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- Serie: Wiley Series on Cognitive Dynamic Systems
- Sprache: Englisch
Long-term Conditions in Adults at a Glance The market-leading at a Glance series is popular among healthcare students and newly qualified practitioners, for its concise, simple approach and excellent illustrations. Each bite-sized chapter is covered in a double-page spread with clear, easy-to-follow diagrams, supported by succinct explanatory text. Covering a wide range of topics, books in the at a Glance series are ideal as introductory texts for teaching, learning and revision, and are useful throughout university and beyond. Everything you need to know about Long-term Conditions in Adults... at a Glance! The go-to textbook for the treatment and management of long-term conditions in adults In Long-term Conditions in Adults at a Glance, a team of distinguished health and social care professionals deliver concise and engaging contemporary knowledge about health and associated disorders. The textbook's format, which includes visually appealing figures and tables, is particularly beneficial for those who prefer a visual approach to understanding complex concepts. Readers will also find: * A thorough introduction to the sociological factors associated with long-term conditions, including environmental, housing, and lifestyle factors * Comprehensive explorations of patient education and self-management, including behaviour change, health education, and patient responsibility * Practical discussions of a variety of long-term conditions, including arthritis, cancer, liver disease, and epilepsy * Evaluations of the treatments and management of long-term conditions, including the use of evidence-based practice and chronic pain management Perfect for student nurses, trainee nursing associates and busy healthcare practitioners, Long-term Conditions in Adults at a Glance will also be of value to registered health and care professionals working in acute and primary care. For more information on the complete range of Wiley nursing publishing, please visit: www.wiley.com/edu/nursing To receive automatic updates on Wiley books and journals, join our email list. Sign up today at www.wiley.com/email All content reviewed by students for students Wiley Health Science books are designed exactly for their intended audience. All of our books are developed in collaboration with students. This means that our books are always published with you, the student, in mind. If you would like to be one of our student reviewers, go to www.reviewnursingbooks.com to find out more.
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Table of Contents
Cover
Title Page
Copyright Page
Contributors
Preface
Part 1: Long‐term conditions: sociological factors
1 Determinants of health
Determinants of Health
The Impact of Determinants of Health
2 Health inequalities
Social justice
Health inequalities
Impact of health inequalities
The wider determinants of health
Relieving the effects of health inequalities
3 Environmental factors
Physical factors
Psycho‐social factors
Conclusions
4 Housing
The home
Health and the home
Medical assessment: housing
Adapted housing
5 Public health
Public health
Prevent, protect, and promote
Making every contact count
The MECC approach
6 Lifestyle factors
Lifestyle factors
Encouraging healthier lifestyles
Behavioural change
The transtheoretical model of change
7 Socioeconomic status
Socioeconomic status
Socioeconomic classification
Long‐term conditions and socioeconomic status
8 Holistic needs assessment
Holistic needs assessment
House of care
Self‐care, self‐management
Part 2: Patient education and self‐management
9 Behavioural change
The Wanless report
Interventions
Changing behaviour
The role of health‐care professionals
Supporting behavioural change
10 Health education
How to use a spectrum of effective coaching skills
Systemic strategies to improve health education
Conclusion
11 Patient responsibility
The NHS Constitution
Shared responsibilities
12 Self‐care and self‐management
Long‐term conditions
Self‐care
Social prescribing
13 Effectively supporting carers
Who are carers?
Signs of ‘burnout’
What is the emotional impact of caring?
How to effectively support carers
Conclusion and summary
14 Empowerment in long‐term conditions
Definition of empowerment
Fundamental components of the empowerment process
15 Experts by experience
Experts by experience
The role of EbEs in LTC
EbEs in education
EbEs in clinical practice
EbEs in research and audit
Part 3: Long‐term conditions
16 Alcohol dependency
Prevalence
Screening
Symptoms
Treatment approach
17 Anorexia nervosa
Diagnostic criteria
Atypical anorexia
Support
Psychological treatment for anorexia nervosa in adults
Psychological treatment for anorexia nervosa in children and young people
Other eating disorders
Signs and symptoms
18 Arthritis
Presentation of arthritis
Management
Osteoarthritis
Rheumatoid arthritis
Septic arthritis
Arthritis in children
19 Asthma
Pathophysiology
Impact
Causes
Signs and symptoms
Pharmacological management of asthma
20 Angina
Types of angina
Diagnosis and evaluation
Treatments
21 Anxiety
What is anxiety?
Fight, fright, or freeze
Anxiety disorder
Clinical features
Causes of anxiety
Risk factors
Management
Prevention
22 Atrial fibrillation
Aetiology
Diagnosis
Treatments
23 Bipolar affective disorder
Definition
Symptoms
Variations
Prevalence and causes
Treatment in a manic phase
Treatment in a depressive phase
The challenges that present in treating bipolar disorder
24 Bulimia nervosa
Overview (prevalence, description of the disorder)
Prevalence/statistical information
Signs and symptoms
Atypical bulimia nervosa
25 Bronchiectasis
Pathophysiology
Signs and symptoms
Risk factors/causes
Recommendations for practice
Treatment
26 Cancer
Cancer and long‐term conditions
Incidence
The burden of long‐term health conditions
Three cancer groups
27 Chronic fatigue syndrome
Epidemiology
Aetiology and risk factors
Pathophysiology and symptoms
Diagnosis
Communication throughout the diagnostic process
Management/treatments
Prognosis
28 Chronic venous insufficiency
The venous system
Chronic venous insufficiency
Classification
Theories
29 Chronic obstructive pulmonary disease (COPD)
Introduction
Pathophysiology
Emphysema
Chronic bronchitis
Pathophysiology of exacerbation of COPD
Symptoms
Causes
30 Coronary artery Disease
Definition and epidemiology
Pathogenesis
Symptoms
Recommendations for clinical practice
31 Chronic liver disease
Definition and statistics
Pathogenesis
Symptoms
Recommendations for clinical practice
32 Depression
What is depression?
