Mature Adults
Heart Disease and Cancer
Heart disease and cancer rank as the top causes of adult deaths in the United States. At least 20% of Americans have heart disorders; a million people die each year from heart-related problems.
A full 25% of Americans have hypertension. In adults over the age of 70, the percentage rises to 64%. Hypertension can lead to stroke and heart attack. Kidney damage often results. The incidence of hypertension is equal in men and women, although it is more common in African Americans, especially men.
Many lifestyle factors increase the risk for hypertension. For example, women who take birth control pills and smoke significantly increase their risk. Other contributing factors include a lack of physical activity, excess body weight, use of alcohol, and high salt (sodium) intake.
Diabetes Mellitus
Diabetes mellitus is increasing in all age groups, with an increase of about 600% in the last decade of the 20th century. In the 21st century, nearly 16 million people in the United States have diabetes mellitus. Many individuals have undiagnosed diabetes. Diabetes costs the United States about $100 billion annually. One fourth of the money Medicare spends is for care of people with diabetes. Of the total population, 6% has diabetes, with that number tripling to 18% for people over 65 years of age. These statistics are relevant to all healthcare providers as well as the individual tax-payer because diabetes mellitus and its complications consume millions of public and private funds that could be saved or utilized as prevention or educational sources.
Diabetes is the largest cause of kidney failure, blindness, and limb amputation in the United States. Clients with diabetes have two times the rate of cardiovascular disease and two to four times the numbers of CVAs. Hypertension is 60% to 70% more likely in diabetic clients. Each of these secondary chronic illnesses leads to further physical and mental deterioration.
Diabetes is sometimes preventable and generally manageable, but not curable. The incidence of diabetes is higher in African Americans, Hispanic Americans, Native Americans, and Asian Americans. Race increases the risk, but nutrition, weight control, and lifestyle management can offset many of these risks. Preventive education is important.
Men’s Health
Men’s health issues include the number 1 and 2 killers, which are heart disease and cancer. Heart disease, including heart attack, kills 500,000 men each year in the United States. Cancer is three times more likely in male than in female clients. Prostate and lung cancer are the most common cancers in men.
African American men are at highest risk of heart disease and hypertension, with a 47% higher rate than that found in white men. Lung diseases, suicides, and Alzheimer’s disease are less common in African American than in white Americans.
Men need to consider prevention of accidents, a leading cause of death in all male age groups. In adult men, accidents are the third leading cause of death (after heart disease and cancer). Men are 2.5 times more likely to die in motor vehicle accidents than are women, especially men aged 15 to 24 (five times more likely).
Men should be aware of prostate health. Benign prostatic enlargement is common and can be symptom free or cause difficulty in urination. Prostate cancer is the most common cancer found in American men and is more common in African American men. Men at highest risk are those with obstructive urinary symptoms or an enlarged prostate, or those with a father or brother who died of prostate cancer before age 65. The prostate-specific antigen (PSA) test is used as a screening tool and to determine the effectiveness of treatment after prostate cancer is diagnosed.
Men should also self-examine for testicular cancer. Each year testicular cancer is diagnosed in 7,100 men in the United States, most of whom are between the ages of 15 and 35. Careful observation for symptoms and regular examinations are the best preventive measures against prostate and testicular cancer.
Women’s Health
Women’s health issues include concerns related to reproduction and menopause. Maternal health is discussed in Unit 10. Menopause brings additional health challenges to women.
Osteoporosis (loss of bone density) is the most prevalent bone disease in the world and causes more than 1 million fractures of the hip, spine, and wrist yearly in the United States. At least 20% of older people with hip fractures do not survive more than a year. About one third of women over age 50 suffer spinal fracture, resulting in loss of height and a stooped appearance.
After menopause, the loss of the estrogenic hormones speeds bone density loss, which affects 60% to 75% of all postmenopausal women. Women lose bone density and have twice as many fractures as men, especially if they are slender or underweight. The incidence of osteoporosis is higher in white and Asian American women than in other races.
These factors also influence the incidence of various disorders. For example, cardiovascular disease affects fewer women between ages 45 and 64; but after age 65, the prevalence of this problem more than doubles. Cardiovascular disease causes nearly half of the deaths among all women and is the leading cause of death by age 65. Cardiovascular disorders in women often present with different symptoms than in men. Fortunately, research has led to earlier recognition and treatment of female cardiovascular disorders. Women who lack calcium are also at higher risk of developing osteoporosis. Lack of exercise is a contributing factor, as are smoking, family history of osteoporosis in mother or sister, and removal of ovaries before age 50.
Cancer is a concern for women. Because of the increase of smoking in women, lung cancer now leads the mortality rate of cancer in women. Breast and ovarian cancer are the second and third leading causes of cancer deaths in the United States.
Women need to protect themselves through regular checkups, including mammography (for breast cancer) and Pap tests (for cervical cancer). Regular mammogram checkups are considered an excellent preventive measure. All women should do breast self-examination monthly.
Older Adults
The major causes of death in the older population are heart disease, cancer, stroke, COPD, pneumonia, and influenza. Many chronic problems are also of concern because of their impact on a person’s everyday life. These problems include arthritis, osteoporosis, incontinence, vision and hearing impairment, and dementia.
