Living with Chronic Illness

William P. Wattles, Ph.D.

Psychology 314

Acute disease

short-term less common than

chronic either die or get well

Chronic illness

A disorder that persists for a long time and is either incurable or results in pathological changes that limit normal functioning.

Chronic illness

Virtually everyone will eventually develop some type of chronic condition.

Chronic illness

Must deal with:– Symptoms of the

disease– Stress of Treatment– Feelings of

vulnerability– Loss of Control– Threat to self-esteem

Examples of chronic illnesses

Cancer diabetes arthritis ALS asthma chronic obstructive pulmonary disease multiple sclerosis

Parkinson’s disease muscular dystrophy sickle cell anemia HIV

Chronic disease

long-lasting common

50% at any point in time 100% at one time or another

Variable course never completely healthy

Coping with Chronic Disease

Attitudes and belief about illness personal traits such as depression and

optimism coping strategies compliance with prescribed regimens social support.

Attitudes and Beliefs

According to both the Theory of Reasoned Action and Health Belief Model attitudes and beliefs predict adaptive behavior.

Social norms attitudes affect facilitating conditions

Personality

Depression may take the energy away needed to adapt to the disease

anxiety may interfere with sleep and other health processes.

Optimism-a generalized expectation that the future looks good-associated with more adaptive behaviors.

Social Support.

Social support presumably serves to buffer the effects of stress for the cancer patient and may improve the prognosis.

The most helpful behaviors seem to be emotional support, sympathy and caring.

Impact of Chronic Illness

Crisis theory – individuals need a state of equilibrium– chronic illness upsets this state– people search for ways to restore

homeostasis– failure to do so results in

anxiety fear stress

Impact on the patient

Psychological functioning– social– physical– mental health

Self-image– positive and negative changes

Coping strategies

Opportunities for psychology

Strategies to improve compliance– “Noncompliance is a substantial problem in

the treatment of chronic illness.” Creation of support groups Dealing with psychological

repercussions Sustaining of personal relationships

Impact on the family

Adult children– change in relationship

Spouse Parents

Diabetes

Diabetes is a disease in which the body does not produce or properly use insulin

Insulin acts to reduce levels of glucose in the blood by interacting in some unknown way with cell membranes.

Diabetes

Diabetes is a disease in which the body cannot properly store and use fuel for energy.The fuel that your body needs is called glucose, a form of sugar.

Glucose comes from foods such as breads, cereals, pasta, rice, potatoes, fruits and some vegetables

The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles.

Among states having data for 1994 and 2002, the age-adjusted prevalence of diagnosed diabetes increased more than 10% between 1994-2002 (see detailed tables for maps).

In twenty-three states including South Carolina, age-adjusted prevalence was at least 50% higher in 2002 than in 1994.

Prevalence of Diagnosed Diabetes per 100 Adult Population

0

2

4

6

8

10

12

14

16

18

20

1994 1995 1996 1997 1998 1999 2000 2001 2002

year

pe

rce

nt

18-44

45-64

65-74

75+

Total

Age-adjusted

Incidence of Diabetes

The prevalence of diabetes (diagnosed plus undiagnosed) in the total population of people who were 40-74 years of age increased from 8.9% in the period 1976-1980 to 12.3% by 1988-1994.

“The increasing frequency of obesity and sedentary lifestyles in the population, make it likely that diabetes will continue to be a major health problem in the U.S.”

Diabetes is a life-long condition.

High blood glucose levels over a long period of time can cause blindness, heart disease, kidney problems, amputations, nerve damage, and erectile dysfunction.

Good diabetes care and management can delay or prevent the onset of these complications

Type 1 diabetes

Type 1 diabetes occurs when the body makes little or no insulin. It used to be called insulin-dependent or juvenile diabetes.

There is nothing to be done to prevent type 1 diabetes, even early diagnosis will not prevent it.

It is not caused by eating too much sugar.

Type 2 diabetes

Type 2 diabetes occurs when your body can’t use the insulin it makes.

A person with type 2 diabetes, you may be able to keep your blood glucose levels in a target range by healthy eating, exercising and taking diabetes medication.

Adjusting to Diabetes

Type 1 Insulin-dependent Before age 15 underweight equal between men and women requires insulin imperils kidney

Type 2 Noninsulin dependent After age 30 overweight affects more women affects poor more than middle class no injections imperils heart

Incidence of Diabetes

General Population 6.2% African American 13% Latinos 10.2% Men 8.3% Women 8.9%

The good news

People can live a long and healthy life by keeping their blood glucose levels in the target range.

They can do this by: Eating healthy meals Exercising Taking diabetes medication, including

insulin

Insulin-dependent diabetes mellitus (IDDM)

Management very demanding– injections– diet– exercise

Serious costs of failing to comply– blindness– kidney failure– amputation

Lifestyle changes

Eat healthy Eat three meals and a bedtime snack each day. Include a food from each of the food groups at each

meal. If you are thirsty, drink water or diet pop.

If you are overweight, eat smaller portions. Reduce your intake of fat.

Limit sweet and fatty foods.

Cardiac Rehabilitation

Fifty percent survive Major surgery and recovery Lifestyle changes

– diet– exercise– stop smoking

Motivation

Psychological reactions to CHD

Depression Anxiety Anger Fear Guilt Interpersonal

conflict

Coping with Cancer

Approximately 1.25 million people diagnosed with cancer in 1998

Coping with Cancer

Surgery Radiation Chemotherapy Hormonal treatment Immunotherapy

Cancer treatment side effects

Loss of hair burns nausea vomiting fatigue sterility

Survival

More than half of all cancer patients survive at least five years

HIV and AIDS

Relatively new disease

“The virus is not easily transmitted from person to person”– sex– IV drug– blood transfusion

Preventable

AIDS/HIV

1999-IN the U.S., HIV/AIDS fell from 8th to 14th among leading causes of death.

It remained the leading cause of death for black persons aged 25-44.

Alzheimer’s Disease

Degenerative disease of the brain– cognitive impairment– memory loss– personality change

Sure diagnosis only by autopsy

Cause unknown

Alzheimer’s and the family

Enormous cost to the family and society Financial and emotional resources

exhausted Combines with loss of loved one

Chronic stress of providing care for Alzheimer’s patients lowers immune system functioning and increases vulnerability to illness.

The End