Depressive disorders
Clinical features
Aetiology
Management
33 Diabetes mellitus type 1
Definition and epidemiology
Altered pathophysiology
Diagnosis
Clinical management
Other clinical considerations
Complications
34 Diabetes mellitus type 2
Definition and epidemiology
Altered pathophysiology
Diagnosis
Clinical management
Other clinical considerations – prevention and remission
35 Dual diagnosis
Prevalence
Definition
Symptoms
Treatment approach
36 Diverticular disease
Introduction
Risk factors
Signs and symptoms
Treatment and management
37 Epilepsy
Disability
Epilepsy
Seizures
Care and support
Driving and epilepsy
38 Heart failure
Causes of heart failure
Diagnostic tests
Treatments
39 HIV
HIV as a long‐term condition
Human immunodeficiency virus
Treatments for HIV
Long‐acting therapy
Stigma and HIV
Supporting those with HIV
40 Hypertension
Causes
Pathophysiology
Complications
Recommendation for practice
41 Inflammatory bowel disease
The causes of IBD
Crohn's disease
Ulcerative colitis
Signs, symptoms and investigations
Clinical management and interventions
Complications of IBD
42 Multiple sclerosis
Incidence and prevalence
Pathophysiology
Treatments
43 Parkinson's disease
Altered pathophysiology
Parkinson's symptoms
Diagnosis of Parkinson's
Clinical management
Recommendations for practice
44 Peripheral arterial disease
Arteries
Peripheral arterial disease
Atherosclerosis
Acute arterial thrombus or embolism
Inflammatory vascular disease
Skin changes in PAD
Assessment
Treatment
45 Psoriasis
Skin: long‐term conditions
Psoriasis
Living with psoriasis
46 Rheumatoid arthritis
Pathophysiology
Presentation and clinical features
Common Co‐Morbidities
Diagnosis
Management
47 Sickle cell
Epidemiology
Pathogenesis
Pathophysiology
Signs and symptoms
Episodes of pain
Acute chest syndrome
Infections
48 Schizophrenia
Symptoms
Positive symptoms
Negative symptoms
Diagnosis
Prevalence
Genetics
Brain and chemical differences
Mortality
Support, treatment and relapse prevention
49 Vascular dementia
Dementia
Causes of dementia
Dementia: clinical features
Diagnosis
50 Viral hepatitis
Hepatitis
Supporting people with viral hepatitis
51 Visual impairment
Eye function
Visual acuity
Pharmacology
Part 4: Management of long‐term conditions
52 Frameworks of care delivery – new ways of working
Social care for older people with multiple long‐term conditions
Person‐centred care framework
Leading change, adding value
National framework for NHS continuing healthcare and NHS‐funded nursing care
53 Evidence‐based practice
Nurse education
What is evidence‐based practice?
What are the perceived or actual barriers to nurses applying evidence‐based practice?
Hierarchy of evidence‐based practice
Knowledge translation
54 Leadership and management
Autocratic style
Democratic style
Laissez‐faire style
Bureaucratic style
Situational style
Transactional style
Transformational style
Organisational culture
55 Chronic pain management
Causes of chronic pain
Chronic pain assessment
Chronic pain management
Pharmacological strategies
Non‐pharmacological strategies
56 End of life care
One chance to get it right
The Gold Standards Framework
Actively dying phase
DEATH: after care and support
57 Advanced care planning
Advanced decision to refuse treatment
ReSPECT document
Implementing/developing an ACP/ADRT/ReSPECT plan
Creating the ACP/ADRT/ReSPECT
Bibliography
Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Chapter 21
Chapter 22
Chapter 23
Chapter 24
Chapter 25
Chapter 26
Chapter 27
Chapter 28
Chapter 29
Chapter 30
Chapter 31
Chapter 32
Chapter 33
Chapter 34
Chapter 35
Chapter 36
Chapter 37
Chapter 38
Chapter 39
Chapter 40
Chapter 41
Chapter 42
Chapter 43
Chapter 44
Chapter 45
Chapter 46
Chapter 47
Chapter 48
Chapter 49
Chapter 50
Chapter 51
Chapter 52
Chapter 53
Chapter 54
Chapter 55
Chapter 56
Chapter 57
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Examples of Health Determinants
Chapter 2
Table 2.1 Selected impacts of wider determinants on health and well‐being. ...
Chapter 3
Table 3.1 Long‐term conditions and main risk factors.
Chapter 4
Table 4.1 An example of medical priority bands.
Chapter 6
Table 6.1 Lifestyle factors impacting on health.
Chapter 7
Table 7.1 Social class based on occupation (Registrar‐General's Social Clas...
Table 7.2 National statistics socioeconomic classification analytic classes...
Chapter 9
Table 9.1 Motivational interviewing techniques.
Chapter 10
Table 10.1 The barriers to effective health education can be patient‐relate...
Table 10.2 Using the Kirkpatrick model in diabetic patients after a health ...
Chapter 12
Table 12.1 Self‐management.
Table 12.2 Some examples of self‐management support.
Chapter 17
Table 17.1 Eating disorder and anorexia.
Table 17.2 Some common signs and symptoms of anorexia.
