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Chronic Disease Management Guide for Patients and Families

Written by: University of Tulsa   •  Dec 20, 2023
Nurse Sitting on a Couch With an Older Adult Patient and Another Adult.

Chronic Disease Management Guide for Patients and Families

Chronic diseases are one of the most significant health care challenges facing the U.S., especially older demographics. Most chronic diseases are incurable, which means that people with these afflictions must prioritize chronic disease management and mitigation. For patients, that entails maintaining a close relationship with their health care providers and following their treatment plans as closely as possible.

Chronic diseases impact not only the individuals who have them but also their friends, family, and co-workers. Although chronic diseases pose a long-term challenge, many can be effectively managed, allowing those with these afflictions to carry on with their day-to-day activities and have a high quality of life. By comparison, those who don’t properly manage their chronic conditions run the risk of decreased quality of life and shorter life expectancy.

To fully comprehend chronic disease management, getting familiar with the most relevant statistics, the common types of chronic conditions, and the best practices and resources available to patients is important.

What’s a Chronic Disease?

According to the Centers for Disease Control and Prevention (CDC), a chronic disease is broadly defined as any medical condition that lasts longer than a year and requires chronic disease management. By comparison, acute conditions typically develop suddenly and last days or weeks, such as the common cold or flu.

In addition to how long they last, chronic diseases are also commonly linked with conditions that hinder daily living or reduce the ability to conduct everyday activities and work-related functions. Diabetes, cancer, and heart disease remain the most prevalent chronic diseases affecting U.S. adults. If these chronic conditions aren’t properly managed, they’ll steadily worsen, potentially leading to increased severity in symptoms and shortened life expectancy.

Chronic Disease Relevant Statistics

Statistically, the prevalence of chronic diseases is steadily increasing as are the nation’s health care costs associated with chronic disease management. The following are some of the most relevant chronic disease statistics:

  • The National Council on Aging (NCOA) reports that 95% of older adults live with one chronic disease; 80% have two or more.
  • According to the U.S. Census Bureau, populations aged 65 and over represented 4.7% of the population in 1920; in 2020, they represented 16.8%, meaning the patient demographic most vulnerable to chronic disease has more than tripled in the past century.
  • Chronic diseases are the primary drivers of the country’s $4.1 trillion annual health care costs, according to NCOA.
  • Chronic pain and diabetes are the most expensive chronic conditions: Chronic pain costs $635 billion annually, and diabetes costs $327 billion annually, according to a recent NCOA report.
  • Heart disease impacts more than 79 million people and is the cause of over 40% of deaths, according to the American Hospital Association (AHA).
  • 26% of the population have hypertension, according to the AHA.
  • The number of people with diabetes has more than doubled in the past 15 years, according to the AHA.
  • The AHA reports a direct correlation between the rise of chronic diseases and the rise in health care costs.
  • According to the AHA, active nonsmokers have an 11% chance of developing heart disease, stroke, or diabetes by age 65; by comparison, an inactive smoker has a 58% chance of developing these chronic conditions.

The Most Common Types of Chronic Diseases and Conditions

The data shows that older demographics are at the highest risk of developing a chronic condition that must be managed. Additionally, the data attributes the majority of the nation’s health care costs to chronic conditions. The sections below explore the most common chronic diseases and conditions currently impacting the U.S. population.

Heart Disease

Heart disease is a broad term used to describe numerous heart conditions. For example, coronary artery disease — a condition that affects the organ’s blood flow — is categorized as heart disease. The primary symptoms of heart disease include arrhythmia, heart attack, and heart failure and can result in:

  • Discomfort or pain in the chest
  • Palpitations in the chest
  • Shortness of breath
  • Dizziness
  • Heartburn
  • Extreme fatigue
  • Swelling in the legs, abdomen, or neck

According to the CDC, approximately 695,000 deaths in the U.S. in 2021 were due to heart disease; this translates to 20% of the overall fatality rate.


Cancer occurs when abnormal cells divide and replicate at an uncontrollable rate and impact normal cells in other parts of the body. It can develop in bone, blood, organs, and tissue; this explains why cancer is one of the most common chronic conditions impacting the population. According to the American Cancer Society, approximately 1 in 3 people in the U.S. will develop some type of cancer in their life.

Chronic Lung Disease

Chronic lung disease — also known as chronic respiratory disease (CRD) — is the umbrella term used to describe numerous long-term diseases that impact the lungs. Asthma, for example, isn’t curable; however, several methods of chronic disease management will open the individual’s airways and help relieve the common symptoms associated with CRDs, such as shortness of breath.