Suicide in older adults is more likely than for any other age group. Alzheimer’s disease is among the 10 leading causes of death of those over 65 years of age.
CATEGORIES OF DEVIATION FROM WELLNESS
Disease
Diseases are classified in several ways. Usually, they are classified according to their etiology (cause), the body system that they affect, the extent of their involvement in the organ or body, or the way they are acquired. Classifying diseases according to cause is not always satisfactory because the ultimate causes of many diseases are still unknown.
Organic and Functional Diseases
A disease is classified as organic or functional. Organic disease means that detectable structural change has occurred in one or more organs that also alters usual function. Functional disease is a disorder in which a structural cause cannot be identified. The person, however, experiences changes that affect his or her ability to conduct the usual activities of daily living. The person is said to be dysfunctional if he or she cannot perform usual activities.
Hereditary Disorders
One or both biological parents may transmit a hereditary (genetic) disorder to an embryo, resulting in the child’s physical impairment. For example, hemophilia (prolonged blood clotting time) is a hereditary disorder transmitted from mother to child. It appears mostly in male children because it is almost always carried on the X chromosome. The mother is the carrier and generally free of symptoms.
Congenital Disorders
Congenital disorders are also present at birth. Unlike hereditary disorders, however, they are not necessarily transmitted through genes. Congenital disorders may be genetic or may be caused by another unfavorable condition that affects normal fetal development. For example, herpesvirus in the mother can be transmitted through the placenta or during the birth process and can cause congenital defects. If a woman contracts rubella (German measles) during pregnancy, the disease may cause body abnormalities or defects in the infant. Consumption of alcohol or smoking by a pregnant woman can profoundly affect the fetus. Congenital heart disease and clubbed feet (deformities of bones in the feet) are examples of abnormal fetal development.
Infectious Diseases
A common cause of disease is invasion of the body by microorganisms, such as bacteria or viruses, or by animal parasites. This microscopic invasion is called an infection. Some infections are local, which means the area of invasion is limited to one area or organ. Systemic infections involve the whole body. Microorganisms that cause infections may or may not be contagious, which means the infection can be transferred from one person to another.
Deficiency Diseases
Deficiency diseases are disorders of nutrition that result from a lack of one or more dietary nutrients. For example, lack of vitamin C causes scurvy. A deficiency of several vitamins, or general malnutrition, is more common in the United States than is a single vitamin deficiency. If the body does not use nutrients properly (malabsorption syndrome), various disorders result. Deficiency diseases also may be seen in the immune system. An immunodeficiency syndrome caused by HIV/AIDS is often manifested in the body by infections, malignancies, and neurologic disease.
Metabolic Disorders
A disturbance of one or more of the endocrine glands causes metabolic disorders. Endocrine glands secrete hormones that regulate body processes.For example, the thyroid hormone affects the rate of metabolism for the entire body, and insulin deficiency results in diabetes mellitus. Dysfunction occurs from hypersecretion (too much) or hyposecretion (too little) of a hormone.
Neoplastic Diseases
The growth of abnormal tissue or tumors is called neoplastic. These growths can be benign or malignant. A benign tumor results from the growth of cells similar to the tissue in which it appears. A benign tumor is often surrounded by a capsule. Once removed, the tumor usually does not recur. It may be disfiguring, but it is not dangerous unless it crowds other structures or robs surrounding tissues of their blood supply. A malignant tumor (e.g., cancer) is a wild and disorderly growth of cells that is unlike the tissue from which it arises. This cell growth robs normal tissues of nutrients.
Malignant cells also tend to spread to other parts of the body, a process called metastasis.
Traumatic Injuries
Traumatic injuries are those injuries caused by external forces. Injuries incurred in automobile accidents and falls are examples. Mental trauma (e.g., emotional distress) also falls under this category.
Occupational Disorders
Certain occupational groups are subject to conditions particular to their jobs. Construction workers constitute 20% of deaths from occupational causes. Agricultural workers and miners also have high rates of mortality.
Morbidity can also be related to occupational exposures. Employees who work around chemicals, radiation, and other hazardous materials are more likely to be susceptible to acute and chronic conditions. People working in noisy areas for prolonged periods must wear protective devices to prevent permanent hearing loss.
KEY POINTS
• Although many definitions of health exist, optimum health includes physical, emotional, mental, social, and spiritual well-being.
• The state of one’s health is on a continuum and is dynamic, changing from day to day.
• The concept of high-level wellness relates to the higher level needs in Maslow’s hierarchy.
• Lifestyle changes can have a major impact on health and wellness.
• The four most important wellness lifestyle factors are physical activity, healthy diet, maintenance of appropriate body weight, and not smoking.
• Some stress is beneficial, whereas too much stress can lead to physical and emotional disorders.
• Keys to changing behavior include health promotion, education, and community health awareness.
• Infant mortality remains a health concern in the United States.
• The major cause of death and disability in young children involves accidents.
• Accidents continue to be a major health concern for adolescents and young adults, along with homicide and suicide.
• Heart disease and cancer are the top causes of death in adults.
• The etiology of diseases and disorders may be organic, functional, hereditary, congenital, infectious, deficiency, metabolic, neoplastic, traumatic, or related to an occupation.
