Chronic Health Disorders Management - Lecture Notes PDF

Because learning changes everything. ® Chapter Eleven Management of Chronic Health Disorders Copyright ©2021 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chapter Outline...

Because learning changes everything. ® Chapter Eleven Management of Chronic Health Disorders Copyright ©2021 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.  Chapter Outline Emotional responses to chronic health disorders. Personal issues in chronic health disorders. Psychological interventions and chronic health disorders. Quality of life. © McGraw Hill 2  Chronic conditions At any given point in time, 60% of the population has a chronic condition and the medical management of these chronic disorders, including psychological disorders accounts for 90% of the nation’s health spending (Center for Disease Control and Prevention, 2019). A chronic condition is a human health condition or disease that is persistent or otherwise long-lasting in its effects. They usually cannot be cured. Some can be life-threatening (i.e., stroke), others linger and need management (i.e., diabetes). Although the prevalence of physical limitations increase with age, chronic conditions are not confined to older adults. More than one third of young adults aged 18-44 have at least one chronic condition. Chronic diseases include: heart disease, cancer, stroke, arthritis, asthma, lung disease, cancer, diabetes, hypertension, osteoporosis, multiple sclerosis, Parkinson’s disease © McGraw Hill 3  Emotional Responses to Chronic Health Disorders Immediately after a chronic health disorder is diagnosed, a patient can be in a stage of crisis marked by physical, social and psychological disequilibrium. Denial: Psychological defense mechanism by which people avoid the implications of a disorder. Refuse to acknowledge the reality of their condition Minimize the severity, that it will shortly go away Interferes with absorption of treatment information and compromises health. Temporarily protective © McGraw Hill 4  Emotional Responses to Chronic Health Conditions Anxiety Health-Related Anxiety: Characterized by excessive worry about health symptoms and treatment outcomes. Especially high when waiting for test results, awaiting medical procedures. Fear of the Unknown: Patients become overwhelmed by potential changes in their lives and the prospect of dying. © McGraw Hill 5  Emotional Responses to Chronic Health Disorders Depression: is characterized by feelings of persistent sadness, loss of interest in activities once enjoyed, and hopelessness; that the illness will never improve. Up to 1/3 of medical inpatients with chronic disease report symptoms of depression and up to ¼ suffer from severe depression. Especially common among stroke, cancer and heart disease patients. Depression is sometimes a delayed reaction due to the time taken to fully understand the implications of the condition. Assessing it in the chronically ill can be complicated because many symptoms of depression (i.e., fatigue, sleeplessness, weight loss) can also be symptoms of disease or side effects of treatment. Depression increases with: Experience pain and disability. Experience negative life events. Lack social support. © McGraw Hill 6  Patients’ Beliefs about Chronic Health Disorders Nature of the health disorder: Patients may adopt an inappropriate model for their disorder. Hypertensive patients may believe incorrectly that if they feel all right, they no longer need to take medication. Cause of the health disorders: Patients may blame stress, physical injury, disease causing bacteria, and God’s will for their disorders. Self-blame can lead to guilt, self-recrimination, or depression. Blaming another person for one’s health disorder is maladaptive. Some believe disorder caused by stress brought on by family members. © McGraw Hill 7  Patients’ Beliefs about Chronic Health Disorders Controllability of the health disorders. They can prevent a recurrence of disease though good health habits or even sheer force of will. Comply with various treatments and physician’s recommendations, achieve control. Patients who have a sense of control or self- efficacy with respect to the disorder are more adaptive. Experience of control or self-efficacy may prolong life. © McGraw Hill 8  Personal Issues in Chronic Health Disorders The Physical Self Self-concept: Stable set of beliefs about one’s personal qualities. Can produce severe changes in self concept and self- esteem. Body image: Perception and evaluation of one’s physical functioning and