Moderate-stage illnesses can be characterized by moderate, as opposed to low, degree of functional impairment and disability and moderate to high self-management and caregiver burden. At this stage, symptoms often interfere with usual lifestyles. Examples include painful hip or knee osteoarthritis and stage 2 or 3 Parkinson’s disease.

We define late-stage chronic illnesses as those that are slowly or rapidly progressive or terminal and are characterized by high functional impairment and disability and self or caregiver management burden. People with late-stage chronic illnesses often have multiple chronic conditions (MCCs) and may suffer a rapidly progressive decline in multiple functions. For example, people with severe dementia or people with diabetes and severe vascular disease often have a progressive course with high burden on significant others.

Functional impairment can relate to restrictions in physical, mental, or social function. Disability is a more severe impairment that limits the performance of functional tasks and fulfillment of socially defined roles (handicap). For example, physical disability is the inability to complete specific physical functional tasks, called activities of daily living call TPD Total Permanent Disability.

Diabetes can lead to impairment and disability indirectly, such as its effects on blood vessels. For example, visual impairment and end-stage renal disease are often microvascular complications, and coronary heart and cerebrovascular disease are frequently macrovascular complications.

Data from the National Health and Nutrition Examination Survey show that cardiovascular disease (i.e., coronary heart disease or chronic