PSY333H1 Lecture Notes - Chronic Condition, Massachusetts Route 3, Paradigm Shift

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Published on 6 Jul 2012
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Lecture for Chapter 11 Chronic Illness
Scope of the issues
paradigm shift from acute to chronic illness
at any given time 58% of Canadian population are dealing w/ chronic condition in which
81% is of senior population
Chronic illness accounts for 2/3 of Canadian health spending
Spectrum of chronic conditions from mild ( partial hearing loss )to severe and life threatening
( cancer, diabetes)
Thing w/ chronic illness is that not just treatment but there is self-management
o Self-management - patient’s involvement in their illness from taking medications,
changes to their life, coping …( not just hand in physician to treat chronic ill patients
themselves have large part in managing their illness)
Chronic condition (Figure) from textbook
Looking at distribution among SES, gender, and age group series of bars
Effects of SES :
o as we descend on SES status fewer people in no chronic conditions, more chronic
condition, and escalation in people of having multiple chronic condition
o Higher SES : increase in Canadians w/ no chronic illness
o Lower SES: increase in Canadians w/ 2 or more chronic illness
o Females tend to have fewer individual in no chronic condition compared to male
meaning Males more free of chronic illness
70% Males w/out chronic illness
64% Females w/out chronic illness
o Chronic illness increases w/ age
o 94% of 12-19 years of age have no chronic illness
o 14% of 80+ years of age have no chronic illness
What is impact of Chronic Diseases?
there still needed to be coping w/ diagnosis regardless of how severe or mild it is
1. Causes premature death
a. 2005 over 60% deaths globally result from chronic disease
b. Prevalence rates are highest in developed countries (e.g. Canada, US) due to people
living longer and not dying earlier ( which occurs typically in developing or
underdeveloped countries) living longer , gives time for chronic illness to set it
i. In less developed countries, more likely to die of acute illness
2. Economic & social burden to families, communities and society
a. Direct (health care) + indirect (disability e.g. not being to work, welfare) cost of chronic
i. $ 10 billion for Diabetes
ii. $18 billion for Cancer
iii. $20 billion for Arthritis
iv. ~50 B annually on 3 chronic conditions
3. Compromises Quality of life looking directly at patient themselves not just how long one
lives but how well
a. Activities, emotions etc.
Quality of Life
Historically QOL is measured only by length of life + sings of disease no consideration of
psychological or social effects but psychological distress often expressed by chronically ill
Quality of life (Now) looks at more holistic approach
o QOL : degree to which a person is able to maximize their functioning in:
Physical limit activities? Pain? Energy? e.g. arthritis physical joint pain
will limit your activities, pain from illness or treatment (cancer w/
chemotherapy results in fatigue (loss of energy))
Psychological depression ? Anxiety? (e.g. distress from diagnosis of life
threatening, get major anxiety )
Vocational return to work? ( Given diagnosis the individual continue to work
e.g. chronic illness have to use the washroom, epilepsy licence removed in
operator jobs etc.)
Social limit interactions? Intercourses? (E.g. partial hearing loss, they can
come as standoffish)
Why do we need to study Quality of Life among the Chronically Ill?
1. Document effects of illness how illness X effects patient
a. Shows how illness affects vocational, social and personal activities, as well as daily living
b. Provides basis for interventions designed to improve QOL
2. Helps pinpoint which particular problems likely to emerge for patients w/ particular disease ma
3. Address impact of treatments on QOL - what if treatment more harmful than disease?
a. some chronic illness the treatment itself cause poor functioning so have to figure
out if treatment is causing more harm than benefit
b. e.g. cancer low survivor ship & causing harm from treatment X then this treatment X
is not good solution
4. QOL information can be used to compare therapies
a. which treatment maximize QOL e.g. Drug A has worse side effects than Drug B but
treatment results similar from comparison will pick Drug B
5. Inform Decision-Makers about which treatment will maxim likelihood of survival & w/ highest
possible QOL
a. which treatment will be prefer by patients
b. compare impact of choric chronic conditions on health-care costs
c. assess cost-effectiveness of different therapies
How the “self” is changed by diagnosis of chronic illness?
Mental Self makes up how we conceptualize our self is made up of 4 self and if any of this
area is threatened then self-concept, self-efficacy, self-esteem can suffer
Mental self:
o Physical self
o Achieving self
o Social Self
o Private self/ independent
Physical Self
body image perception & evaluation of physical functioning
o some chronic illness are associated w/ body image e.g. anorexia or bulimia are illness
of body image
o Other illness causes physical deterioration so body functions declines
E.g. Amputee this change view of themselves report not being whole
themselves , feel like they are half-man
Similar paraplegic, breast tissue lost in breast cancer patient, burns especially in
facial area
poor body image low self esteem & increased likelihood of depression and anxiety
o can also influence the adherences to treatment and how willing patient is to adopt co-
management role in Treatment
body image can be improved through psychological & educational intervention though can’t
change physical but can address psychological basis of physical self (body image)
Achieving Self
most of us gain a sense of achievement form our jobs or leisurely activities ( work or non-work
o e.g. made a deal today, saved a patient’s life, got A on my midterm, ran marathon at
personal best time
illness - limits work & non-work activities which reduced achievement( limit vocation &
private life activities) e.g. marathon person gets put in wheel chair
if achieving self is affected mental self can suffer (self-concept suffers)
Social Self