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Long-term conditions

Find out more about diabetes, heart disease, chronic pulmonary disease (COPD), cancer, dementia, epilepsy, seizures and stroke.

A long-term condition is defined as a condition that cannot, at present be cured; but can be controlled by medication and other therapies. 

Living with a long-term condition can be a daily challenge. It does not matter how old you are or how long you have lived with your condition, each of us will have different levels of tolerance and ways of coping. Long-term conditions are more prevalent in older people (58% of people are over 60 compared to 14% under 40) and in more deprived groups (people in the poorest social class have a 60% higher prevalence than those in the richest social class and 30% more severity of disease). People with long term conditions now account for about 50% of all GP appointments, 64% of all outpatient appointments and over 70% of all inpatient bed days. 

Taking care of your own health can help you overcome the day to day challenges of your condition and help you make the most of your life, rather than avoiding or missing out on things because of it. Leading a healthy lifestyle really helps if you have a long-term condition. Watching what you eat and drink and getting more exercise will boost your general wellbeing, improve your mobility and help ease your symptoms.

Diabetes

diabetesDiabetes is a common lifelong health condition. There are 3.3 million people diagnosed with diabetes in the UK and an estimated 590,000 people who have the condition, but do not know it. It is a condition where the amount of glucose in your blood is too high because the body cannot use it properly. This is because your pancreas doesn't produce any insulin, or not enough insulin to help glucose enter your body’s cells, or insulin that is produced does not work properly – known as insulin resistance. 

There are two main types of diabetes:

Type 1 Diabetes: This is often diagnosed in childhood and cannot be controlled without taking insulin. Type 1 is an autoimmune disease as it results from the immune system mistakenly attacking parts of the body, in particular it targets insulin-producing beta cells in the pancreas. People with type 1 diabetes need to inject themselves with insulin to compensate the death of their beta cells. Everyone with type 1 diabetes is insulin dependent.

Type 2 Diabetes: The autoimmune system of people with type 2 does not attack the beta cells. Instead, type 2 diabetes is the body losing its ability to respond to insulin also known as insulin resistance or being able to produce enough insulin. Type 2 diabetes is usually diagnosed in people over 30 year old and can be associated with excess body weight, high blood pressure and/or high cholesterol. It is usually treated initially without medication or tablets. People with type 2 diabetes may need insulin injections usually due to low sensitivity to insulin or beta cell failure.

Heart disease

Blood pressure measuring kitHeart disease is a general term used to describe a number of acute (short term) and chronic (long-term) medical conditions that affect the heart. Heart disease is common in the general population, including those of working age, and is the biggest cause of death in the UK. Although heart disease can have genetic causes, lifestyle choices have a larger impact on its likelihood. 

Types of heart disease include:
Cardiac Arrhythmia, such as Atrial Fibrillation, is an irregular heartbeat. The heart can beat too slowly or too fast with an abnormal rhythm. There are various types of arrhythmia. Most are harmless but some can be life-threatening.

Cardiomyopathy is a disease of the heart muscle. It affects people of all ages and is usually inherited. The heart muscle becomes enlarged, thick or rigid, affecting its ability to pump blood.

Congenital heart disease is a problem with the heart’s structure and function that is present at birth. It affects about 1 in every 145 births.

Coronary heart disease, also known as ischaemic heart disease is the most common type of heart disease and is the leading cause of death. Plaque builds up inside the blood vessels of the heart, obstructing the supply of oxygen rich blood to the heart muscle. Coronary heart disease causes around 94,000 deaths in the UK each year. Angina is a symptom of coronary heart disease and affects about 2 million people in the UK.

Heart failure is a serious condition but is usually secondary to other heart conditions. It affects about 900,000 people in the UK. It is a condition in which the heart loses its ability to pump blood efficiently through the body. 

Heart valve disease occurs if one or more of the valves in the heart doesn't work properly, resulting in extra strain on the heart, causing the heart top pump less efficiently.

Hypertensive heart disease is caused by high blood pressure. As the heart pumps against this pressure, it has to work harder, resulting in other heart abnormalities and dysfunctions.

Inflammatory heart disease is an inflammation of the heart muscles due to an infection that is usually caused by bacteria, a virus or from an internal abnormality, such as autoimmune disorder. There are three main types of inflammatory heart disease: Pericarditis – Endocarditis and Myocarditis.

Marfan syndrome is a rare connective tissue disorder. It affects blood vessels, causing damage to the heart.