A stroke occurs when an artery in the brain either becomes blocked (ischemic stroke) or ruptures (hemorrhagic stroke). Either type of stroke can result in severe brain damage, disability, or death. What distinguishes a stroke from other chronic conditions is that its symptoms develop suddenly. Persons experiencing a stroke may experience:

  • Numbness in the face or appendages (typically on one side)
  • Confusion
  • Trouble speaking and understanding speech
  • Problems in one or both eyes
  • Lack of coordination and/or inability to walk
  • Dizziness
  • Extreme migraine

Strokes require an immediate response. According to the CDC, every minute matters, so those who suspect they’re experiencing a stroke should seek medical attention as soon as possible.

Alzheimer’s Disease

Dementia is a broad term that describes numerous conditions that impact at least two brain functions. Out of the many varieties of dementia, Alzheimer’s disease is the most common. The CDC reports that 5.8 million Americans had Alzheimer’s disease in 2020. The major symptoms of Alzheimer’s disease include the following:

  • Memory loss
  • Confusion
  • Getting lost in familiar places
  • Difficulty handling finances and common tasks
  • Impaired judgment
  • Changes in mood, behavior, and personality
  • Regularly losing or misplacing things

Since Alzheimer’s disease is incurable, early detection and chronic disease management are key to slowing down its symptoms.


Diabetes is a chronic condition that alters how the body breaks down food and converts it into energy. Normally, the body turns most of the food consumed into glucose, which is then released into the bloodstream and triggers the release of insulin. Insulin is essential for using glucose as energy.

However, for those with diabetes, the body doesn’t create adequate levels of insulin. This results in high levels of sugar remaining in the bloodstream and can lead to numerous health issues, including kidney disease, impaired vision, and heart disease. According to the CDC, diabetes is the primary cause of adult blindness, lower-limb amputations, and kidney failure.

Chronic Kidney Disease

The kidneys are responsible for the filtration and removal of excess fluids, toxins, and other forms of waste in the bloodstream. Additionally, they help regulate the bloodstream’s chemical balance, promote bone health, and create red blood cells.

For those who are affected by chronic kidney disease (CKD), the toxins and waste that are normally filtered remain in the body, resulting in numerous health issues. Patients affected by CKD may experience anemia, frequent infections, loss of appetite, and depression. According to the CDC, approximately 37 million adults in the U.S. have CKD.

Chronic Pain

Chronic pain is a blanket term used to describe any pain that lasts for three months or more. Some varieties of chronic pain are intermittent, while others are continuous. Regardless, the commonality is that chronic pain decreases quality of life and interferes with daily activities. In fact, many people with chronic pain experience depression or irritability due to the persistent pain.

Chronic pain can be caused by:

  • Nerve damage
  • Trauma
  • Arthritis
  • Cancer
  • Musculoskeletal issues
  • Abnormal brain activity
  • Chemical imbalances

What Causes a Chronic Disease?

An individual who develops a chronic disease will likely live with it for the rest of their life. People who wish to mitigate the chances of developing a chronic disease should familiarize themselves with the factors that put them at risk. According to the CDC, people should be mindful of the following risk factors that are directly linked with the cause of chronic diseases:

  • Tobacco use
  • Poor nutrition
  • Lack of physical activity and exercise
  • Drug and alcohol abuse
  • Family history of chronic disease
  • Environmental factors, such as exposure to dangerous chemicals and toxins

By making health-conscious decisions, individuals can mitigate their chances of developing a chronic condition. However, some chronic conditions may develop despite their best efforts; this is why regular visits to the physician for screenings and other precautionary measures are essential for identifying health care challenges in the earliest stages.

What’s Chronic Disease Management?

Acute conditions typically resolve themselves with a combination of time and medical intervention. Chronic conditions, on the other hand, are usually lifelong afflictions that increase in severity as time goes on. This means that chronic disease management becomes an essential part of a person’s life to reduce symptoms, slow the spread of the disease, retain function and ability, and maintain quality of life.

Chronic disease management is an integrated approach to managing chronic conditions that includes the following:

  • Getting regular screenings for chronic conditions
  • Getting regular checkups from a health care provider
  • Monitoring and coordinating treatment
  • Learning about the chronic condition and how it’s managed
  • Avoiding situations and behaviors that trigger symptoms

Tips and Strategies for Chronic Disease Management

Although no person can reduce their risk of developing a chronic disease to zero, research in nursing and other areas of medicine shows that numerous methods of prevention and management are available.

How to Prevent Chronic Diseases

Some factors that cause chronic diseases are out of a person’s control, such as their family history or their exposure to certain environmental factors. For example, some families have a history of heart conditions or cancer. Environmental factors, such as prolonged exposure to toxins, can cause health care issues.

Other factors are within a person’s control, such as diet and drug use. According to the CDC, the following health-conscious choices reduce a person’s risk of developing a chronic disease:

  • Quit smoking or, even better, never start smoking.
  • Eat a healthy, balanced diet.
  • Get regular exercise.
  • Only drink alcohol in moderation or not at all.
  • Get regular screenings to catch health care concerns early.
  • Prioritize oral health.
  • Get enough sleep.
  • Know the family history and what conditions pose the most risk.