Table 17.3 Diagnostic criteria.
Chapter 18
Table 18.1 Patterns of arthritis presentation.
Table 18.2 A summary of other forms of arthritis and rheumatological condit...
Chapter 19
Table 19.1 Patients at risk of developing near‐fatal or fatal asthma.
Chapter 22
Table 22.1 The symptoms and impacts of AF
a
.
Chapter 24
Table 24.1 Disorder and bulimia nervosa.
Table 24.2 Some of the common signs and symptoms of bulimia.
Chapter 25
Table 25.1 Forms of bronchiectasis.
Table 25.2 Suspect bronchiectasis in adults (NICE 2022).
Chapter 27
Table 27.1 Aetiology and risk factors for CFS.
Table 27.2 Symptoms experienced by ME/CFS patients.
Table 27.3 Investigations of a patient with suspected ME/CFS.
Chapter 28
Table 28.1 Mechanisms of action.
Table 28.2 Risk factors for venous insufficiency.
Chapter 29
Table 29.1 COPD symptoms.
Table 29.2 Medical Research Council (MRC) dyspnoea scale.
Chapter 33
Table 33.1 Insulin therapies (Joint Formulary Committee 2023).
Chapter 34
Table 34.1 Modifiable and non‐modifiable risk factors for T2D.
Table 34.2 HbA1c targets.
Table 34.3 Summary of medications for type 2 diabetes – refer to NICE (2022...
Chapter 36
Table 36.1 Key terminology.
Table 36.2 Structures of the large intestine and associated functions.
Table 36.3 Complications associated with diverticular disease.
Chapter 37
Table 37.1 Terminology used by the DVLA in relation to epilepsy.
Chapter 38
Table 38.1 Symptoms of heart failure.
Table 38.2 Stages of heart failure.
Chapter 39
Table 39.1 HIV medicines. Source: Tseng et al. (2015); British National For...
Chapter 40
Table 40.1 Symptoms of high blood pressure.
Chapter 41
Table 41.1 Diagnostic procedures for IBD.
Chapter 42
Table 42.1 Types of MS.
Chapter 43
Table 43.1 Cardinal features of Parkinson's.
Table 43.2 The non‐motor symptoms of Parkinson's.
Table 43.3 Medications used to treat Parkinson's.
Table 43.4 Medications to avoid in people with Parkinson's.
Chapter 44
Table 44.1 Risk factors for PAD.
Table 44.2 Interpretation of ABPI results (NICE 2021).
Chapter 46
Table 46.1 Medication and Monitoring of RA.
Chapter 47
Table 47.1 Treatment of sickling episodes.
Chapter 48
Table 48.1 Essential diagnostic requirements for schizophrenia (WHO 2019)....
Chapter 49
Table 49.1 Symptoms related to specific subtypes of dementia.
Chapter 50
Table 50.1 A summary of the hepatitides.
Table 50.2 Hepatitis at a glance.
Chapter 51
Table 51.1 Common eye conditions that can cause visual impairment (NICE 202...
Chapter 52
Table 52.1 Social care for older people with multiple long‐term conditions....
Table 52.2 Three crucial gaps identified in the FYFV.
Chapter 53
Table 53.1 Quality appraisal of evidence.
Chapter 54
Table 54.1 The nine dimensions of leadership.
Chapter 56
Table 56.1 Some therapeutic medications used in EoLC.
Chapter 57
Table 57.1 The six steps approach when considering ACP.
Table 57.2 The patient’s understanding of key information.
Table 57.3 The most commonly identified circumstances where ACP are not imp...
List of Illustrations
Chapter 1
Figure 1.1 The Rainbow model
Chapter 2
Figure 2.1 Equity, access, human rights, and participation; the four essenti...
Chapter 3
Figure 3.1 Long‐term conditions in numbers. England.
Figure 3.2 Prevalence of long‐term conditions in England. AF, atrial fibrill...
Chapter 4
Figure 4.1 Unhealthy, unsuitable and precarious housing.
Chapter 5
Figure 5.1 Public Health Liverpool: targeted health campaign.
Figure 5.2 The 3 Ps and surveillance.
Figure 5.3 Eight steps diagram for planning and implementing MECC.
Chapter 6
Figure 6.1 Factors associated with lifestyle.
Figure 6.2 Talking about lifestyles.
Chapter 7
Figure 7.1 An illustration of the relationship between socioeconomic group a...
Figure 7.2 Co‐morbidities between the most affluent and the most deprived....
Chapter 8
Figure 8.1 The whole is greater than the sum of its parts.
Figure 8.2 Holism and interconnectedness.
Figure 8.3 The House of Care (Licenced under the Open Government Licence v3....
Figure 8.4 Self‐management and long‐term conditions.
Chapter 10
Figure 10.1 Coaching skills in health education for patients.
Chapter 11
Figure 11.1 Deal for health and wellness.
Chapter 13
Figure 13.1 Examples of different types of support.
Figure 13.2 Carer well‐being model; factors affecting well‐being.
Chapter 14
Figure 14.1 Patient health‐related outcomes resulting from patient empowerme...
Figure 14.2 Key contributions to active participation.
Figure 14.3 Self‐management stages and indicators of empowerment.
Chapter 15
Figure 15.1 Person‐centred care model (NHS England 2021). Available at: http...
Chapter 16
Figure 16.1 Alcohol unit reference.
Chapter 19
Figure 19.1 Pathophysiology of asthma.
Chapter 20
Figure 20.1 Coronary artery disease showing healthy heart, angina pectoris, ...
Chapter 21
Figure 21.1 Considerations for health and social‐care professionals.
