Intended for healthcare professionals

Letters Chronic disease to top agenda

Stroke and dementia are also chronic diseases

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d1154 (Published 22 February 2011) Cite this as: BMJ 2011;342:d1154
  1. Desmond O’Neill, president1
  1. 1European Union Geriatric Medicine Society
  1. doneill{at}tcd.ie

Piot and Ebrahim argue for a more effective and forceful approach to preventing chronic disease and point out that the weight of the burden is shifting to low and middle income countries.1 This is particularly important for older people, because the largest numbers now live in these countries and they have more chronic disease.

Definitions of chronic disease are also arbitrary and circumscribed. They seem dated in light of modern understanding of the two most important causes of morbidity and mortality in later life—stroke and dementia—which are often omitted from such discussions.

Stroke is increasingly seen as a chronic disease with acute events,2 and the aetiology of the most common form of dementia, Alzheimer’s disease, is intimately linked with cardiovascular and cerebrovascular disease.3 Studies show that these diseases are also important causes of morbidity and mortality in low and middle income countries.4 5

Encouragingly, some countries, such as Ireland and the US, are starting to redefine stroke as a chronic disease and this is also reflected by recent iterations of chronic disease by WHO. However, dementia still lags behind in this respect.

This lack of consistency undermines the intellectual coherence of chronic disease as a concept, and it hinders the development of the widest possible coalition of professional and lay advocates to promote better prevention and management. Failure to adopt the principles of geriatric medicine and gerontology for these age related chronic diseases also reduces our ability to factor in effective management strategies to account for the comorbidity and complexity that accompanies chronic disease in the group most affected—older people.

Notes

Cite this as: BMJ 2011;342:d1154

Footnotes

  • Competing interests: None declared.

References