Chronic Illness Overview

Overview of Chronic Illness

• Chronic illness is a prevalent issue

Extent of the Problem

• 60% of adults have at least one chronic illness
• 42% of adults live with multiple chronic illnesses
• 20% of adults under 45 have at least one chronic illness
• 25% of children have a chronic illness
• Chronic illnesses can cause physical and emotional strain on patients and their families
• The diagnosis of a chronic illness can be a crisis

Models of Adjustment to Chronic Illness

• Stage models aren't well supported for adjusting to chronic disease
• Adjustment is a dynamic process influenced by:
  • The disease's characteristics, such as its rate of progression
  • Individual characteristics, such as optimism and neuroticism
  • The person’s social environment, such as social support
  • Background factors, such as early childhood experiences like trauma or illness

Adaptation Models

• Lazarus’ stress and coping model focuses on appraisal, coping strategies, and reappraisal
• Moos and Schaefer's approach breaks adjustment into:
  • Illness-related tasks, such as dealing with healthcare staff, symptoms, and treatment
  • Psychosocial tasks, such as self-image, competence, and maintaining relationships
• Taylor's model considers the adjustment process as a search for meaning, gaining control, and restoring self-esteem

Tasks of Adjustment to Chronic Disease

• Coping with the symptoms
• Managing the stress of treatment
• Living as normal a life as possible
• Facing the possibility of death
• Psychological functioning impacts quality of life more than physical functioning

Coping Strategies

• People with chronic diseases use various coping strategies
• Avoidance coping like ignoring or denial can be more effective than problem focused strategies
• Problem-focused coping can be more effective when the illness is controllable

Effects of Chronic Illness

• Diagnosis causes changes in self-perception
• It forces people to reevaluate their lives, relationships, and body image
• It involves a sense of loss
• Finding meaning in the illness is important
• Finding a positive aspect is beneficial, and people with positive expectancies and optimism fare better

Support from Family

• Families should be flexible and establish routines
• Find ways to support needs without reinforcing anxiety or depression
• Invisible support is support the provider reports offering, but support not received by the patient
• Emphasis on meaning-making and positive attitudes.
• Family members must acknowledge the illness, its difficulties, and listen to the patient's concerns

Alzheimer's Disease

• Alzheimer's has no cure
• Degenerative brain disease with nerve fiber plaques and tangles in the cerebral cortex and hippocampus
• Early onset occurs before age 60, while later onset occurs after 65.
• Risk factors include age, E4 gene stroke, head injury, and diabetes

Symptoms of Alzheimer's

• Cognitive symptoms include memory loss, delusions, sleep issues, hallucinations and depression
• Behavioral symptoms include agitation, irritability, sexual behavior issues, and dangerous behavior

Helping Alzheimer's Patients

• Difficult to treat, but programs providing pleasant stimulation have some effectiveness
• Pleasant stimulation includes music, relaxation, and aromatherapy
• Cognitive training programs only have modest benefits
• Family help is also important
• Improve communication with the patient
• Modify the environment to reduce confusion and limit problematic behaviors

Diabetes Mellitus

• Results from insulin deficiency
• This prevents cells from absorbing glucose
• Uncontrolled diabetes causes; coma, death, kidney failure, retina damage and cardiovascular damage

Types of Diabetes

• Insulin-dependent diabetes mellitus (Type I) is an autoimmune disease, with genetic risk factors
• Non-insulin-dependent diabetes mellitus (Type II) accounts for 95% of cases

Factors of Type II Diabetes

• Genetic components
• Lifestyle factors
• Overweight
• Sedentary lifestyle
• Disproportionately affects ethnic minorities

Medical & Psychological Interventions for Diabetes

• A strict and complex treatment regimen is required
• This includes daily monitoring of blood sugar
• Additionally, prescribed medication is frequently required
• Lifestyle interventions are also suggested
• Health psychology explores:
  • The role of psychosocial factors in disease
  • How people conceptualize their disease
• Factors influencing compliance with medical regimen

Psychosocial Factors & Diabetes

• Stress affects diabetes through two pathways:
  • Family stress may impact later autoimmune response in children
  • Stress negatively impacts glucose metabolism for those with the disease
• Depression and negativity lead to worse glucose control
• Social support is linked to better adherence to treatment regimens
  • Doctors better meal plan adherence
  • Family and friends greater glucose monitoring and exercise

Understanding the Disease

• One's perception of the personal risk factors may not be accurate
• Having close support from family and friends can increase the perception of the disease
• Problem focused can be developed with a belief of consequences
• Using the medication may be more likely with a better understanding of controlling the disease
• It is highly important to believe in self-care

Interventions

• China Study: a 6 year intervention showd reduction in type II diabetes with just diet and exercise
• US Study: a program with behavioral skills related to self-control
• Self control can be improved by:
  • Adherence
  • Treatment

Asthma

• Asthma is chronic inflammatory disease that obstructs tubes, to block air from traveling through the body.
• Wheezing, coughing, and breathing problems are symptoms.
• At times the patient may seem fine

Causal Models for Asthma

• Diathesis-stress model is exposure to the environment as well as one's genetics.
• The hygiene hypothesis is that certain substance cannot make the body immune.

Managing Asthma

• Asthma can be managed similarly to diabetes
• Restrictions can be needed via:
  • Heath System
  • Lifestyle
    • Life threatening issues

Treatment Regimen

• Side effects can lead to poor compliance
• Personal triggers must be learned and avoided

Underlying Adherence Issues

• Lack of awareness can be problematic
• Cause
• Disease
• Management
• Symptoms

Asthma Interventions

• Educational Interventions focus on disease and it's management

  • Not necessarily the best way to change behavior

• Behavioral Interventions improve by self-care

  • Identifying triggers
  • Management
  • Setting plans

• Digital Interventions improve in nature and aid children

Facing Death

• The person wants control over how they wish to live and die
• Carr, 2003: Death comprises of:
  • Physical and Social comfort
  • Appropriate Medical Care
  • Psychological distress

Adjustment to Dying

• Denial: to avoid anxiety it is best to accept the severity that is ahead
• Anger: emotional questioning and reaction from blame and frustration
• Bargaining: negotiating a fair outcome with health care
• Depression: from disease progression it leads to hopelessness
• Acceptance: coming to terms with morality and prepare for whatever is ahead

Alternative to Stage Theory

• Emotional and cognitive patterns can respond to the end of life.
• A set of emotions is not followed from the stage
• Good emotions can occur from finding meaning

Dying Role

• Responsibilities with key elements has privileges
• Practical items can happen by planning items in the end of the life
• Relation: the dying can show other roles like parents
• Personal Items: Finding meaning in end, finishing store
• Denial of healthcare is a barrier
• Lack of care and hospital arrangements is difficult
• Social emotional tasks cannot be completed concentrating on other objects

Tasks of Dying

• Fear and Anxiety must be faced
• Comfort must be provided
• Desires need completion
• Social and physical support

Dignity Therapy for End of Life Adjustment

• Psychotherapy can focus on life elements and death as well as:
  • What they would like remembered
  • What is most relevant

Randomized Trials

• This can improve well-being from qualities of life and not emotional episodes
• Different Cultures can be different
  • Preserve and turn attention in ones-self for Western culture
  • Pay attention and respond to what others need in Eastern Culture

Models for Grief

• 4 profiles
  • Well Being
  • Healing/Return
  • Unaffected
  • High Improvement