one has medical equipment that depends on power, contact your local power company to inform them that in case of power failure how long your loved one would be safe without power and the need to have power restored on a priority basis. Consider if feasible, a back-up power generator. OR, make plans to move your loved one in case of power failure. Also contact your local emergency coordinator and/or home care provider.



• Encourage your loved on to use an emergency medical information program such as the Vial of Life. Vial of Life is a program that helps emergency personnel locate important medical details in the event of an emergency in the home. A vial containing all important medical information is stored in the refrigerator and a sticker on the fridge door alerts emergency personnel that the vial is inside.

            VON is a partner with Vial of Life in a number of locations. Check with your local VON Site.

• Help safety-proof your loved one's home to prevent falls and other accidents. See Home Safety Checklists below and 'Falls Prevention' under Practical Skills for Caregivers
  .

International and Canada-wide Home Safety Checklists :

Home Safety Checklist

Check for Safety: A Home Fall Prevention Checklist, Centers for Disease Control and Prevention, 2006

Are You in Jeopardy? Home Safety Checklist, Grey-Bruce Fall Prevention and Intervention Program, 2010 – checklist is done by room or subject and recommends resources to address gaps.

Home Safety Checklist for Your Aging Parent, 2010, S. Erickson, Erickson Resource Group

Being Prepared Before a Change in Condition Occurs

There are things you can do to be prepared before a change in condition or care transition occurs. These steps include:

• Use the Contact Information template under Caregiver  Tools to record emergency response information; all the names, addresses, phone numbers and areas of specialty or responsibility for each of your loved one's physicians, health care providers (including pharmacists), home care and community support providers and organizations and caregivers. Include the condition or problem treated by each of these physicians or health care providers.

• Document the emergency contact information for each of the physicians, health care providers, home care providers and caregivers in case of crisis.

• Make a list of medications (including over the counter and herbs) that your loved one is taking using the Medication Record, from Knowledge is the Best Medicine under Safe Use of Medicines  OR the Medication Chart template under Caregiver Tools. Document the pharmacy name and address. Try to use only one pharmacy for your loved one's medications. The pharmacist can then watch for possible adverse drug interactions.

• Make a list of your loved one's health status, conditions and history including surgeries using the Health Status and History template under Caregiver Tools. Ask you loved one to keep a copy with them and to put a copy on the refrigerator and with each phone.

• Support your loved one to complete Powers of Attorney for Finances and Medical Decisions and Advanced/Personal Directives so you can act on their behalf and follow their wishes. See Caregiver Resources: Legal for information by province about Powers of Attorney and Advance/Personal Directives. See VON's Caregiver Connect Guide, Personal advance health care directive.

• Make sure you and other key caregivers have a copy of all the above documents.

Take and Manage Medications

Help ensure your loved one takes his/her medications as prescribed. In those that require medication to control their condition, following a healthy lifestyle may reduce the need for, or the amount of, medication required.

Canada-wide

See 'Safe Use of Medicines' under Practical Caregiver Skills

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Healthy Coping

Canada-wide

See 'Taking Care of You'for self-care strategies for you in your role as caregiver

Chronic Conditions and Caregiving in Canada: Social Support Strategies, Stewart, M. (Ed.), - a book on engaging family and friends to help with support for those with chronic conditions. Available through Amazon.


Coping with Stress, Health Canada, 2007


Coping with Stress, Canadian Mental Health Association and Heart and Stroke Foundation, 2009 – a 32-page pdf booklet with strategies to manage stress in your personal life.


Five Ways to De-Stress at Work, Heart and Stroke Foundation, 2011


Living Life to the Fullest: Creative Coping Strategies for Managing Chronic Illness, Perkins, C. – a book available for purchase or for instant download with purchase.


Manage Stress - More than Medication, Pfizer Canada, 2011


Stop that Stress, Heart and Stroke Foundation, 2011


Stress Management, Veterans Affairs Canada, 2008


Stress Management Test, Heart and Stroke Foundation, 2011

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Reducing Risks for Complications/Other Chronic Conditions through Healthy Eating, Being Active, Being Smoke-free and Low -risk Alcohol Intake

Not eating well, being overweight or obese, lack of physical activity, smoking and high alcohol consumption contribute to the risk of complications and many common chronic conditions – arthritis, high blood pressure, heart disease and stroke, diabetes, lung disease (asthma and COPD). Complications and risk for other chronic conditions can also be prevented or reduced through Healthy Eating, Being Active, Being Smoke-Free and avoiding alcohol or Low-risk Drinking/Alcohol Consumption.

• Healthy Eating



• Being Active



• Being Smoke-free

Canada-wide

Just Breathe: Becoming and Remaining Smoke Free, Heart and Stroke Foundation, 2011


How to Quit Smoking, the Canadian Lung Association, 2010


Quit Smoking, Health Canada, 2010


Quit Now, Health Canada, 2010 – resources to take you through the quitting process: "On the Road to Quitting" and "Quit 4 Life" (for youth 14-19).

Canada-wide

Low Risk Drinking Guidelines. Centre for Addiction and Mental Health, 2009
For advice on alcohol and health, talk to your doctor or other health professional or call 1-800-463-6273 (416-595-6111 in Toronto).