A ‘vicious cycle’: The relationship between disability and chronic conditions

‘There is a two-way relationship between disability and chronic disease,’ Professor Mark Harris, GP and Professor of General Practice at the University of New South Wales, told newsGP.
 
That relationship is made clear in Chronic conditions and disability 2015, the latest report from the Australian Institute of Health and Welfare (AIHW) demonstrating that chronic conditions – which have become Australia’s leading cause of illness and death – are also strongly associated with disability.
 
The AIHW estimates that more than 5.4 million people in Australia have one of eight common chronic conditions: coronary heart disease, stroke, diabetes, arthritis and related disorders, back pain, osteoporosis, asthma and emphysema.
 
Of these, 50% also had a disability, and almost all of these were more likely to report more than one chronic condition than those without a disability.
 
Associate Professor Robert Davis, GP and Chair of the RACGP Specific Interests Disability network, has found in the course of his practise that many patients with disability have more than one chronic condition.
 
‘Many times it’s multiple diseases, particularly people with metabolic disorders who have cardiovascular problems, hypertension, weight problems and high cholesterol,’ he told newsGP.
 
According to Professor Mark Harris, the association between chronic conditions and disability is often explained by the physical limitations both impose on patients.
 
‘The nature of disability, particularly physical disability, is that people are less mobile and less able to engage in physical activity,’ he said. ‘That makes them more vulnerable to a whole range of these long-term conditions, as well as to falls and injury.
 
‘Also, because these patients are engaged in less physical activity, [conditions such as] coronary heart disease, stroke, diabetes, osteoporosis are likely to be worse, or they tend to have greater risk of those things.’
 
Professor Harris emphasises that it is also important to consider issues of mental health.
 
‘Disability and chronic disease are both associated with depression – both [conditions] can limit social and employment activities, and that can have an effect on people’s mental state,’ he said.
 
‘That depression can then make it more difficult for them to follow a healthy lifestyle in terms of diet and physical activity. So they might be more prone to weight gain, which might make them more likely to develop diabetes or arthritis in their joints.’
 
Professor Harris believes the AIHW report can serve as an important reminder for GPs to keep in mind the associations between disability and chronic conditions, and their implications for patient care.
 
‘For the GP, the thoughts are about prevention, so trying to prevent disability in someone who’s got a chronic disease,’ he said. ‘And in people with disability, trying to prevent the development of additional chronic conditions, because the more chronic conditions you’ve got, the more problems you’re likely to have, so you get into this vicious cycle.’
 
Associate Professor Davis agrees, and believes that GPs have a central role in terms of intervening in this particular health issue.
 
‘The big point is that GPs are intimately involved with [the care of] people before, after and during disability and chronic illness, and the most cost-effective way of dealing with these is preventive health,’ he said.
 
‘So decreasing the rates of cardiovascular disease, stroke, emphysema, diabetes, osteoporosis – GPs are part of that, in terms of patient education and early identification.
 
‘And likewise, if people develop these problems early on and they’re treated appropriately, you can deal with the illness before the person develops a disability, as well.’
 
Associate Professor Davis believes it is important for primary healthcare to be supported in efforts to reduce disability and chronic conditions.
 
‘Supporting primary healthcare has a positive effect on the amount of disability in the community and the cost involved in that,’ he said.
 
‘GPs have an important preventive role, if and when people do develop these diseases … It’s really part of what GPs do.’

chronic conditions chronic disease disability multimorbidity