Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
36 Cards in this Set
- Front
- Back
|
What is Di Matteo's (1991) definition of chronic illness? |
“chronic illness or handicap involves oneor more impairment or deviation from normal structure or functioning that,whether extensive or not, remain permanent. Chronic conditions are notreversible and they are usually accompanied by some sort of residualdisability” |
|
|
Is there a single universally accepted definition of chronic definition? what are the characteristics? |
- incurable - long-lasting but progression variable - limits what one can do - requires ongoing care (symptom relief, self-management) |
|
|
Why is there a need to look at chronic conditions? |
- increased in numbers - healthcare challenges - increase life expectancy, aging population both developed and developing countries |
|
|
Compared to acute illnesses, chronic conditions are? |
gradual onset, long duration, multiple causes, uncertain diagnoses, prognosis and intervention, no cure, pervasive uncertainty, complementary knowledge between professionals and patients |
|
|
What are the chronic conditions that are increasing in numbers? |
- cardiovascular diseases - cancer - respiratory disease (asthma, COPD) - diabetes |
|
|
Do people have one or multiple chronic conditions? |
Adults and seniors -- multiple Children -- single |
|
|
What are the common chronic conditions before 40 and after 40s? |
Up to mid 40s: accidental conditions such as paralysis After 40s: - cardiovascular disease - cancer - stroke - arthritis - diabetes - AIDS |
|
|
Describe the financial burden of chronic conditions |
- As the number of chronic conditions one has increases, cost of health care increases substantially - 2020: main cause of death - currently 70% of US health care costs - WHO: if we don't manage chronic diseases, they will become the most expensive problem for health systems |
|
|
How are chronic illnesses categorised? |
1) predictability 2) contagious 3) life-threatening vs. benign 4) controllability - self-management increases control, unpredictable course and few opportunity leads to helplessness |
|
|
Key notes about chronic illnesses |
- patients life irreversibly changed, disease and consequences are dynamic - uncertainty - understand trends, patterns and pace - goal is not to cure but maintenance of pleasurable and independent living |
|
|
What are the 4 steps to adjusting to chronic illness? |
1) uncertainty -- understand symptoms and severity 2) disruption -- intense emotional reactions as life routine is disrupted 3) adaptation -- strive to recovery, gain control 4) restoration of well-being |
|
|
What are the physical aspects of chronic illness |
- primary: chest pain - secondary: cognitive impairments - types of symptoms: contagiousness, visibility, intrusiveness - not always responsive to treatment |
|
|
What are the 4 types of stressors regarding treatment? |
1) brief 2) intense, complex 3) lengthy 4) intrusive |
|
|
What are 5 treatment factors? |
1) Complexity of treatment (e.g. diabetes) 2) Intrusiveness of treatment (e.g. endstage renal disease) 3) Side effects - nausea, hair loss, skin discoloration, taste aversion --> poor adherence secondary side effects --> cognitive dysfunction 4) Accessibility (geographical barriers totreatment) 5) Cost (direct/ indirect)–even in copayment models |
|
|
What are the two types of emotional responses to chronic illnesses? |
1) clinical - mood and anxiety disorders 2) subclinical - denial, anger, fear, frustration, anxiety etc. |
|
|
Why do patients experience emotional distress? |
Loss loss of health, loss of body parts, loss of roles, loss of secure future etc |
|
|
Shock |
Short lived reaction to diagnosis –being stunned and bewildered –Having feelings of detachment from situation –psychic numbness –cognitive disorientation –decreased mobility and speech May be related to uncertainty – theoverwhelming burden of unanswered questions re to diagnosis |
|
|
Denial |
Defence mechanism to ward off negative impact ofcondition - block off full realisation Minimising threat - complete negation of chronicity extent and implications ofcondition |
|
|
What are the positive consequences of denial? |
+ protect patient from acute adverseemotions +keeps patient form dealing with full range of problems |
|
|
What are the negative consequences of denial? |
- delay in seeking treatment -poor treatment adherence and management of condition -negative emotions due to unrealistic recovery expectations |
|
|
Anger/Hostility |
1) Internalised Self-directed feelings and behaviours of resentment,bitterness and self blame 2) Externalised Attributions of blame to others (e.g.medical staff family) or aspects of environment (e.g. poor medical care/access) |
|
|
Anxiety |
1) Immediately after diagnosis –overwhelmed by life changesrequired –loss and threat of death 2) Intermittently throughout course ofillness –in response to symptoms andtreatment side effects (e.g.chemotherapy; medication side- effects)–in response to events such awaitingtest results, invasive medical procedures (e.g. surgery)–in anticipation of futurecomplications, flare ups, disease progression / deterioration |
|
|
Depression |
30% of patients show symptoms of depression |
|
|
Why is it difficult to diagnose depression |
Depressive symptoms, such as fatigueor weight loss, are also symptoms of disease or side effects of treatment |
|
|
What are the implications of depression? |
–Adherence –Rehabilitation; return to work –survival –suicide rates |
|
|
What happens after a heart attack? depressed vs. non-depressed |
More % of depressed people die following a heart attack |
|
|
How does depression affect diabetes outcome? |
- Poorer glycemic control - Poorer self-care/adherence to treatmentplan - Increased physical symptoms - Increased functional impairment - More likely to develop diabetescomplication - Greater healthcare costs in primary care |
|
|
Trajectory of distress |
1) emotional distress highest at time of diagnosis and declines over subsequent months 2) differs across individuals 3) if sustained, may negatively affect health and illness |
|
|
What are positive responses to illness? |
1) positive appraisals -- optimism 2) positive emotions - psychological resilience, more effective problem solving, improve functional recovery 3) finding benefit |
|
|
Personal issues in chronic illness |
- self-concept - body image - self-esteem, emotional distress |
|
|
Social impact of chronic illness |
- disruption - difficulty in social leisure work - time, stigma - change in interpersonal relationships - impact on others |
|
|
Vocational issues in chronic illnesses |
Restrict or change work activities Job discrimination Financial difficulties |
|
|
Impact on others |
–Emotional distress–Poor physical health (immune function)–Quality of care – institutionalisation–Positive aspects of caregiving |
|
|
What are thre 3 major outcomes in rehabilititation and interventions |
1) health 2) maximum function 3) quality of life |
|
|
Interventions in chronic illness |
1) education 2) social cognitive theory 3) cognitive behavioral therapy 4) multi-component models |
|
|
Expert-patient program |
–Peer led program–Self efficacy (problem solving,goal setting, building confidence)–6 consecutive weekly groupsessions/2.5. Hours –Highly structured/scripted manual |