Figure 21.2 Types of anxiety.
Chapter 22
Figure 22.1 Atrial fibrillation.
Chapter 23
Figure 23.1 Visual representation of the different mood phases over time for...
Figure 23.2 Severity of the phases of bipolar across the spectrum to each ex...
Chapter 25
Figure 25.1 Representation of the cycle that leads to development of bronchi...
Chapter 26
Figure 26.1 People with cancer in the UK.
Figure 26.2 Cancer and co‐existing conditions.
Figure 26.3 Three broad cancer groups.
Chapter 27
Figure 27.1 The proposed aetiology, pathophysiological pathways and associat...
Chapter 28
Figure 28.1 Blood flow.
Chapter 29
Figures 29.1 Emphysema.
Figure 29.2 Bronchitis.
Chapter 30
Figure 30.1 Risk factors and manifestations of cardiovascular disease.
Figure 30.2 Pathophysiology of atherosclerosis and subsequent plaque rupture...
Chapter 31
Figure 31.1 Examination findings of the patient with CLD.
Chapter 32
Figure 32.1 Considerations for health and social‐care professionals.
Figure 32.2 Types of depression.
Chapter 33
Figure 33.1 How insulin works.
Figure 33.2 Regulation of blood glucose control.
Figure 33.3 Pathophysiology of T1D.
Chapter 34
Figure 34.1 Pathophysiology of type 2 diabetes.
Figure 34.2 HbA1c patient decision aid.
Chapter 35
Figure 35.1 Addiction, dual diagnosis and mental health.
Figure 35.2 An integrated treatment approach.
Chapter 36
Figure 36.1 Large intestine.
Figure 36.2 Diverticular pouch.
Chapter 37
Figure 37.1 Signs and symptoms of a seizure.
Chapter 38
Figure 38.1 Red flags for heart failure.
Chapter 39
Figure 39.1 Treatment pathway.
Chapter 40
Figure 40.1 Complications of hypertension.
Chapter 41
Figure 41.1 Common types of inflammatory bowel disease.
Chapter 42
Figure 42.1 Progressive course of multiple sclerosis. https://onlinelibrary....
Chapter 44
Figure 44.1 Leg ulcer management.
Chapter 45
Figure 45.1 Common locations of psoriasis.
Figure 45.2 Types of psoriasis.
Figure 45.3 Normal skin and psoriasis.
Chapter 46
Figure 46.1 Joint pain and the destruction of cartilage.
Chapter 47
Figure 47.1 Sickle cell.
Chapter 49
Figure 49.1 Vascular dementia symptoms.
Chapter 52
Figure 52.1 Leading change and adding value.
Chapter 53
Figure 53.1 Hierarchy of evidence: a framework for evaluating health‐care in...
Chapter 55
Figure 55.1 Pain pathway.
Figure 55.2 Example of assessment domains.
Figure 55.3 Classifications of pharmacological analgesics (examples).
Figure 55.4 Non‐pharmacology management strategies.
Guide
Cover Page
Title Page
Copyright Page
Contributors
Preface
Table of Contents
Begin Reading
Index
WILEY END USER LICENSE AGREEMENT
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Long-term Conditions in Adults at a Glance
Edited by
Aby Mitchell RGN, MSc, PGCert, BA, FHEA
Senior Lecturer in Nursing Education, Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King’s College London
Barry Hill MSc Adv Prac, PGCAP, BSc (Hons) CCRN, DipHE/O.A. Dip, SFHEA, TEFL, NMC RN RNT/TCH V300
Associate Professor, Nursing Science and Critical Care; Director of Employability, Northumbria University, UK
Ian Peate OBE FRCN
Editor in Chief British Journal of Nursing. Visiting Professor St Georges University of London and Kingston University London; Visiting Professor Northumbria University; Professorial Fellow Roehampton University; Visiting Senior Clinical Fellow University of Hertfordshire
This edition first published 2023© 2023 by John Wiley & Sons Ltd
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Library of Congress Cataloging‐in‐Publication DataNames: Mitchell, Aby, editor. | Hill, Barry (Lecturer in nursing), editor. | Peate, Ian, editor.Title: Long‐term conditions in adults at a glance / Aby Mitchell, Barry Hill, Ian Peate.Other titles: At a glance series (Oxford, England)Description: First edition. | Hoboken, NJ : Wiley‐Blackwell, 2023. | Series: At a glance series | Includes bibliographical references and index.Identifiers: LCCN 2023000297 (print) | LCCN 2023000298 (ebook) | ISBN 9781119875871 (paperback) | ISBN 9781119875888 (adobe pdf) | ISBN 9781119875895 (epub)Subjects: MESH: Chronic Disease | Adult | Socioeconomic Factors | Life Style | Patient Education as Topic | Self‐Management | HandbookClassification: LCC RB127 (print) | LCC RB127 (ebook) | NLM QZ 39 | DDC 616/.0478–dc23/eng/20230516LC record available at https://lccn.loc.gov/2023000297LC ebook record available at https://lccn.loc.gov/2023000298
Cover Design: WileyCover Image: © SEBASTIAN KAULITZKI/SCIENCE PHOTO LIBRARY/Getty Images; SCIEPRO/Getty Images; SCIEPRO/SCIENCE PHOTO LIBRARY/Getty Images
Contributors
Claire Anderson [Chapter 53]Interim Deputy Dean Berkshire, College of Nursing Midwifery and Healthcare, University of West London, London
Pamela Arasen [Chapter 10]Senior Lecturer in Critical Care Nursing, University of West London (UWL), London
Emily Ashwell [Chapter 18]Community Case Manager Nurse, Buckinghamshire Healthcare NHS Trust
Daren Bailey [Chapter 35]Crisis Resolution and Home Treatment Team Hub Manager, Berkshire Healthcare NHS Foundation Trust
Rachael Betty [Chapter 13]RMHN and Trainee Academic Advisor for the Accredited Learning Centre; Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust
Sarah Bisp [Chapter 32]Lecturer Mental Health Nursing, Northumbria University, Newcastle
Daniela Blumlein [Chapter 1]Senior Lecturer in Adult Nursing, University of West London, London
Roberta Borg [Chapter 27]Advanced Critical Care Practitioner (ACCP), The Newcastle upon Tyne Hospitals NHS Foundation Trust
