The Impact of Chronic Illness Assignment Paper

The Impact of Chronic Illness Assignment Paper

The Impact of Chronic Illness Assignment Paper

The purpose of this study was to assess the impact of chronic illness on patients in relation to its physical, psychological, and social effects, and its effects on activities of daily living. A structured questionnaire was used to interview 177 patients. Chronic illness had the greatest effect on psychological functioning, followed by physical and social functioning. The least affected aspects of a patient’s functioning were related to performing activities of daily living (ADLs). Results indicated that the diagnosis, duration of disease, and developmental stage of the patient’s children were useful in predicting the impact of a chronic illness on a patient’s physical functioning. Diagnosis, duration of disease, and economic status had a significant impact on a patient’s psychological functioning. Diagnosis, duration of disease, age, sex, occupation, education, and marital and economic status were important factors relative to social functioning. Diagnosis, age, marital status, the developmental stage of the children, and the primary caregiver were the most important factors related to the effects of chronic illness on ADLs. The results of the study serve as a guide for a comprehensive assessment of chronically ill patients.The Impact of Chronic Illness Assignment Paper

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Advances in medicine have prolonged the life of many people with chronic diseases. Chronic diseases may not kill but they consume a lot of health care resources and threaten the quality of life of the sufferers.111 The ultimate goal of modern health care for patients with chronic disease is not only to delay death but also to promote health and quality of life. Health-related quality of life (HRQOL) has become an important measure of the outcome of care for patients with chronic diseases in the last two decades. It has also been found to be predictive of health service utilization and mortality.2,1214 It is subjective and should include the essential domains of physical, psychological, daily role and social functioning, and general health perception The Impact of Chronic Illness Assignment Paper

Australia’s population is ageing: our average healthy life expectancy of 73.2 years is second only to that of Japan (74.5 years).1 Total life expectancy is some 10 years longer, but this further longevity may be accompanied by significant and increasing disabilities.2 Burden-of-disease data show that depression, dementia, asthma, osteoarthritis, hearing loss and diabetes account for nearly 30% of the years of life lost due to disability in Australia. These are all chronic conditions that are increasingly prevalent,3 in the face of healthcare workforce shortfalls in Australia.4 Thus, there is a need to explore alternative models of healthcare delivery. These need to be collaboratively developed and should provide a range of healthcare professionals with broad knowledge and competency to care for patients with chronic illness.The Impact of Chronic Illness Assignment Paper

Recently, Wagner defined what constitutes a patient care team and outlined strategies necessary for the effective functioning of chronic disease programs.5 A patient care team comprises diverse healthcare professionals who communicate regularly about the care of a defined group of patients and participate in that care on a continuing basis.6 The strategies that underpin this team care include:5

  • Population-based care;

  • Treatment planning, which should be negotiated with the patient;

  • Evidence-based clinical management;

  • Self-management support, with the emphasis on patient self-education, self-care and counselling in behavioural change;

  • More effective consultations; and

  • Sustained follow-up, which may not need to be face to face, but could be carried out, for example, over the telephone The Impact of Chronic Illness Assignment Paper

The development of team care for chronic disease needs to involve and cater for both institutional and community care, and these may be very “system” dependent: public and private hospitals and community facilities can have quite different systems and approaches. Current organisational structures for healthcare delivery are discipline-based, but we need to abandon this paradigm in dealing with chronic disease. Healthcare structures are often, by their nature, hierarchical “ego systems”10 and can interfere with the ability to develop comprehensive healthcare delivery services. It is important to break through the barriers between these “silos”.The Impact of Chronic Illness Assignment Paper

The concept of multidisciplinary disease clinics where orthopaedic surgeons and rheumatologists work closely with physiotherapists is well accepted. Cardiologists and cardiac surgeons combine to provide advice on acute intervention in chronic cardiovascular disease. These concepts work well within the hospital system, but need to be adapted for community care.

Another problem with disease management for chronic conditions is that the healthcare system is predominantly geared for healthcare professionals rather than for patients, and for episodes of acute care (albeit often in chronic disease) rather than for chronic care. In the shift of care delivery, it is critical that the “team” work across the interfaces of the community and institutions and that communication between specialists and the primary care teams be maximised for the patients’ good. The development of multidisciplinary disease-specific healthcare delivery teams helps to break down those barriers, but patients need to be involved more in that dialogue.

