Adult Health Issues Flashcards
disease profile of australian adults
chronic disease
define multimorbidity & why is it common
having more than one chronic disease
common due to non-curative nature of chronic disease so accumualte overtime
chronic diseases (biological factors) are exacerbated by ___________ factors & why
psychosocial issues
- commonly increase among older population as they become less connected with society
most prevalent chronic conditions in australia (descending order)
- mental and behavioural conditions
- back problems
- arthritis
- asthma
- diabetes
- heart, stroke, vascular disease
- osteoporosis
- COPD
- cancer
- kidney disease
measure of burden of disease
disability adjusted life year = DALY
what makes up DALY
years lived with disability (YLD) ie/ morbidity + years of life lost (YLL) ie/ premature mortality
burden of disease due to risk factors - top 5 RF
- tobacco use
- overweight
- dietary factors
- high blood pressure
- alcohol use
large proportion of burden of disease in australia are actually _____
preventable
covid-19 in australia 2022 was the ____ leading cause of death
this tended to affect which population
3rd-leading
elderly
obesity itself is a ____ ___ for multiple conditions such as:
risk factor
- heart disease
- OSA
- high cholesterol
- some cancers
- diabetes
- hypertension
- stroke
- osteoarthritis
- liver disease (esp fatty liver)
obesity tends to increase as a society becomes more ______
developed
close to x/3rd of australian adults are obese
1/3rd
prevalence of obesity has steadily been increasing
is the burden of chronic diseases affecting the healthcare system
yes
a challenge affecting the healthcare system is cost or lack of _____ in australia
expenditure
cost of healthcare in australia has been steadily ______ both in terms of _____ care as well as cost per ____
- increasing
- absolute
- person
what is the only way to deal with chronic disease and why
- prevention
- because it is incurable once onset
bulk of health care expenditure is devoted to ___________ _______ not curative healthcare
preventative healthcare
how many levels of prevention are there
3
primary, secondary, tertiary
primary prevention is aimed at preventing
intervention aimed at reducing risk of onset of disease
ie/ dealing with risk factors for that disease
eg/ for CHD - incr exercise, lowering bp, lipid lowering drugs
secondary prevention is aimed at preventing
interventions that reduce risk of disease progression
- very often this means recurrence of that disease
eg/ CHD - surgery coronary arteries,
tertiary prevention aimed at preventing
(rarely used)
interventions that prevent end terminal point of that disease pathway
ie/ mortality or further morbidity
whether an intervention is primary or secondary depends on what
what reference disease actually is
who put out the National Preventive Health Strategy
how long is it
- aus gov
- 10yr strategy
- macro level
the focus areas of the National Preventive Health Strategy are to
- decr tobacco and nicotine use
- improving access to healthy diet
- improving access to physical activity
- improving access to cancer screening and prevention
- improving immunisation
- decr alcohol and other drug harm
- promoting and protecting mental health
the focus areas of Strategy align with what
major disease burden risk factors
2 common cancer screening strategies in australia
- bowel cancer screening
- breast cancer screening
who receives bowel cancer screening and when
- eligible australians aged 50-74
- mailed free test done at home (FOBT)
- every 2 years
bowel cancer screening program aims to
reduce deaths from bowel cancer
by detecting early signs of disease
if bowel cancer is found early, more than __% of cases can be successfully treated
90%
people undergoing screening for bowel cancer criteria:
- don’t currently have bowel cancer
- are not high risk for bowel cancer (eg/ from previous condition like polyp, strong family history)
ie/ the general population with average risk
who receives breast cancer screening and when
- women over 40yrs old
- can have free mammogram
- every 2 years
- program actively invite 50-74yr olds
breast cancer screening program aims to
reduce illness and death from breast cancer (breast cancer morbidity and mortality)
by detecting disease early
age group invited to have these screens have
higher likelihood of having this disease
people undergoing screening for breast cancer can have: (would be helpful for them)
- previous breast cancer
- high risk (eg/ strong family history)
as well as general population
[pitfalls of prevention] what is the prevention paradox
great benefit to the community, little average benefit to individuals
[pitfalls of prevention] in order for prevention to be effective, ___ need to undergo preventive intervention in order to prevent ill-health in a __
- many
- few[
[pitfall of prevention] can be ____ and potentially have ____ ____
(be cautious of preventive strategies still)
- costly
- adverse effects (eg/ radiation exposure from mammograms)
screening is distinct from _______
diagnosis
- does not confirm presence of disease that has been screened
screening is applied to which individuals, otherwise it is not a screening strategy
asymptomatic, well
positive screening tests need subsequent ______ _____
provide a reason why
diagnostic confirmation
there are potentially other causes for the positive screening result
eg/ many conditions other than bowel cancer that can have bleeding from GI tract
eg/ not all masses detected on mammogram are breast cancer
problems with screening
hence need _____ ____
- false negatives (miss some cancers)
- false positives (poss misdiagnose conditions)
hence need subsequent diagnostic confirmation
likely subsequent diagnostic methods following bowel cancer screening and breast cancer screening
bowel cancer: FOBT
-> colonoscopy
breast cancer: mammography
-> biopsy of detected mass
false positives can be problematic because
- patient has to go unnecessary diagnostic testing - that may be physically or emotionally traumatic
possibility that screening may not lead to ____ ___
provide example
overall benefit
screening may pick up on slow growing cancers
subsequent management of these cancers may not have changed their prognosis overall had they not be screened
- eg/ cancer detected later on in natural course
- eg/ cancer may not have needed to be treated because so slow growing
clinical preventive interventions aim at preventing ___-___ disease, not curing ____ ___
- end-stage
- risk factor (generally not curable)
what is an example of a preventative intervention that has inherent adverse effects and can be costly particularly as they can be in use for a long time
medications
[compression of morbidity graph] goals of care at a macro level (should be this)
increase health span - less morbidity
not necessarily to increase lifespan (may be lifespan to some extent - delay death)
[compression of morbidity graph] goal is to have what shape
- square
- someone lives in very good health until they die; with minimal or no time having morbidity before death
- time spent in good health may or may not be longer
[compression of morbidity graph] prioritising ____ over trying to increase _____
ie/ ? > ? which most patients prefer
- morbidity
- lifespan
ie/ quality of life > quantity of life
value-based healthcare equation
value =
health outcomes that matter to patients / costs of delivering the outcomes
value-based healthcare is a ____ model
funding
value-based healthcare talks about reimbursing providers of health services only if…..
they achieve good outcomes - as defined by the patient (not by clinicians)
consumer first rather than provider
current funding model in australia is ‘fee for service’ which says that
hence it does not incentivise ____
if we deliver a particular service we get reimbursed for it, regardless of outcome of that service
- outcomes