Angela Childs [Chapter 23]Specialist Clinical Mental Health Practitioner/Deputy Service Manager East Berkshire CRHT
Sadie Diamond‐Fox [Chapter 30]Strategic Lead for Advanced Practice Programmes and Assistant Professor in Advanced Critical Care Practice at Northumbria University, Advanced Critical Care Practitioner at Newcastle upon Tyne Hospitals and Supervision and Assessment Lead for Advanced Critical Care Practice at Health Education England North East and Yorkshire
Jane Douglas [Chapter 46]Assistant Professor, Adult Nursing,Northumbria University, Newcastle
Claire Ford [Chapter 51]Programme Lead for MSc Nursing and Assistant Professor Adult Nursing, Northumbria University, Newcastle
Caitlin Gallon [Chapter 51]Registered Nurse in Ophthalmology, The Newcastle upon Tyne Hospitals NHS Foundation Trust
Charlotte Gordon [Chapter 34]Assistant Professor, Adult Nursing, Northumbria University, Newcastle
Ian Griffiths [Chapter 1]Senior Staff Nurse, Medical Infusions, Royal Berkshire NHS Foundation Trust
Annette Hand [Chapter 43]Clinical Academic Professor of Nursing at Northumbria University, Newcastle
Barry Hill [Chapters 9,12,19,20,22,25,29,38,40,42,47,52,54]Associate Professor, Nursing Science and Critical Care; Director of Employability, Northumbria University, UK
Vishal Jugessur [Chapter 23]Service Manager Crisis Resolution Home Treatment Team, Registered Mental Health Nurse and Nonmedical Prescriber, Berkshire Healthcare Foundation Trust
Giuseppe Leontino [Chapter 3]Senior Lecturer in Simulation and Immersive Technologies, University of West London, London
Louise Lingwood [Chapter 3]Assistant Professor in Mental Health Nursing at Northumbria University, Newcastle
Jemma‐Louise McCann [Chapter 56]Advanced Clinical Practitioner / District Nurse, Non‐medical Prescriber, Community Practice Teacher, Berkshire Healthcare Foundation Trust
Aby Mitchell [Chapter 28]Senior Lecturer in Nursing Education, Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King’s College London
Tichaona Mubaira [Chapters 17,24]Clinical Nurse Specialist, Crisis Resolution and Home Treatment Services, Berkshire Healthcare NHS Foundation Trust and Associate Lecturer, University of West London, London
Karl Nicholl [Chapter 46]Biologics Nurse Specialist in Rheumatology, the Freeman Hospital, Newcastle upon Tyne
Laura Park [Chapters 36,55]Lecturer, Adult Nursing, Northumbria University, Newcastle
Reuben Pearce [Chapter 48]Nurse Consultant, Crisis and Home Treatment Services, Berkshire Healthcare NHS Foundation Trust and Associate Lecturer, University of West London, London
Ian Peate [Chapters 2,4–8,11,26,37,39,45,49,50]Editor in Chief British Journal of Nursing. Visiting Professor St Georges University of London and Kingston University London; Visiting Professor Northumbria University; Professorial Fellow Roehampton University; Visiting Senior Clinical Fellow University of Hertfordshire
Helen Phillips [Chapter 16]Drug Alcohol and Smokefree Lead, Mental Health Inpatients, Berkshire Healthcare
Helen Robson [Chapter 48]Nurse Consultant, Inpatient MH Services, Berkshire Healthcare Foundation Trust
Lucy Saunders [Chapter 24]Assistant Psychologist and QMIS/Carers Co‐ordinator at Crisis Resolution and Home Treatment Team (CRHTT) West, Berkshire Healthcare NHS Foundation Trust
Sara Sinclair [Chapters 56,57]SPQ District Nursing Team Leader, Berkshire Health Foundation Trust
Kelley Storey [Chapter 43]Parkinson’s Disease Nurse Specialist, Newcastle upon Tyne Hospitals NHS Foundation Trust
Sara Tavares [Chapter 14]Heart Failure Specialist Nurse, Non‐medical Prescriber and Immersive Technologies at University of West London, London
Sue Tiplady [Chapter 15]Assistant Professor Nursing Science, Northumbria University, Newcastle upon Tyne
Leticia Wedderburn [Chapters 16,35]Urgent Care Dual Diagnosis Coordinator and Psychological Medicine Practice Development Nurse, Wexham Park Hospital, Berkshire
Preface
In the 70 years since the founding of the NHS, life expectancy has increased by around 13 years. But different types of diseases are becoming more common. More people are living with cancer or dementia largely due to increases in life expectancy and falls in the rate of premature death. With advances in prevention and medical care the UK mortality rate from heart and circulatory diseases has declined by more than three quarters in the last 40 years. But cardiovascular disease remains the biggest cause of premature mortality and the rate of improvement has slowed. Long‐term conditions or chronic diseases are conditions for which there is currently no cure, and which are managed with drugs and other treatment, for example: diabetes mellitus, chronic obstructive pulmonary disease, arthritis, and hypertension. Longer‐term health conditions also make an increasing contribution to the overall burden of disease. Mental health, respiratory and musculoskeletal conditions are responsible for a substantial amount of poor health and place a substantial burden on the NHS and other care services. The latest Global Burden of Disease study shows that the top five causes of early death for the people of England are: heart disease and stroke, cancer, respiratory conditions, dementias, and self‐harm. It also reveals that the slower improvement since 2010 in years‐of‐life‐lost is mainly driven by distinct condition‐specific trends, predominantly in cardiovascular diseases and some cancers.
