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34 Cards in this Set
- Front
- Back
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What is the DDA?
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the disability discrimination act. Someone who has a mental or physical impairment that has a substantial and long term (>1 year) effect on their ability to carry out day to day activities (eating washing, walking etc. must require 1 capacity of the act mobility, manual dexterity, speech, hearing, seeing and memory. 2005 amendment= from point of diagnosis.
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What % of disabled people are in a wheelchair?
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5%
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What % of disabled people have impaired vision?
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22%
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What % of disabled people are hearing impaired?
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30%
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what is the relationship between disability and income?
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disability is overrepresented in those with lower income but conversely often lead to a considerable expense?
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what is the relation ship between illness and the geography of the uk?
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lowest in the south east. highest in old industrial areas, with ageing populations who earned lower incomes when they were young.
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What class of chronic illnesses are assumed to have the worse impact on health?
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Musculoskeletal
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What number of people have chronic disabling health problems?
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8.8 million
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What percentage of resources are taken by the 10% most ill/disabled?
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90%
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What are the key points the DH made in 2004 on the Management of “long term conditions”?
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“Match level of care to level of need” Increase support for self care, Strengthen usual primary care, Offer responsive specialist care, Anticipate needs of vulnerable cases,
This equates to passing the main care from specialists/hospitals to GPs. Many patients and GPs do not feel this provides best care. |
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What is the WHO definition of Impairment, Disability, handicap (term not used now)?
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Impairment is organic disease or structural abnormality
Disability is a problem in functioning normally in the community Participation in society is also affected by the environment – (used to be called handicap) |
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What does the WHO think effects social activity?
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its a function of a person and their environment.
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Describe the Institutional barriers of “risk”?
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People with sensory disabilities and mobility problems are often refused entry to buildings on the grounds that they are a “fire risk”, or a health & safety problem.
Up to half disability discrimination in employment cases are defended by employers on health & safety grounds. During the firefighters’ strike in 2000, many disabled people were excluded from work (and from earning). |
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What is the legal position on self-inflicted illnesses?
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NICE and its advisory bodies should avoid denying care to patients with conditions that are, or may be, self-inflicted (in part or in whole)."
This reversed a previous judgment, ignoring the concept of ‘deservedness’ in the NHS |
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What are the 6 psychological tasks in in "Adjustment"
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1) initial adjustment to diagnosis
2) Loss of functions, or keeping going at a cost. 3) Managing symptoms, coping with treatment regimens, minimising symptom worsening 4) Establishing and maintaining relationships with healthcare teams 5) Changing relationships; fostering social support 6) Supporting a sense of self, identity, autonomy & self- determination. |
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Which of the 6 psychological tasks in in "Adjustment" does the doctor play a part in?
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All of them
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Describe the process of coping?
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Coping is a process, not a single event
There is no universally good coping strategy, or bad coping strategy. Whether a strategy is good or bad depends on the context, on the problem it’s applied to, and short term and long term effects may differ. It’s undermined by depression: risk higher in: younger groups, higher levels of pain & greater disability Coping involves weighing up problem or threat & resources available to tackle it The threat can be over- or under-estimated. So can the adequacy of resources to deal with threat. Patients may overestimate medical resources: insisting there must be a cure for their condition, or at least a treatment with no adverse effects. |
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Describe “misimagining” disability / illness?
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Healthy people overestimate the negative impact of disabilities and illnesses.
They tend to focus on all the things they wouldn’t be able to do, forgetting the things which they could still do / be. Ill & disabled people overestimate value put on good health by healthy people. We recalibrate our expectations with age, but also with our state of health. So it’s important not to project our feelings about their health state on to patients. |
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What is Problem-focused coping?
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prioritises reducing stressful situations
- but not clear how much this helps adaptation. |
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What is Emotion-focused coping ?
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prioritises reducing distress
& is associated with more successful adaptation. |
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Other than Emotion-focused coping, how is adaptation promoted?
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acquiring information
planning realistically (rather than going on “how I feel”) cts may differ. It’s undermined by depression: risk higher in • younger groups • higher levels of pain & greater disability. “misimagining” disability / illness Healthy people overestimate the negative impact of disabilities and illnesses. They tend to focus on all the things they wouldn’t be able to do, forgetting the things which they could still do / be. Ill & disabled people overestimate value put on good health by healthy people. We recalibrate our expectations with age, but also with our state of health. So it’s important not to project our feelings about their health state on to patients. BMJ 15th August 2009 Understanding coping Coping involves weighing up ! problem or threat & resources available to tackle it The threat can be over- or under-estimated. So can the adequacy of resources to deal with threat. It may be unclear what the extent of threat is: " You can tough it out, ignoring symptoms at the risk of getting worse, or you can trust one doctor's judgment at the risk of selecting unwisely.” Patients may overestimate medical resources: insisting there must be a cure for their condition, or at least a treatment with no adverse effects. Coping: practical & emotional Problem-focused coping prioritises reducing stressful situations - but not clear how much this helps adaptation. Emotion-focused coping prioritises reducing distress & is associated with more successful adaptation. Adaptation is also promoted by • acquiring information • planning realistically (rather than going on “how I feel”) Striving for control is often unrealistic so results in repeated failures – which doesn’t help emotions. Acceptance – not resignation: emotional distance from worries, keeping to plans, carrying on despite symptoms. |
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What is Problem-focused coping?