Future healthcare professionals will need to have some skills or knowledge of case management and integration of care. They will need to:

  • Be aware of health promotion and disease prevention issues;

  • Be able to act as the patient’s advocate; and

  • Empower patient self-care through education and provision of basic skills for self-care. Patients with chronic disease will have increasing knowledge of their conditions and will want to be involved in decision-making. Healthcare professionals will need to be aware of this patient empowerment The Impact of Chronic Illness Assignment Paper

The “generic” healthcare professional

There may be a role for a more “generic” healthcare professional who has a defined range of allied health skills (physiotherapy, occupational therapy, nursing, etc), but not necessarily the specialty expertise of any one discipline. These people would work closely with other members of the healthcare team, particularly general practitioners. “Generic” healthcare professionals with various skills may be useful in the care of patients with chronic disease or in assessing elderly patients in a community setting. They might be particularly useful in rural areas where allied health professionals are often in short supply. These “generic” healthcare professionals could use technologies such as video or computer to link with specialists, medical or other (physiotherapists, pharmacists, etc), in urban centres. Similarly, “generic” healthcare practitioners with skills in acute resuscitation, dental care, basic physiotherapy, counselling and limited prescribing could provide useful care in local communities, especially if they have contact with, and are regarded as part of a team of, healthcare professionals in regional centres. This model might also have a place in providing services in community aged-care facilities, closely linked with local general practice and community services.The Impact of Chronic Illness Assignment Paper

Data from the United States suggest that partnerships between primary care physicians and “advanced practice nurses” can provide better patient outcomes.13 If the training of advanced practice nurses were extended to include knowledge of physiotherapy, occupational therapy and pharmacy, these “generic” healthcare professionals could provide a broad range of advice and services in partnership with other disciplines.

Assessing alternative systems

The important issue is that we should consider alternative models of healthcare delivery for chronic disease, and assess whether they might work in Australia.

In some other areas of healthcare, particularly in the US and Europe, other healthcare professions have taken on roles hitherto considered the purview of the doctor. Nurse anaesthetists are well accepted in Scandinavia, where they have an important role in assessing chronic pain and managing post-operative pain.14,15 The idea of “medical practitioner assistants”, where nurses or others can be trained to be anaesthetic assistants or assist in other procedures, has long existed in the US. The supply of non-medical clinicians in the US is growing significantly, with the number of non-physician clinicians in primary care expected to be equivalent to 20% of the supply of physicians by 2015.16 A recent US study17 of the trend towards care by non-physician clinicians has shown that, although the number of patients visiting non-physician clinicians is increasing, many are seeing physicians as well. This is accompanied by a shift towards the provision of preventive services by non-physician clinicians and an increase in the proportion of patients seen by both types of providers. It is important that these physicians and non-physicians are truly complementing each other, delivering the same services to different groups or different services to the same group. For patients, the type of clinician may be less important than whether the care meets their needs and achieves a “better” or “equivalent” outcome. The success of these models depends on close collaboration and communication between the various care providers. It is important to evaluate these models carefully from the start to ensure that continuity and quality of care are not reduced The Impact of Chronic Illness Assignment Paper

We need to work together to identify tasks performed by one professional group that might be equally well performed by others. This would then free that group to concentrate their expertise in other important areas. For example, pharmacists or nurses might be involved in providing repeat prescriptions, or reviewing medication and compliance; radiographers or expert systems could be involved in x-ray interpretation; and human movement professionals might be involved in exercise programs for obesity, osteoporosis and chronic arthritis. Optometrists might play a role in the management of specified eye problems. Indeed, it should be asked whether it is possible to train non-medical practitioners to perform specific procedures such as gastrointestinal tract endoscopy, cataract extraction or arthroscopy.

We could also consider professional groups outside the healthcare system, such as teachers. Developing closer links between the healthcare and education systems could have significant effects on what children learn about the most important thing they have — their own bodies. Teachers could play a very important public health role as health educators to children in the 8–16-year age bracket. Development of basic knowledge, particularly on the importance of exercise, could play an important role in reducing the current epidemic of obesity in young people, which will inevitably lead to chronic diseases such as diabetes, arthritis and cardiovascular disease.The Impact of Chronic Illness Assignment Paper

The aim of this study was to assess the impact of chronic diseases on the HRQOL of Chinese patients in a primary care clinic in Hong Kong. Most previous studies on the relationship between chronic diseases and quality of life were carried out in Western populations, which might not be applicable to our population, 96% of whom are Chinese.18 We wanted to know whether different diseases affected HRQOL differently and whether one aspect of HRQOL might be affected more than others. We hoped that the information could help doctors and health administrators to identify the needs of patients with chronic diseases better so that their services could be more patient-centred.