appearance. Body image can plummet during illness. Chronic conditions lead to physical changes such as weight gain or loss, skin changes (e.g., rashes, scarring), hair loss, or other visible signs of illness (e.g., swelling, prosthetics, use of mobility aids). Chronic illness might contribute to body dysmorphic disorder; person becomes overly concerned with changes in their appearance. This can be particularly difficult if the condition alters how they look, making them feel disconnected from their former self-image. Poor body image increases risk of depression and anxiety. Influences a person’s adherence to treatment and willingness to adopt a co-management role. © McGraw Hill 9  Personal Issues in Chronic Health Disorders The Achieving Self Refers to the goals, ambition and desire to fulfil potential. Closely tied to purpose, self-worth. Professional life is an essential part of their identity and sense of achievement. A chronic health condition can: disrupt career trajectories, reduce earning potential, or create challenges in performing work-related tasks, result in absences from work, reduced hours, or the need to modify job responsibilities. cause workplace discrimination or perceptions of being less capable by colleagues and superiors which can erode confidence and create anxiety about job security, promotions, or future career advancement. face a disconnect between what they want to do and what their body allows them to do which can create a sense of frustration, guilt, or even anger, as they may still have the drive and intellectual capability to achieve, but physical limitations (fatigue, pain, etc.) prevent them from doing so. © McGraw Hill 10  Personal Issues in Chronic Health Disorders The Social Self Chronic illness can create a sense of isolation for various reasons: Withdrawal from social situations out of fear of being judged, not wanting to be a burden. Cancel plans frequently due to fatigue, pain, or other health challenges, leading to a sense of disconnection from previously close relationships. Stigma: because others may not fully understand their illness, particularly when it’s not outwardly visible. This can lead to negative assumptions about the person’s capabilities, character, or reliability. For example, someone with a chronic illness might be labeled as "lazy" if they don’t appear sick but are still unable to work or engage in social activities. © McGraw Hill 11  Personal Issues in Chronic Health Disorders Chronic health conditions can strain relationships with partners, family, and friends. People with chronic illnesses: May rely more heavily on family and friends for emotional or practical support, such as help with daily tasks, medical appointments, or childcare. May no longer be able to take on the same responsibilities, whether that’s caring for children, managing household chores, or participating in family events. Caregiver Burden: Family members or loved ones may take on caregiving roles, which can create an imbalance in relationships. The primary caregiver might experience stress. Might have issues with intimacy. Affects one’s sexual health and intimacy. For example, chronic pain, fatigue, or medication side effects can impact sexual function and can strain intimate relationships. Caregiving can alter the romantic dynamic. The partner with the illness may feel like a burden or experience a sense of loss of intimacy. Can be financially impacted. Not covered by health insurance sufficient to meet their needs or stop working and lose their insurance coverage. © McGraw Hill 12  Caregivers are crucial The typical caregiver is a woman in her 60’s caring for an elderly spouse, but caregivers also come in the form of adult children caregiving for their parents, or parents caring for their disabled child. Some caregiving is short-term or intermittent, but caregiving for family with Alzheimer’s, Parkinson’s, multiple sclerosis and stroke is long term and grueling. Family members have an important advantage possessed by no other professional. Caregivers are often with the care recipient day in-day out and know what is best for the person. Caregiver is ideally positioned to detect a change from the care recipient’s usual functioning and recognition of health problems. Caregiver activities include providing information about the diagnosis, assisting with a medical encounter, carrying out and monitoring subsequent treatment and supporting health promotion. © McGraw Hill 13  Spousal caregiving (a) co-residence; (b) the longevity of the marital tie; (c) the emotional connection established with