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Lecture 8

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Nevena Simic

LECTURE 8 – Chronic Illness  Midterm viewing: -Office hours: tomorrow 3:30-5:30 room 4004 -Grading challenges? Submit in writing within 24 hours Outline  Issues surrounding chronic illness -Quality of life -Changing self -Adjustment The Scope Of The Issue…  At any given time 58% of Canadian population has some chronic condition -81% of senior population  Accounts for 2/3 of Canada’s health spending  Spectrum of chronic conditions = mild (partial hearing loss) to severe and life threatening (cancer, diabetes)  Self-management: patient’s involvement in their illness -Medication, changes to their life, coping… What Is The Impact Of Chronic Disease? 1. Causes premature death  2005: >60% of deaths globally result from chronic disease  Prevalence rates highest in developed countries  Not being killed off by war so living long for chronic illness to form 2. Economic and social burden to families, communities and society  Direct (health care) + indirect (disability) cost of chronic disease o $10 billion diabetes, $18 billion cancer, $20 billion arthritis 3. Compromise quality of life Quality Of Life  Historically measured only by length of life + signs of disease o No consideration of psychological or social effects o Psychological distress often experienced by chronically ill  Quality of Life: degree to which a person is able to maximize their functioning? o Physical: limit activities? Pain? Energy? Ex) Arthritis o Psychological: depression? Anxiety?  Ex) Cancer o Vocational: return to work?  Ex) Chronis disease o Social: limit interactions? Intercourse?  Ex) Hearing loss Why Do We Need To Study Quality Of Life (QOL) Among The Chronically Ill? 1. Document effects of illness -Basis for interventions designed to improve QOL 2. Pinpoint which particular problems patients with particular disease may expect 3. Address impact of treatments on QOL 4. QOL information can be used to compare therapies 5. Inform decision-makers: which treatment maximizes survival and QOL How The “Self” Is Changed By The Diagnosis? How Is The “Self” changed By Chronic Illness?  Physical self / Achieving self / Social self / Private Self all make up Mental self Physical Self  Body Image: perception and evaluation of physical functioning -Poor body image  low self-esteem, increased likelihood of depression and anxiety -Influences adherence to treatment and how willing patient is to adopt co-management role in treatment -Can be improved through psychological and educational intervention Achieving Self  Most of us gain a sense of achievement from our jobs or leisurely activities o Brokered a deal today o Saved a patients life o Got an A on my midterm o Ran marathon at personal best time  Illness  limits work & non-work activities  reduced achievement  Self-concept suffers Social Self -Illness  limit social interactions -Hard to rebuild social relationships -Family and friends = source of self-esteem -Source of support -Fears about withdrawal of support among most common worries of chronically ill Private Self  Illnesses create need to be dependent on others o Help with choirs o Can’t contribute to household income o Need more emotional support  Loss of independent, strain of imposing on others  reduction in private self How is the self changed by ___? Small group activity: pick a disorder and discuss how it affects the various aspects of self? Breast cancer:  Physical: body image, loss of femininity (breasts). Lack of sexual contact because of fear husband won’t think you’re attractive or want to be with you because you’re not a “female” anymore.  Achieving: loss of hope to do anything because you feel hopelessness and think you’ll face death soon  Social self: too sad to interact with friends. Want to be left alone. People think it’s contagious and don't interact with you.  Private self: feel isolated and not partake in family activities. Scared to tell daughter to do testing incase of family hereditary. Problems Associated With Chronic Illness  Chronic illness raise specific problems on the road Physical Problems  Two types: Result of illness vs. consequence of treatment o Disease: chest pain in heart patients, joint pain in arthritis o Treatment: medication for hypertension  drowsiness, weight gain, impotence  Physical rehabilitation: learn how to use body to its fullest  Several goals: o Learn how to sense changes in the environment and in themselves so as to make appropriate physical accommodations o Learn new physical and management skills if necessary  how to get in and out of bathtub o Learn how to control the expenditure of energy Vocational Problems  Illness may affect/restrict work activities -Paraplegic pharmacist -Flight attendant with seizures  Many chronically ill patients face discrimination -Cancer patients are fired/laid off 5x as often as other workers -Moved into less demanding position, less likely to be promoted  Financial impact -Patient and family; -Many people do not have a private insurance plan to cover their prescription costs Social Interaction Problems  Patients don't want the pity of others  Family, friends and coworkers may have difficulty adjusting to the diagnosis -Stereotypes about certain groups of chronically ill patients: AIDS & lung cancer  See patient as having brought on disease through own negligence  Intimate ot
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