1. Living with Chronic Illness William P. Wattles, Ph.D. Psychology 314

2. Acute disease n short-term n less common than chronic n either die or get well

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

4. Chronic illness n Virtually everyone will eventually develop some type of chronic condition.

5. Chronic illness n Must deal with: –Symptoms of the disease –Stress of Treatment –Feelings of vulnerability –Loss of Control –Threat to self-esteem

6. Examples of chronic illnesses n Cancer n diabetes n arthritis n ALS n asthma n chronic obstructive pulmonary disease n multiple sclerosis n Parkinson’s disease n muscular dystrophy n sickle cell anemia n HIV

7. Chronic disease n long-lasting n common n 50% at any point in time n 100% at one time or another n Variable course n never completely healthy

8. Coping with Chronic Disease n Attitudes and belief about illness n personal traits such as depression and optimism n coping strategies n compliance with prescribed regimens n social support.

9. Attitudes and Beliefs n According to both the Theory of Reasoned Action and Health Belief Model attitudes and beliefs predict adaptive behavior. n Social norms n attitudes n affect n facilitating conditions

10. Personality n Depression may take the energy away needed to adapt to the disease n anxiety may interfere with sleep and other health processes. n Optimism-a generalized expectation that the future looks good-associated with more adaptive behaviors.

11. Social Support. n Social support presumably serves to buffer the effects of stress for the cancer patient and may improve the prognosis. n The most helpful behaviors seem to be emotional support, sympathy and caring.

12. Impact of Chronic Illness n 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 n anxiety n fear n stress

13. Impact on the patient n Psychological functioning – social – physical – mental health n Self-image – positive and negative changes n Coping strategies

14. Opportunities for psychology n Strategies to improve compliance – “Noncompliance is a substantial problem in the treatment of chronic illness.” n Creation of support groups n Dealing with psychological repercussions n Sustaining of personal relationships

15. Impact on the family n Adult children – change in relationship n Spouse n Parents

16. Diabetes n Diabetes is a disease in which the body does not produce or properly use insulin n Insulin acts to reduce levels of glucose in the blood by interacting in some unknown way with cell membranes.

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

18. n 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.

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

22. Incidence of Diabetes n 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.”

23. Diabetes is a life-long condition. n High blood glucose levels over a long period of time can cause blindness, heart disease, kidney problems, amputations, nerve damage, and erectile dysfunction. n Good diabetes care and management can delay or prevent the onset of these complications

24. Type 1 diabetes n Type 1 diabetes occurs when the body makes little or no insulin. It used to be called insulin- dependent or juvenile diabetes. n There is nothing to be done to prevent type 1 diabetes, even early diagnosis will not prevent it. n It is not caused by eating too much sugar.

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

26. Adjusting to Diabetes n Type 1 n Insulin-dependent n Before age 15 n underweight n equal between men and women n requires insulin n imperils kidney n Type 2 n Noninsulin dependent n After age 30 n overweight n affects more women n affects poor more than middle class n no injections n imperils heart

27. Incidence of Diabetes n General Population 6.2% n African American 13% n Latinos 10.2% n Men 8.3% n Women 8.9%

28. The good news n People can live a long and healthy life by keeping their blood glucose levels in the target range. n They can do this by:  Eating healthy meals  Exercising  Taking diabetes medication, including insulin

29. Insulin-dependent diabetes mellitus (IDDM) n Management very demanding – injections – diet – exercise n Serious costs of failing to comply – blindness – kidney failure – amputation

30. Lifestyle changes n Eat healthy n Eat three meals and a bedtime snack each day. n Include a food from each of the food groups at each meal. n If you are thirsty, drink water or diet pop. n If you are overweight, eat smaller portions. Reduce your intake of fat. n Limit sweet and fatty foods.

31. Cardiac Rehabilitation n Fifty percent survive n Major surgery and recovery n Lifestyle changes – diet – exercise – stop smoking n Motivation

32. Psychological reactions to CHD n Depression n Anxiety n Anger n Fear n Guilt n Interpersonal conflict

33. Coping with Cancer n Approximately 1.25 million people diagnosed with cancer in 1998

34. Coping with Cancer n Surgery n Radiation n Chemotherapy n Hormonal treatment n Immunotherapy

35. Cancer treatment side effects n Loss of hair n burns n nausea n vomiting n fatigue n sterility

36. Survival n More than half of all cancer patients survive at least five years

37. HIV and AIDS n Relatively new disease n “The virus is not easily transmitted from person to person” – sex – IV drug – blood transfusion n Preventable

38. AIDS/HIV n 1999-IN the U.S., HIV/AIDS fell from 8th to 14th among leading causes of death. n It remained the leading cause of death for black persons aged 25-44.

39. Alzheimer’s Disease n Degenerative disease of the brain – cognitive impairment – memory loss – personality change n Sure diagnosis only by autopsy n Cause unknown

40. Alzheimer’s and the family n Enormous cost to the family and society n Financial and emotional resources exhausted n Combines with loss of loved one n Chronic stress of providing care for Alzheimer’s patients lowers immune system functioning and increases vulnerability to illness.

41. The End