There are currently 15.4 million people in England with an LTC. Due to an ageing population, it is estimated that by 2025 there will be 42% more people in England aged 65 or over. This will mean that the number of people with at least one LTC will rise by 3–18 million. People with LTCs account for a significant and growing proportion of health and social care resources. The Department of Health's best estimate is that the treatment and care of people with LTCs account for 70% of the total health and social care spend in England, or almost £7 in every £10 spent. Social care expenditure, too, is focused on those with LTCs and will be put under pressure by the ageing population. By 2022 the proportion of those aged 65 and over will increase by 37% to 10.8 million; the number of people aged 65 and over with some disability will increase by 40% to 3.3 million; the number of disabled older people receiving informal care (in households) will rise by 39% to 2.4 million; the number of people in residential care homes will increase by 40% to 280 000; and the number of people in nursing homes will increase by 42% to 170 000. This need for social care will mean that by 2022 public expenditure on long‐term care will rise by 94% to £15.9 billion. The total long‐term care expenditure is forecast to rise by 29% to £26.4 billion. This is equivalent to a rise from 1.4% to 1.8% of GDP.
Health‐care professionals are in a key position to support patients with long‐term conditions attain a better quality of life through purposeful interventions that aim to minimise symptoms, reduce the intensity and frequency of acute exacerbations of the disease and enhance psycho‐social well‐being. Several public consultations such as ‘Independence, Well‐being and Choice’ (GOV.UK) and ‘Your Health, Your Care, Your Say’ (NHS) have provided consistent messages from people with long‐term conditions about what is important to them. Overall, people say they want services that support them to remain as independent and healthy as possible. They want increased choice, with information to help them make choices and to understand and manage their conditions better. They want far more services delivered safely and effectively in the community or at home, with more seamless, proactive, and integrated services that are personalised to them and their needs.
Part 1Long‐term conditions: sociological factors
Chapters
1
Determinants of health
2
Health inequalities
3
Environmental factors
4
Housing
5
Public health
6
Lifestyle factors
7
Socioeconomic status
8
Holistic needs assessment
1Determinants of health
Daniela Blumlein and Ian Griffiths
Figure 1.1 The Rainbow model
Source: Dahlgren and Whitehead 1991.
Table 1.1 Examples of Health Determinants
Category
Examples of Health Determinants
Biological Factors
Age, sex, inherited illnesses, genetics, co‐morbidities, old age
Personal Lifestyle Factors
Smoking, obesity, alcohol consumption, substance abuse, level of physical activity
Social and Community Networks
Family connections, circle of friends, social isolation, loneliness
Living and Working Conditions
Employment status, level of education, access to clean water, sanitation, healthcare services, quality of housing, exposure to pollution, food production methods
Socioeconomic, Cultural, and Environmental Conditions
Conflicts and wars, droughts, floods, climate crisis, crime, economic issues like recessions and inflation, food security, pandemics
Determinants of Health
This chapter explores the intricate concept of health determinants, endeavouring to establish an understanding of how various influences can impact and shape an individual's health trajectory throughout their lifespan. The concept of health extends far beyond the absence of illness; it is a state of complete physical, mental, and social well‐being. Health is a resource for everyday life, not merely the objective of living, which underscores the importance of health determinants.
When we discuss an individual's well‐being and health, it necessitates more than the absence of a specific illness or health disorder, whether physical or mental. The holistic health and well‐being of a person are influenced by an assortment of known factors. These elements can generate either positive or negative effects on a person's physical or mental health and are generally recognised as 'determinants of health'.
Among the seminal models in understanding these determinants is the Rainbow model (Figure 1.1). Despite its years of inception, this model remains to be a cornerstone in health discussions and is widely applied today. It offers a comprehensive framework outlining how external and internal factors, along with various root causes, can significantly impact a person's overall health and well‐being.
The Impact of Determinants of Health
Health inequalities persist as a global challenge, making their presence felt in almost every country around the world. The living conditions of an individual, influenced by an array of societal factors, significantly contribute to these disparities, directly and indirectly affecting their health outcomes.
Researchers and health professionals have identified various determinants of health (Table 1.1), with the following being some of the most pivotal:
Biological factors:
Age, sex, and constitutional factors such as inherited illnesses and genetics play a crucial role. Co‐morbidities or the inevitability of old age can significantly influence health outcomes.
Personal lifestyle factors:
Health is greatly influenced by personal behaviours and habits. Factors such as smoking, obesity, alcohol consumption, substance abuse, or the level of physical activity can determine a person's health trajectory.
Social and community networks:
The importance of social and community connections is paramount. A strong support system in the form of family, friends or a social circle can contribute positively to health outcomes, whereas loneliness and social isolation can have the opposite effect.
Living and working conditions:
A person's living and working conditions are significant health determinants. They include elements such as employment status, level of education, access to clean water, sanitation and healthcare services, housing quality, exposure to pollution, and food production methods.