Chronic Pulmonary Disease (COPD)

COPD is the name for a collection of lung diseases including chronic bronchitis, emphysema and chronic obstructive airways disease. 

People with COPD have difficulties breathing, primarily due to the narrowing of their airways, this is call airflow obstruction. If you have COPD you may have one or more of these conditions. COPD is a condition where the airways become inflamed and the air sacs in your lungs are damaged. This causes your airways to become narrower, which makes it harder to breathe in and out. There is no cure for COPD, but there are lots of treatments available to help manage your condition and improve your symptoms and live an active life.

The main cause of COPD is smoking and the condition usually affects people over the age of 35 who are, or have been, heavy smokers. People who don’t smoke but have long-term severe asthma can get COPD. It can also be caused by long-term exposure to air pollution, fumes and dust from the environment or your work place. 

You can inherit COPD, but this is very unusual. There is a genetic condition called Alpha-1 antitrypsin deficiency that causes damage to your lungs. This condition can lead to a particular type of COPD – Emphysema, especially in people who smoke.

Cancer

Cancer is when abnormal cells in your body divide in an uncontrolled way. Some cancers may spread into other tissues within the body. There are more than 200 different types of cancer and 1 in 2 people within the UK will get cancer in their lifetime. 

Cancer can start almost anywhere in the human body. In the human body cells grow and divide to form new cells as needed. When cells grow old, or become damaged, they die and new cells take their place. However, when cancer develops the orderly process breaks down and cells can become more and more abnormal. For example, old or damaged cells survive when they should die and new cells form when they are not needed. These extra cells can divide without stopping and may form growths called tumours. Many cancers form from masses of tissue, commonly known as solid tumours. Cancers of the blood such as leukaemia generally do not form from solid tumours.

Types of cancer

Types of cancer

Key signs and symptoms of cancer

Spotting cancer early is important as it means treatment is more likely to be successful. So it’s important you tell your doctor if you notice anything on this list, or any other unusual or persistent change to your body. Although anyone can develop cancer, it’s more common as we get older – around 9 out of 10 cases are in people aged 50 or over. There are more than 200 different types of cancer, with many different symptoms. The symptoms listed below highlight the key ones to be aware of, however if you spot something that isn't normal for you, get it checked out.

Key cancer signs table

Long-term conditions and mental health

Thirty percent of people with long-term conditions will present with mental health problems, leading to poor outcomes and poor quality of life, the most common in older people is dementia, depression, anxiety and behavioural problems. 

Dementia

Elderly confused manDementia is a chronic or persistent disorder of the mental processes caused by brain disease or injury and marked by memory disorders, personality changes and impaired reasoning. Your risk of developing dementia increases as you get older and it usually occurs in people over the age of 65. 

Dementia is caused when the brain is damaged by diseases such as Alzheimer’s disease or a series of strokes. Alzheimer’s disease is the most common cause of dementia but not all dementia is due to Alzheimer’s. The specific symptoms that someone with dementia experiences will depend on the parts of the brain that are damaged and the disease that is causing the dementia.

Symptoms of dementia
Every person is unique and will experience dementia in their own way. The different types of dementia tend to affect people differently, especially in the early stages. A person with dementia will have cognitive symptoms, problems with thinking or memory. They will often have problems with the following:

  • Difficulty recalling day to day events that happened recently
  • Becoming confused about where they are and losing track of the day or date
  • Concentrating, planning or organising, difficulty making decisions or solving problems, carrying out tasks such as cooking
  • Difficulty following a conversation or finding the right words for something
  • Difficulty judging distance and seeing objects in three dimensions

A person with dementia will also have changes in their mood, they may become irritable or frustrated, withdrawn or anxious and easily upset or unusually sad. With some types of dementia a person may even see things that are not there – visual hallucinations or believe things that are not true – delusions.

You may find it useful to contact Dementia UK who offer advice and support to families, professionals and anyone worried about their memory through a specialist dementia helpline – Admiral Nursing Direct.

Epilepsy

People diagnosed with epilepsy have abnormal electrical activity in their brain which can cause seizures. Seizures used to be called “fits” but this is now generally considered to be inappropriate and an outdated way to describe them. Epilepsy is estimated to affect more than 500,000 people in the UK, this means that almost one in every 100 people has the condition. 

Epilepsy is a neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain. It is usually only diagnosed after a person has had more than one seizure. Epilepsy is most commonly diagnosed in children and people over 65 years of age.