How to Manage Chronic Diseases

The specifics of chronic disease management depend on several factors. Health care providers must factor into what treatments have historically been effective for the condition in question, how severe the patient’s chronic condition is, and the medical history and current status of the patient.

For example, a 25-year-old patient with early-stage cancer will receive a completely different series of treatments from a 70-year-old patient with late-stage cancer. Because early-stage cancer is localized to a small area, the chances of successfully treating it are high. By comparison, late-stage cancer means the condition has spread to organs and other areas of the body. At that point, little can be done, so the goal of treatment shifts to providing as much comfort as possible.

What patients should also know is that they have access to resources to supplement the treatment plan provided by their primary care provider or specialist. Patients with chronic disease should explore the following programs and resources for additional assistance:

  • Chronic Disease Self-Management Education (CDSME) programs help patients and their caregivers learn about chronic conditions, how they’re treated, and methods for improving quality of life. The Self-Management Resource Center offers various formats of the programs and provides chronic disease resources and support for those with diabetes, chronic pain, cancer, HIV, and other chronic conditions.  
  • Better Choices, Better Health (BCBH) is an online interactive resource created for those who are managing one or more chronic health care conditions. By providing support and education via an online community, participants report decreased feelings of depression, improved social interaction, adherence to healthy behaviors and medications, and savings on health care expenses.
  • BRI Care Consultation is a care-coaching program that’s designed for those with chronic disease and their caregivers and family members. Conducted by phone and email, the program aims to empower participants by using ongoing patient assessments, personalized action plans, and regular follow-ups to confirm that patients and their caregivers are seeing improvement in stress and depression. The program has also proven to be effective in mitigating hospital readmissions and emergency room visits.
  • The HealthMatters Program is designed for those who have developmental or intellectual disabilities. By leveraging community-academic partnerships, the organization delivers evidence-informed and evidence-based health promotion programs that reduce cognitive-emotional challenges while improving patient health, cardiovascular fitness, and overall quality of life.
  • The World Health Organization (WHO) reports that 1.28 billion adults (aged 30-79) globally have hypertension. Health Coaches for Hypertension Control directly supports this demographic via group sessions that teach methods of self-management and further educate participants about the condition. Reducing systolic blood pressure, making better dietary choices, and learning coping methods for stress are some of the main health outcomes of the program.
  • EnhanceWellness is an evidence-based fitness program that pairs people with instructors and personal health coaches to improve their social, emotional, and physical wellness. During the program, participants clearly define the health goals they wish to achieve. The coaches and instructors of the program use motivational techniques to guide participants to success.

Chronic Disease Management Resources

Those who are affected by a chronic condition should take advantage of every resource that’s available to them. For additional support, self-education, and further guidance on chronic disease management, individuals should explore the following:

  • Individuals who wish to learn more about the challenges of chronic disease, health care costs associated with chronic disease, and the CDSMP should explore the NCOA article on chronic disease self-management.
  • For more information about evidence-based chronic disease self-management programs, individuals should refer to the NCOA article, which provides a comprehensive overview.
  • Readers can learn more about the Self-Management Resource Center’s small group programs, mailed programs, conditioned-focused programs, and internet asynchronous programs on its main programs webpage.
  • The CDC’s informational webpage about chronic diseases covers what chronic diseases are and how they are caused.
  • Individuals who want to learn more about decreasing the risk factors that cause chronic conditions should explore the CDC article on methods of prevention.
  • According to the CDC, individuals can do four critical things to prevent chronic diseases. Readers can learn more about these health-conscious tips and find supporting resources in the CDC article.
  • For additional tips on reducing and managing chronic diseases, the American Medical Association (AMA) has published seven steps for patients to explore that promote optimal health outcomes.
  • Those with a chronic condition who wish to learn more about chronic disease management should refer to the CDC’s step-by-step breakdown. The four-step process ensures that individuals with chronic diseases receive the medical attention they need while making behavioral changes that improve their quality of life.
  • Readers who are managing one or more chronic conditions are encouraged to explore Aetna’s article outlining the five steps patients can take to improve their quality of life. In addition to these useful tips, the article also features several relevant links to government and nonprofit organizations that can support them.
  • AHA’s Health for Life publication features useful information and statistics about chronic disease management, risk reduction, and the health care industry. It’s an excellent resource for those who appreciate seeing the story of chronic diseases told through data, statistics, and trends.

Learning About Chronic Diseases Now Can Help Reduce Your Risk

When reviewing the facts and statistics associated with chronic conditions, the picture becomes clear that it’s an issue Americans of all ages should be mindful of when considering their long-term health, quality of life, and medical expenses. Education and awareness are critical.

By getting familiar with chronic diseases, including the risk factors, methods of prevention, and chronic disease management tactics, individuals will develop a holistic understanding that can benefit them and their family members in the future. Individuals who are interested in learning about the clinical aspect of treating and managing chronic diseases should explore their formal education options, such as a nursing education program.

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