Socioeconomic, cultural, and environmental conditions:
Wider societal issues, including conflicts and wars, droughts, floods, climate crisis, crime, economic turbulence such as recessions and inflation, food security, and pandemics, also bear heavily on health.
The Rainbow model shifts the focus onto these wider aspects that may influence an individual's health. It moves beyond a strictly medicalised model, which often centres on treating an illness without addressing its wider causes or potential preventative measures. This broader perspective is crucial as it allows policy makers and healthcare professionals to collaborate closely with other professionals, developing strategies that provide a structured pathway to addressing each of the determinants of health.
For instance, if substandard housing conditions emerge as a significant issue, a broad range of professionals may be called upon to address the problem. This multidisciplinary team might involve architects, housing officers, healthcare professionals, police forces, environmental services, and community representatives.
Another way to consider health determinants is through a comparison of individuals living in starkly contrasting environments. Consider a person residing in a war‐torn country, confronted with the daily realities of violence, fear, and famine, against someone living in a peaceful country, with ready access to a variety of foods and high‐quality healthcare services. The overall well‐being of these two individuals would be remarkably different, largely influenced by the determinants of health.
The task of addressing these health inequalities and ensuring equal access to healthcare services is paramount and complex. Policy makers shoulder a substantial responsibility to legislate for a more equitable society. In the UK, attempts have been made towards this through the implementation of the Care Act (Department of Health, 2014) and the NHS 10‐Year Long Term Plan (NHS, 2018). These measures aim to enhance access to services and support individuals in maintaining good health throughout their lifespan. Ensuring these services are provided at every life stage, from prenatal to end‐of‐life care, is crucial.
A comprehensive understanding of the determinants of health is instrumental in forging policies and strategies aimed at improving population health and reducing health inequalities. By exploring the breadth and depth of these determinants, we open avenues for intervention, prevention, and health promotion, ultimately empowering individuals, and communities to achieve optimal health and well‐being.
2Health inequalities
Ian Peate
Figure 2.1 Equity, access, human rights, and participation; the four essential principles underpinning social justice.
Table 2.1 Selected impacts of wider determinants on health and well‐being.
Source: Adapted from Williams et al. 2020.
Sector
Examples
Income
Income has the potential to determine a person's ability to buy health‐improving goods, for example, food to membership to a gym. Attempting to cope on a low income is a cause of stress and it can also affect the way people make choices regarding health affecting behaviours
Housing
Overcrowded housing and poor‐quality housing stock are correlated with an increased risk of cardiovascular diseases, respiratory diseases, depression as well as anxiety. In those colder homes, when external temperature falls, death rates increase much faster. Households from minority ethnic groups are more likely than white households to live in overcrowded homes and to experience fuel poverty.
Environment
Being able to access to good‐quality green space has been associated with improvements in physical and mental health as well as decreased levels of obesity. Those in deprived areas and in those areas with higher proportions of minority ethnic groups have poorer levels of access to green spaces. Exposure to air pollutants has been linked to deprivation and ethnicity. Within the most deprived areas of London, for example, people from non‐white groups have been found to be more exposed to higher concentrations of one of the main pollutants associated with traffic fumes – nitrogen oxide.
Transport
People who are living in the most deprived areas have a 50% greater risk of dying in road accident than those living the in the least deprived areas. Children in deprived areas are four times more likely to be killed or injured on the road than those in wealthier areas.
Education
People with a university degree or an equivalent level of education at age 30 years can expect to live more than 5 years longer than those with lower levels of education.
Work
Lower life expectancy, poorer physical, and also mental health are linked with unemployment for individuals who are unemployed and also for those in their households. The quality of work and this includes exposure to hazards, job security, and whether the job/type of work promotes a sense of belonging, impacts physical, and mental health.
The social determinants of health are the broad social and economic circumstances that when brought together can influence a person's health throughout their lives (see Chapter 1). A number of these determinants that contribute to health can result in health inequalities with those people who are poorer experiencing worse health outcomes than those who are better off.
Social justice
Social justice is concerned with making society function better. It is about fairness, fairness in health care, employment, housing and more, providing people with the support and the tools they need to help them turn their lives around with a focus on prevention and early intervention. Where problems emerge, there needs to be a focus on interventions related to recovery and independence as opposed to maintenance. Social justice and discrimination are incompatible concepts. There are a number of key drivers that underpin any social justice strategy, for example, wealth, education, privilege, opportunities, and health.
There are four essential principles associated with social justice (see Figure 2.1). Without these four principles social justice cannot be achieved: human rights, access, participation, and equity.
Reducing health inequalities is seen as a driving force for the NHS and Public Health as the best evidence of how health is improving; it is however complex. There are many causes of health inequalities; few of these causes are directly related to the provision of health and social care. Health inequalities are irrefutably related to social justice.
The lower a person's social position, the worse their health outcomes are likely to be. Health inequalities cannot be attributed simply to genes, unhealthy behaviour, or difficulties in access to medical care, important as those factors may be. There is often a tendency to apportion ‘blame’ to individuals and groups, but the reality is far more complex.
Health inequalities
Health inequalities are avoidable and unfair differences in health status that occur between groups of people or communities. They can include inequality in health outcomes by socioeconomic status or level of deprivation or by characteristics, for example, gender, ethnic group, or sexual orientation. Some individuals and families face multiple disadvantages and they do not always receive the support that they need, when they need it.