The impact of each chronic disease on HRQOL was measured in terms of the likelihood of sub-optimal functioning or health instead of numerical scores used by many other studies.46,8 We hoped that this would make the clinical significance of the results easier to interpret, and that doctors in primary care could use them to predict the risk for their patients.The Impact of Chronic Illness Assignment Paper

Many earlier studies have shown that co-morbidity is common and may influence the patients’ HRQOL.68,11,1921 Demographic factors such as age, gender and socioeconomic status could also affect people’s health perception. Therefore, we also estimated the effect of each chronic disease and compared their relative impact independently of the effects of demographic factors and co-morbidity.

The study was carried out in a teaching family medicine practice in Hong Kong. The practice was one of 60 Government outpatient clinics (GOPCs) which provides low-cost primary care for the public. The majority of patients with chronic diseases in Hong Kong are followed up in GOPCs for financial reason.18 At the time of the study, the practice had 5305 Chinese patients with an average of 70 persons consulting each day.

All patients aged 18 years or above consulting the practice from July 5 to August 3, 1995 were invited to take part in the study. Each patient in the study was interviewed with a structured questionnaire before the consultation with the doctor. The subject answered the questions in person unless he/she could not communicate, in which case the accompanying person (proxy) answered the questionnaire.The Impact of Chronic Illness Assignment Paper

The questionnaire consisted of questions on demographic and morbidity data and the Chinese version of the Dartmouth COOP Functional Health Assessment Charts/WONCA (COOP/WONCA charts).

Morbidity data were collected by a checklist for the presence of eight common chronic diseases that represented a wide range of problems from the asymptomatic to the potentially fatal. Each respondent was asked specifically if he/she had ever been diagnosed by a doctor as having hypertension, diabetes mellitus, asthma or chronic obstructive pulmonary disease (COPD), heart disease of any kind, stroke, osteoarthritis (OA) of the knee, joint diseases other than those of the knees (other joints) and depression. Asthma and COPD were considered as one group because there is considerable clinical overlap between them. No distinction was made for the different types of heart diseases because patients cannot always tell the difference between them. The records of the respondents were also reviewed for the presence of these diagnoses. A subject was considered to have the particular disease if he or she was sure that such a diagnosis had been made by a doctor or the diagnosis was documented in his/her record.The Impact of Chronic Illness Assignment Paper

The COOP/WONCA charts consist of one chart each on physical fitness, feelings, limitation in daily activities, limitation in social activities, overall health and change in health. They have been validated and tested on patients in primary care in different cultures including the Chinese.22,23 The first five charts cover the essential concepts of HRQOL.1517 The chart on change in health does not assess HRQOL but provides additional information for the interpretation of the results of the other charts. Each chart is rated on a five-point Likert scale, with higher scores indicating worse function or health status. A summary of the questions and response choices of the COOP/WONCA charts is shown in Appendix A.The Impact of Chronic Illness Assignment Paper

The scores of each of the five COOP/WONCA charts on HRQOL were grouped into two categories (optimal and sub-optimal) for further analysis. The optimal category consisted of scores 1 and 2 and the sub-optimal category consisted of scores 3, 4 and 5 for the charts on physical fitness, feelings, daily activities and social activities. Scores 1, 2 and 3 were grouped into the optimal category, while scores 4 and 5 were grouped into the sub-optimal category for the overall health chart. The proportions of sub-optimal COOP/WONCA scores for each disease group were compared with those of patients without any of the chronic diseases (control group). The difference in proportion between them was tested by the chi-square test.