What causes epilepsy?
For some people there is no obvious cause, their epilepsy is not caused by a specific medical condition. It might be that there is a genetic factor and this type of epilepsy is known as primary or idiopathic epilepsy. Other epilepsy can be a symptom of a medical condition. Various conditions can cause epilepsy such as head injuries, infections such as meningitis or brain tumours, subarachnoid haemorrhages, and stroke and birth injuries or problems with the brain developing during childhood. This type of epilepsy is known as secondary or symptomatic epilepsy.

Not all seizures are due to epilepsy, seizures can happen for many different reasons such as diabetes or a heart condition, and some seizures are caused by conditions such as low blood sugar (hypoglycaemia). Some very young children have convulsions when they have a high temperature and these are not the same as seizures.

Living with epilepsy
As epilepsy affects people in different ways, everyone’s experience of living with the condition is different. 

Know your triggers: The more you know about the things that trigger your seizures and how to avoid them, the less debilitating your epilepsy will be. Keep a diary and write down when you had your seizures and what you had been doing beforehand may help you work out if you have any triggers. 

Take your medication: Anti-epilepsy medication controls seizures in around 70% of people. Work with your doctor to find the medication that suits you best and take it exactly as prescribed, this is probably the most effective way to live with epilepsy. Missing out medication may make you more likely to have seizures.

Stroke

support elderly ladyA stroke is a disruption in the blood supply to the brain. Most strokes are caused by blockages (usually blood clots) disrupting the brain’s blood supply. These are called ischaemic strokes. Some strokes are caused by bleeds. These are called haemorrhagic strokes. The brain depends on a supply of blood for the oxygen and nutrients it requires to function properly. When the blood supply is disrupted, brain cells are starved of oxygen and nutrients. This causes damage to the brain tissue. 

Stroke is a medical emergency. If you suspect someone is having a stroke call the emergency services. 

Stroke is the leading cause of adult disability in the UK. Strokes can affect people of any age but are more common in older people. Some people have a temporary blockage in the blood supply to their brain which clears of its own accord, quickly and before any lasting damage to the brain is done. This is called a transient ischaemic attack (TIA). 

Stroke symptoms 
The affects of a stroke vary between people and individual symptoms depend on which parts of the brain are affected and for what specific functions these parts of the brain are responsible. The severity of the symptoms depends on how much damage is done to the brain. The main symptoms of a stroke are:

  • Physical problems in one side of the body – numbness and weakness
  • Drooping on one side of the face
  • Speech problems – slurred speech, muddled words
  • Visual problems – blurred visions and loss of vision

Stroke symptoms are usually sudden, they can occur while you’re sleep and if this happens you can wake up with the symptoms. People might also experience longer-term effects such as:

  • Psychological problems such as depression or difficulty controlling emotions
  • Bowel or bladder problems – incontinence
  • Problems swallowing
  • Dizziness and balance problems
  • Memory problems
  • Pain
  • Fatigue
  • Loss of awareness of one side of your body

What causes a stroke?
Most strokes are caused by damaged arteries, the blood vessels through which blood flows from the heart to the rest of the body. Damage to the arteries carrying blood to the brain can cause strokes in the same way that damaged arteries in the heart can cause heart attacks. Our arteries tend to harden, narrow and weaken as we get older but people with high blood pressure, smokers, people with high cholesterol, and people with heart disease or diabetes, or a family history of heart disease or diabetes are at an increased risk. 

Ischaemic strokes are caused by blockages, usually blood clots in one of the arteries supplying the brain. Clots can form in these arteries themselves or form in a blood vessel elsewhere in the body and travel to the brain. Clots commonly form where arteries have narrowed due to a build-up of fatty deposits, cholesterol on their inner walls. The narrowing or furring of the arteries is called atherosclerosis. Although stroke affects the brain and not the heart, people with an irregular heartbeat, atrial fibrillation are at an increased risk. An irregular heartbeat can cause blood clots which can travel to the brain and cause a stroke. 

Haemorrhagic strokes are caused by one of the blood vessels supplying the brain bursting and causing a bleed. The most common cause is high blood pressure which damages and weakens the arteries making them more likely to tear. Some people have haemorrhagic strokes because they have Aneurysms, balloon-like swellings in the arteries which burst. If an aneurysm bursts and causes bleeding over the surface of the brain, it is called a subarachnoid haemorrhage.

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