a spouse; and (d) multifaceted care demands that include basic activity of daily living assistance, instrumental activities of daily living assistance, and socioemotional support. As aging occurs, it can become increasingly difficult to function effectively as a spousal caregiver. Caregivers between the ages of 66 and 96 have a 63% higher mortality rate than non-caregivers of the same age. (Montgomery & Williams, 2001 ; Tennstedt, Crawford, & McKinlay, 1993). © McGraw Hill 14  Caregiving as Chronic Stress Evidence shows that family members who provide intense caregiving are at risk for adverse physical and mental health effects health when compared to matched non- caregiving controls. It does this by: Affecting cardiovascular function Engaging in - exaggerated/blunted Compromising immune Altering stress maladaptive blood pressure, heart function – hormones – HPA health behaviors rate exaggerated/blunted axis outcomes as a coping (Roepke et al., 2011) cytokine and c-reactive like cortisol mechanism protein circulation which regulation (Secinti et al., leads to inflammation Creating blunted (Mausbach et al., 2022) (Li et al., 2007) or lower level 2005) antibody responses (Gallagher et al., 2009) © McGraw Hill 15  Caregiver Stress: Contributing Factors Role confusion Role as caregiver and also family member (spouse, parent/child, etc.) Unreasonable demands From self and others, need of care recipient, family and home responsibilities, work responsibilities. Care-recipient not always appreciative. Unrealistic expectations Feeling responsible for making care recipient better, improving their health or life circumstances, etc. Lack of control Skills and resources (including money or insurance) needed to manage care Lack of privacy Little time for and with yourself © McGraw Hill 16  Caregiver Stress: Contributing Factors Individual Characteristics Younger C Younger CR Diagnosed past 5 years Health of C Relationship to CR Negative Cognitive Work Characteristics Appraisals Caregiver Employed Financial burden Psychological Emotionally unrewarding Distress Caregiver Role Demands Primary C Social Support/Resources Frequent contact Substitute C when Provide most of the care Medication concerns needed Frequent ADL/IADL Caregiving guidance & assistance advice Frequent level of supervision Lower income © McGraw Hill 17  Caregiver Perspectives "Traveling back and forth three hours and being terrified something will happen when I am not there." "Loneliness, isolation, being trapped, absolutely no help, pulled muscles, torn joints, etc." "Doing it all 24/7 as other family members live out of state." "People who won’t help but are ready to tell you what and how to do things." "I can’t turn my brain off. My daughter is 33 years old and in a wheelchair and attends an adult day program. I have been her caregiver for 33 years. If I vacuum I hold onto my cell phone." © McGraw Hill 18  Compassion Fatigue https://www.youtube.com/watch?v=7keppA8XRas © McGraw Hill 19  The Other Side of the Coin: Rewards of Caregiving Physical activity interventions and engaging in pleasant experiences both promote quality of life and reduce physical health threats related to caregiving (Chattillion et al., 2013; Lambert et al., 2016). Caregiving can also be a positive experience: New relationships through support groups New skills, knowledge, inner strengths Deeper relationship with care recipient Increased compassion, growth After controlling for baseline health Chance to give back, show love status, Brown and colleagues (2003) found that individuals who provided Sense of accomplishment instrumental support to friends, Building memories relatives, or neighbors and people who provided emotional support to their Caregiving can be beneficial if low burden, spouses had lower five-year mortality i.e. allowing time for other activities rates than individuals who didn’t help (meaning-making) others or didn’t support their spouses. © McGraw Hill 20  Personal Issues in Chronic Health Disorders Positive changes in response to chronic health disorders. Experiencing positive reactions and optimism. In a study (Collins et al., 1990), cancer patients report an increased inspiration to act now instead of postponing. Acquiring more empathy and compassion. Feeling stronger and more self-assured. © McGraw Hill 21  Interventions and Chronic Health Disorders Stress management therapies usually have several targets of action within the biopsychosocial model Bio: Antidepressants, healthy behaviors, biofeedback Psycho: Teach adaptive interpretation of stressful events – challenge