The effects of diagnosis, age, social class by occupation,24 marital status, education and gender on the COOP/WONCA scores were analysed by multivariate forward logistic regression. All the independent variables were fitted together into the logistic regression model, and P-values ≤0.05 were considered statistically significant. All data analyses were carried out by the SPSS for Windows 8.0 program The Impact of Chronic Illness Assignment Paper

Seven hundred and sixty (97.8%) of 777 eligible patients completed the survey. Twenty-three (3%) of the questionnaires were answered by proxies. There were 222 (29.2%) males and 538 (70.8%) females. The mean age was 57.6 years (range 18–94 years, SD 18). One hundred and ninety-one (25.1%) people were not known to have any of the surveyed chronic diseases, 202 (26.6%) had one, 188 (24.7%) had two, 89 (11.7%) had three, 28 (3.7%) had four, three (0.4%) had five and one (0.1%) each had six and seven of the chronic diseases. Fifty-seven (7.5%) people were not sure if they had any of the diagnoses.

The number of persons and demographic characteristics of the sample and each disease group are shown in Table 1. Patients with chronic diseases were more likely than controls to be older, less educated, unskilled workers and persons whose spouses were deceased.The Impact of Chronic Illness Assignment Paper

Table 2 compares the unadjusted proportions of sub-optimal COOP/WONCA scores of each disease group with those of patients without any of the diagnoses (control group). Apart from hypertension and diabetes mellitus, the presence of any one chronic disease tended to increase the risk of sub-optimal scores for all the charts. The differences in physical fitness scores were statistically significant for all disease groups. The difference in the feelings scores was statistically significant for depression. The differences in daily activities scores were significant for stroke, OA of the knee, other joint diseases and asthma/COPD. The difference in social activities scores was significant for depression. The differences in the overall health scores were significant for asthma/COPD and depression.The Impact of Chronic Illness Assignment Paper

Table 3 shows the results of multivariate forward logistic regression of the COOP/WONCA scores on each diagnosis and demographic variables. Subjects who were unsure of the diagnosis were categorized into the ‘absence of the diagnosis’ group for the logistic regression in order not to exclude too many cases from the analysis. All the odds ratios for sub-optimal COOP/WONCA scores shown were significant at the 5% level. Each odds ratio was the ratio between the odds of a sub-optimal score of those with and those without the relevant diagnosis, after controlling for the effects of demographic variables and co-existing chronic diseases. Most odds ratios approximated the relative risks since the absolute risk in the unexposed was <20%, except for the physical fitness score. The odds ratios of sub-optimal physical fitness scores for hypertension and depression corresponded to relative risks of 1.3 and 1.8, respectively The Impact of Chronic Illness Assignment Paper

 

The effects of most chronic diseases on the physical fitness score became insignificant when they were controlled for demographic variables and co-morbidity. Hypertension increased the odds of sub-optimal physical fitness scores but reduced the risk of sub-optimal feelings and overall health scores. Diabetes mellitus significantly reduced the likelihood of sub-optimal scores for feelings, social activities and overall health. Heart disease did not have any significant independent effect on any COOP/ WONCA scores. OA of the knee increased the risk of sub-optimal scores for daily activities and overall health. Stroke, other joint diseases and asthma/COPD each increased the risk of sub-optimal scores for daily activities. Depression was a risk factor of sub-optimal scores for all but the daily activities charts.

Age, educational level and gender had some effects on the COOP/WONCA scores but social class and marital status had no effects. Increasing age increased the risk of sub-optimal physical fitness scores. Education decreased the likelihood of sub-optimal physical fitness scores when compared with no formal schooling (primary education OR = 0.4925, CI = 0.32–0.75; secondary education OR = 0.4096, CI = 0.25–0.68; tertiary education OR = 0.3075, CI = 0.14–0.69). Females were more likely than males to have sub-optimal feelings scores.The Impact of Chronic Illness Assignment Paper

This study confirmed that many chronic diseases had an adverse effect on the HRQOL of Chinese patients and that different conditions affected different aspects of life. Sixty-seven per cent of subjects had at least one of the eight chronic diseases, and 41% had more than one. These prevalences were relatively high compared with those reported in the literature.3,19,21 This was because the study practice was a GOPC, which had a high proportion of elderly patients with chronic diseases.