Health inequalities are avoidable, unfair, and systematic differences in health between different groups of people. There are many kinds of health inequality, and many ways in which the term is used. This means that when we talk about ‘health inequality’, it is useful to be clear on which measure is unequally distributed, and between which people.
When discussing health inequality it is essential that all aspects of health, including physical, mental and emotional are addressed. The concept of ‘well‐being’ must also be given consideration. A person may have a incapacitating long‐term condition, however, they may be enjoy a satisfying life; similarly a person could appear to be in good physical health but they may lack the desire and enthusiasm to achieve their full potential (whatever this is for them).
Impact of health inequalities
The term health inequalities is often used to also make reference to differences in the care that individuals receive and the opportunities they have in order to lead healthy lives. Both can influence a person's health status. Health inequalities can be associated with differences in:
health status, for example, life expectancy and frequency of health conditions
accessing care, for example, availability of treatments
quality and experience of care, for example, levels of patient satisfaction
behavioural risks to health, for example, smoking rates
wider determinants of health, for example, quality of accommodation.
Variations in health status and those factors that determine it can be experienced by people who are grouped with respect to a variety of issues. Often, health inequalities can be analysed and addressed by cross cutting policy:
such as socioeconomic factors, for example, income
geography, for example, region or whether urban or rural
particular characteristics including those that are protected in law, such as sex, ethnicity, or disability
those groups who are socially excluded, for example, people who experience homelessness.
The wider determinants of health
The wider determinants of health are the social, economic, and environmental conditions in which people live that have an impact on their health. These include income, education, access to green space and healthy food, the work that people do and the homes in which live in.
When taken together, these factors are the key drivers of how healthy people are and that any inequalities in these factors will be a fundamental reason for health inequality. In reducing health inequalities therefore, it is paramount to address the wider social–economic inequalities. In Table 2.1 a number of examples are given regarding health impacts concerning the wider determinants. In the examples provided they emphasise the individual determinants; these determinants however are frequently experienced together and increase over time.
Relieving the effects of health inequalities
Actions that are more likely to be successful in relieving the effects of health inequalities at an individual level will require a revision of public services and health‐care professionals must have a significant input in any change. Redesign of public services will include targeting high‐risk individuals, and intensive personalised support for those who have most need, along with a focus on early child development.
Stark health inequalities remain and they continue to damage the lives of many people locally, nationally and internationally. There are some groups of people who die much earlier and spend more of their life in ill health than others. This is not happening by chance. These health inequalities are the result of a range of social, economic, and environment factors essentially beyond people's individual control. This is unjust and unfair. They are not inevitable and they can be reversed. All of us should have the opportunity to live a long life, in good health.
3Environmental factors
Giuseppe Leontino
Figure 3.1 Long‐term conditions in numbers. England.
Table 3.1 Long‐term conditions and main risk factors.
Source: Available from https://www.sciencedirect.com/science/article/pii/S2214999616000059#appsec1
Disease
Exposure
Asthma
Tobacco smoke
Ambient/household air pollution
Ecological exposure to PCBs
COPD
Tobacco smoke
Ambient/household air pollution
Ecological exposure to PCBs
POPs
Gastrointestinal dysbiosis
Cancer
Ambient air pollution
Arsenic
POPs
CVDs
Tobacco smoke
POPs
Ambient air pollution
Household air pollution
Ambient noise
T2D
POPs
Bisphenol A/phthalates
Ambient air pollution
HYP
Tobacco smoke
POPs
Ambient air pollution
Arsenic (drinking water)
Neurodegenerative disorder
Heavy metals
Air pollution
Herbicides
Figure 3.2 Prevalence of long‐term conditions in England. AF, atrial fibrillation; HF, heart failure; HYP, hypertension; STIA, stroke and ischaemic attack; CHD, coronary heart disease; COPD, chronic obstructive pulmonary disease; AST, asthma; CAN, cancer; CKD, chronic kidney disease; DM, diabetes mellitus; DEM, dementia; DEP, depression; EP, epilepsy; LD, learning disability; MH, mental health; OST, osteoporosis; RA, rheumatoid arthritis.
Long‐term conditions (LTCs) are chronic health conditions that do not have a cure but that can be managed by medications or other therapies. Figure 3.1 gives a snapshot of the current situation in England whilst Figure 3.2 provides an insight around prevalence of LTCs.
The World Health Organization (WHO) produced evidence that ascribed 24% of the global disease and 23% of all deaths to long‐term environmental exposures in adults, and up to 36% in children aged 0–14 years old.
The environment is made of different elements that contribute to improving and diminishing people's health depending on accessibility to:
clean air and water
transportation
green spaces and cycle lanes
wellness facilities.
Environmental health is concerned with elements of the environment that are directly affected by human activities like man‐made structures, and those linked to the intrinsic meaning of nature itself like geography. Geographical characteristics influence the climate and the resources available to people. For instance, direct sunlight exposure promotes healthy levels of vitamin D. In the United Kingdom (UK) 34% of men and 33% of women have been found to be deficient in this rather life‐essential hormone. In fact, the UK has lower overall vitamin D status compared to Western Europe. Levels of vitamin D < 25 nmol/l can lead to:
rickets
osteomalacia
osteoporosis.
The recommended levels of vitamin D of more than 50 nmol/l can be maintained by fortifying foods like wheat flour or supplementation:
8.5–10 μg of vitamin D a day for babies up to the age of one years old
10 μg of vitamin D a day for children from the age of one years old and adults.
Physical factors
LTCs may originate from an inflammatory response mechanism derived from consistent and prolonged exposure to toxins present in all aspects of the physical environment:
soil
aquatic
atmospheric
built ecosystems.
