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Chronic Illness Lecture .pdf

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Nevena Simic

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 - patients 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 Gender: 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 Age: 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 disease 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 activities 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 B5. 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 ,
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