The unadjusted risks of sub-optimal COOP/WONCA scores shown in Table 2 represented what primary care doctors might expect to find in the real clinical setting. A Chinese patient with depression is likely to have an 88% chance of reporting sub-optimal physical fitness, a 36% chance of moderate to severe emotional problems, a 26% chance of limitation in his/her social activities and a 32% chance of fair or poor health. These risks were twice or more than those expected for patients without any of the common chronic diseases. Some of the observed effects might be the result of the patient’s age, gender, educational level or co-existing diseases, but some demographic and morbidity characteristics tend to cluster together and it is almost impossible to separate one effect from the other in clinical practice.20 On the other hand, it is important to control for the effects of co-morbidity and demographic variables in the evaluation of the effectiveness of care and medical risk adjustment so that these confounding factors will not bias the results.The Impact of Chronic Illness Assignment Paper

The finding that heart diseases were not associated with any significant effect on any COOP/WONCA score was unexpected since previous studies showed that they adversely affected all HRQOL domains.4,5 There was a tendency for our cardiac patients to have a higher risk of sub-optimal scores for all the COOP/WONCA charts than the controls, although the differences did not reach statistical significance. This suggested the possibility of a type II statistical error in that the sample size of 49 subjects was too small to show a statistical significance for a small effect.27 However, a statistically significant change might not be clinically important and further studies are required to determine the minimum clinically important change in quality of life rating for cardiac patients. The other possible explanation was that 86% of the cardiac patients in this study had co-existing chronic diseases; the effects of these diseases might have ‘cashed in’ before heart disease could be entered into the regression model. The last, but not the least important, reason was that cardiac patients with severe disease or disability are followed up by cardiologists, thus most patients in primary care have only mild diseases with little disability. An evaluation on a larger sample of cardiac patients with different severities of illness could help to clarify the relationship between heart disease and HRQOL.The Impact of Chronic Illness Assignment Paper

It seemed contradictory that diabetes mellitus reduced the risk of sub-optimal scores for feelings, social functioning and overall health. De Grauw et al. and others have shown that diabetes mellitus was associated with worse ratings in both physical fitness and overall health domains.5,11 Our finding was unlikely to be a confounding effect of co-morbidity because the latter was controlled for in the regression analysis and the majority of patients with diabetes mellitus did not have other chronic diseases except hypertension. Quality of life rating is subjective and relative to the person’s life expectation. It has been found that successful adjustment has a positive effect on patients’ perceived HRQOL.28 Differences in people’s adaptation to their illnesses and life expectations between the Chinese and Western cultures could be the reason for the different results. The Chinese culture promotes endurance, acceptance and adaptation to one’s fate, including the presence of illnesses. Chinese patients with diabetes mellitus might down-regulate their expectations for life and would feel happy and contented as long as they remained asymptomatic and free from complications. They might even consider themselves fortunate and rate their health status more positively compared with the worst that they could expect from their illness. The promotion of a positive attitude could be as important as perfect glycaemic control in the care of diabetic patients.The Impact of Chronic Illness Assignment Paper

Depression was the most disabling disease affecting not only the psychological well-being but also the physical and social functioning of the person. This finding reinforces the importance of recognizing and treating this disease adequately in primary care. The effect of depression on physical fitness has not been found by others.5,10 Physical and mental health are often considered to be two independent factors of HRQOL, and psychological diseases are not expected to affect the physical component of health.16This unique finding in our patients could be due to a cultural tendency for Chinese patients to somatize their psychological problems The Impact of Chronic Illness Assignment Paper

Patients seemed to perceive OA of the knee to be more disabling than hypertension, diabetes mellitus and heart disease, although these latter three diseases are regarded as the most important chronic diseases by doctors. The amount of resources and number of research studies on hypertension, diabetes mellitus and heart diseases are countless, but those invested in the care of patients with OA are negligible.14 There seems to be a discrepancy between how doctors and patients define the importance of an illness. OA of the knee is often ignored by doctors until the disease is very advanced because it does not kill and is often considered a ‘normal’ ageing process.14,30 This study and that by De-Bock et al. consistently showed that OA of the knee was a risk factor, independent of associated psychosocial factors or co-morbidity, of limitation in daily activities and poor general health.6 Research on the pathophysiology and mechanics of the knee joint has not advanced the care for patients with OA of the knee very far; it may be time for a paradigmal shift towards a more patient-centred approach to this disabling disease The Impact of Chronic Illness Assignment Paper

The effects of hypertension on HRQOL reported in the literature are variable.4,5,8 Our findings of a negative effect on physical fitness but a positive effect on feelings are similar to those of Krousel-Wood et al.8 and Nelson et al.5 Krousel-Wood et al. also found that females with hypertension had better overall health ratings than females seen for other conditions.8