rather than threat; encourage active engagement and coping rather than passive avoidance; discourage catastrophizing, relaxation, imagery, meditation. Social: Provide social support from group therapies; maximize support from existing social networks; teach assertion as a coping skill to resolve conflict. © McGraw Hill 22  What is stress management training? A variety of techniques aimed at reducing impact of psychological stress Relaxation Mindfulness based stress reduction Exercise Coping strategies Cognitive restructuring Social support Stress inoculation training SMT should include most of these factors but rarely does © McGraw Hill 23 Acupuncture http://www.youtube.com/watch?v=JHfKpXODMIc © McGraw Hill 24  Weil, N., Friger, M., Press, Y., Tal, D., Soffer, T., & Peleg, R. (2007). The effect of acupuncture on blood pressure in hypertensive patients treated in a complementary medicine clinic. Integrative Medicine Insights, 2, 117863370700200001. Aim: to assess the effect of acupuncture on blood pressure in hypertensive patients. Methods: BP values measured before and following weekly acupuncture were recorded from the charts of hypertensive 29 patients who came to the clinic for treatment of other problems. Results: SBP dropped significantly and a trend for DBP. © McGraw Hill 25  Acupuncture – scientific evidence! Weil et al (2007). © McGraw Hill 26  Broadbent, E., Kahokehr, A., Booth, R. J., Thomas, J., Windsor, J. A., Buchanan, C. M.,... & Hill, A. G. (2012). A brief relaxation intervention reduces stress and improves surgical wound healing response: a randomised trial. Brain, behavior, and immunity, 26(2), 212-217. Reduce stress and improve wound healing Intervention: breathing, muscle relaxation, and guided imagery following gall bladder surgery 3 days before and 7 days after surgery. Control: usual care Outcome: Stress and hydroxyproline levels (collagen matric indicates healing) © McGraw Hill 27  Results Fig. 2 Change in perceived stress scores Fig. 2 hydroxyproline levels (collagen (PSS4) pre-post healing at wound site) © McGraw Hill 28  Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F.,... & Sheridan, J. F. (2003). Alterations in brain and immune function produced by mindfulness meditation. Psychosomatic medicine, 65(4), 564-570. Trait anxiety Antibody Response © McGraw Hill 29  Carlson, L. E., Speca, M., Faris, P., & Patel, K. D. (2007). One year pre– post intervention follow-up of psychological, immune, endocrine and blood pressure outcomes of mindfulness-based stress reduction (MBSR) in breast and prostate cancer outpatients. Brain, Behavior, and Immunity, 21, 1038-1049. Aim: to investigate the effects mindfulness-based stress reduction (MBSR) program on QoL, stress, mood and endocrine, immune and autonomic parameters in early stage breast and prostate cancer patients. Methods: 49 patients with breast cancer and 10 with prostate cancer enrolled in an eight-week MBSR program that incorporated relaxation, meditation, gentle yoga and daily home practice. © McGraw Hill 30 Fig. 2 Symptoms of stress inventory scores. Fig. 3 Mean daily salivary cortisol values across time. Mindfulness-based stress reduction programs may be effective: stress and biology improving and these improvements seen at over a year of follow-up. © McGraw Hill 31  Patel, C., Marmot, M. G., & Terry, D. J. (1981). Controlled trial of biofeedback-aided behavioural methods in reducing mild hypertension. Br Med J (Clin Res Ed), 282(6281), 2005-2008. Participants: untreated hypertensives recruited Method: received combined intervention (relaxation, meditation, health education). Eight weekly one hour sessions © McGraw Hill 32  Results: © McGraw Hill 33  Friedman, M., Thoresen, C. E., Gill, J. J., Ulmer, D., Powell, L. H., Price, V. A.,... & Dixon, T. (1986). Alteration of type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: summary results of the recurrent coronary prevention project. American heart journal, 112(4), 653-665. Participants: 862 participants. 64 years or less. Non smokers. 90% men. Mainly white. One or more MIs 6 months or more previously Method: 270 participants – cardiac counselling (diet, exercise, adherence) 592 participants - CC plus SMT (type A behavioral counselling) 151 participants – control group © McGraw Hill 34  Results: 30 Recurrence of MI at 4.5 yr follow-up (%) 20 10 0 CC CC + SMT Control © McGraw Hill 35  Helgeson, V. S., Cohen, S., Schulz, R., & Yasko, J. (2000). Group support interventions for women with breast cancer: who benefits from what?. Health psychology, 19(2), 107. © McGraw Hill 36