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prioritises reducing stressful situations
- but not clear how much this helps adaptation. |
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What is Emotion-focused coping ?
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prioritises reducing distress
& is associated with more successful adaptation. |
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Other than Emotion-focused coping, how is adaptation promoted?
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acquiring information
planning realistically (rather than going on “how I feel”) cts may differ. It’s undermined by depression: risk higher in • younger groups • higher levels of pain & greater disability. “misimagining” disability / illness Healthy people overestimate the negative impact of disabilities and illnesses. They tend to focus on all the things they wouldn’t be able to do, forgetting the things which they could still do / be. Ill & disabled people overestimate value put on good health by healthy people. We recalibrate our expectations with age, but also with our state of health. So it’s important not to project our feelings about their health state on to patients. BMJ 15th August 2009 Understanding coping Coping involves weighing up ! problem or threat & resources available to tackle it The threat can be over- or under-estimated. So can the adequacy of resources to deal with threat. It may be unclear what the extent of threat is: " You can tough it out, ignoring symptoms at the risk of getting worse, or you can trust one doctor's judgment at the risk of selecting unwisely.” Patients may overestimate medical resources: insisting there must be a cure for their condition, or at least a treatment with no adverse effects. Coping: practical & emotional Problem-focused coping prioritises reducing stressful situations - but not clear how much this helps adaptation. Emotion-focused coping prioritises reducing distress & is associated with more successful adaptation. Adaptation is also promoted by • acquiring information • planning realistically (rather than going on “how I feel”) Striving for control is often unrealistic so results in repeated failures – which doesn’t help emotions. Acceptance – not resignation: emotional distance from worries, keeping to plans, carrying on despite symptoms. |
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Give examples of how beliefs about illness could effect health care?
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The individual’s beliefs about origins and implications of disease are very important: “My cancer was caused by stress”, “The best thing for arthritic knees is rest”, “People with weak hearts should try to avoid excitement and upset”.
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What 5 things are measured of the Illness Perception Questionnaire (Weinman)?
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1) identity - the symptoms the patient associates with the illness,
2) cause - personal ideas about aetiology 3) time-line - the perceived duration of the illness, 4) consequences - expected effects and outcome 5) cure / control - how one controls or recovers from the illness. |
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What services help adaptation (6) ?
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Good information about condition and prognosis: major role for doctor
Offering & delivering treatments: major role for doctor Helping with adverse effects: major role for doctor Adaptation to home/work environment: OT Provision of home based care: social work Developing skills and strategies to maximise independence & minimise distress: psychology |
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What is parsons sick role/how does it relate to chronic illness?
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This idea originated in the 50s, in sociology: The patient must show s/he wants to be well by complying with
medical advice and treatment. The doctor confirms that the patient is ill rather than lazy or faking, and provides treatment. A patient with legitimate illness is exempt from duties until well. Although this is an acute model, people seem to have the same expectations in chronic illness. If the doctor challenges the authenticity of the illness, the patient’s status is threatened. So challenging the authenticity of illness, or honesty of efforts to get better, tend to lose the patient’s trust. S/he may well respond by amplifying symptoms and complaints ..... “difficult patient” |
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According to the Disability Rights Commission 2007 How can the health gap between disabled people and other citizens be reduced?
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Include improved health outcomes for disabled people in mainstream health targets and standards.
Reduce inequalities through commissioning and targeting. Transform service cultures and staff attitudes. Meet people’s health needs wherever they live and whatever social support they receive. Deliver health services that support social inclusion of families. Meet the requirements of the DDA. |
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What does the GMC say about disability and chronic illness?
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It is particularly important for doctors ... to be aware of the important difference they can make to the way services are delivered to disabled people.”
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What % of adults have chronic health problems?
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66%
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How can you test weather the executive function is the primary deficit?
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inhibition of proponent response (child reverse chocolate test) but can do stroop task fine.
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Which other developmental disorders show executive function problems?
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Tourette’s
ADHD conduct disorder Can’t discriminate between autism and these other disorders? |
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How does autism effect cognitive strength?
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about 1 in 10 have an identified ‘skill’
• savant skills • music • maths • art • perfect pitch |