This study was carried out among patients in primary care who tended to have milder diseases and more stable conditions than patients under specialist care; therefore, the results may not be applicable to the latter setting. Furthermore, the findings from patients of one clinic might not be generalizable to all primary care practices in Hong Kong. We realize that self-reported data are subject to measurement errors, but the same bias should have been present for the disease and control groups so it should not have affected the results of the relative risk estimation and regression analysis.The Impact of Chronic Illness Assignment Paper

The numbers of patients in the heart disease, asthma/ COPD and stroke groups were small; the sample sizes had enough power to detect only a medium effect of 15–20% difference in proportions.27 This study could not exclude some small effects that these chronic diseases might have on the quality of life of patients. We would also like to point out that the controls in this study could have diseases other than the eight chronic conditions surveyed, which could have deflated the difference in HRQOL ratings between them and the ‘disease’ groups. With these limitations, the study did prove that measurement of HRQOL was feasible for Chinese patients in a busy primary care clinic and gave a different perspective on how the importance of a disease could be defined.

This study confirmed that many common chronic diseases adversely affected the quality of life of Chinese patients, as they did for Caucasian patients. Depression, OA of the knee, other joint diseases, stroke, asthma/ COPD and hypertension were each associated with a 30–200% relative increase in the risk of disability or ill health measured by the COOP/WONCA charts. Depression was the most disabling disease and daily role functioning was the most commonly affected HRQOL domain.The Impact of Chronic Illness Assignment Paper

OA of the knee was more disabling than hypertension and diabetes mellitus from the patients’ point of view. This raised the questions of how the importance of a disease should be measured and whether doctors or patients should be the judges. We need to include HRQOL as a routine outcome measure of care for patients with chronic diseases if health services are really for the betterment of the quality of life of people.

The positive impact of diabetes mellitus on HRQOL and the negative effect of depression on physical fitness found in our Chinese patients has not been reported in other cultures. Further studies on more representative samples are required to confirm whether there are true cultural differences in how Chinese people adjust to chronic diseases. It would be useful if we could identify the postitive and negative coping behaviours in each culture so that appropriate counselling could be given to patients.

The Chinese are the world’s largest ethnic group who live in all parts of the world. We hope doctors world-wide will be more aware of the possible impact of chronic diseases on the quality of life of their Chinese patients.The Impact of Chronic Illness Assignment Paper

What are some effects of a chronic illness?

In addition to disease specific symptoms, people commonly complain of invisible symptoms such as pain, fatigue, and mood disorders. Pain and fatigue may become a frequent part of your day.

Physical changes from a disease may affect your appearance. These changes can turn a positive self-image into a poor one. When you don’t feel good about yourself, you may prefer to be alone and withdraw from friends and social activities. Mood disorders such as depression and anxiety are common complaints of people with chronic conditions, but they are extremely treatable.

Chronic illness can also influence your ability to work. Morning stiffness, decreased range of motion, and other physical limitations may force you to change your work activities and environment. A decreased ability to work may also lead to financial problems.The Impact of Chronic Illness Assignment Paper

If you’re a homemaker, your work may take much longer to do. You may need the help of your spouse, a relative, or a home healthcare provider. As your life changes, you may feel a loss of control, anxiety, and uncertainty of what lies ahead. In addition, there may be role reversals in families, as family members who were once stay-at-home now have to go back to work, due to their significant other’s inability to work.

Chronic illness and disability can have damaging, even catastrophic, socioeconomic effects on individuals and their households. We examined the experiences of people affected by chronic heart failure, complicated diabetes and chronic obstructive pulmonary disease to inform patient centred policy development. This paper provides a first level, qualitative understanding of the economic impact of chronic illness.

Quality of Life (QoL) has become a widely used measure in health outcome studies during the past ten years (1). QoL has been defined as ‘‘the perception that an individual has of his or her place in life, within the context of the culture and system values in which he or she lives, and in relation to the objectives, expectations, standards and concerns of this individual’’ (2). The World Health Organization has also defined Health Related Quality of Life (HRQoL) as ‘‘an integrative measure of physical and emotional well-being, level of independence, social relationships and their relationship to salient features of their environment’’. The conceptualization of the term QoL is both objective and subjective and so its measurement requires reference to varied and complex areas. Also, QoL measurement can be very personal as experiences, beliefs, expectations and perceptions of each individual may be unique (3).The Impact of Chronic Illness Assignment Paper

Health-related QoL, irrespective of disease specificity or generality, combines physical, cognitive, emotional, and social functioning experienced and reported by the patient. Further, it can be considered as the appreciation of the pervasive and adverse effects of illness on the patient as perceived by the patient. In other words, it is the “illness experience as opposed to the disease” (3). Generic measures of health-related QoL incorporate a broad spectrum of function, health perceptions and symptoms which can be used in different patient populations including those without a disease. This enables direct comparison of QoL across different disease states and conditions. The inherent limitation of generic measures is that they may overlook important aspects or changes that are of particular value for a specific medical condition (4). Disease-specific measures quantify more clinically relevant domains for a specific disease state than a generic measure. They are often more responsive to changes in health-related QoL and are more sensitive in discriminating the range of impairment in health-related QoL, because their focus is on the most relevant aspects for the problem or condition assessed. Given the breadth and complexity of QoL, it is important to include and assess multiple domains of QoL from a variety of perspectives usually incorporating both generic and specific disease measures. Therefore, the proposed study utilizes cardiac specific QoL as the primary outcome, and generic health-related QoL as the secondary outcome The Impact of Chronic Illness Assignment Paper

Exposure to chronic critical illness has devastating physiological effects on patients and damaging psychological consequences for their family members. The proportion of family members exposed to psychologically taxing conditions of chronic critical illness will continue to mount, consistent with steadily increasing rates of patients admitted to an intensive care unit (ICU) and demand for prolonged mechanical ventilation.1,2 The chronically critically ill (CCI) are a cohort of critically ill patients who require prolonged mechanical ventilation and consume an abundance of healthcare resources in an effort to enhance their likelihood for survival. Patients affected by chronic critical illness have been identified by protracted ICU lengths of stay, need for costly life-sustaining medical technologies, such as a tracheostomy and artificial enteral nutrition, and poor survival rates The Impact of Chronic Illness Assignment Paper

The growing availability of critical care resources, along with technological advances in life-sustaining devices, have allowed many patients to survive acute life-threatening critical illnesses and transition to a chronic phase of critical illness. The CCI are a small and steadily increasing proportion of the critically ill who require prolonged mechanical ventilation during their hospitalization. To date, it is estimated that 5% of mechanically ventilated patients require prolonged mechanical ventilation (> 72 hours) and transition to the state of being chronically critically ill.11,12 Chronic critical illness is a syndrome that consists of patient characteristics such as respiratory insufficiency or failure requiring mechanical ventilation, multiple organ dysfunction related to underlying chronic disease, neuromuscular deterioration, malnutrition, symptom burden and psychological disturbances, such as delirium and depression.101315 The CCI are a subset of the critically ill that have a prolonged state of critical illness that necessitates their utilization of costly hospital and post-hospital resources.Haemophilia is a chronic disease, affecting patients and their families. The impact of such a disease upon each family is dependent upon family type and characteristics and adjustment to it varies with time, in concordance with the family’s lifecycle. In the National Hemophilia Center in Israel we lead a special support system and conduct group therapy from the very early stage of haemophilia diagnosis throughout the lifetime of patients. The general definitions of a family’s lifecycle, the effect of the disease and the required adjustment to it are described in this paper. We refer to special difficulties associated with haemophilia as a chronic, genetic disease and describe ways to cope, discussing the support systems that have been established in our centre.The Impact of Chronic Illness Assignment Paper

The stress of a serious illness, chronic health condition or disabilityin a child often causes problems in a family, particularly if each parent or adult caregiver attempts to deal with his or her own fears and frustrations related to the chronic health condition or disability alone and without support.

In some instances, mothers and fathers become consumed with the care of their child with a chronic illness or disability, at the expense of nearly everything else in their lives. In these situations, parents may find themselves almost constantly looking for new options, reading about alternative treatments, and thinking about the future. T

We suggest that outcomes in health care can be reduced to 3 things: how long people live (survival), how well people live (quality of life [QOL]), and cost. Survival is measured in units of time. Cost, measured in monetary units, relates the economic impact of disease and treatment, including direct medical, direct nonmedical, and indirect and intangible costs. The unit of measurement for both survival (eg, years) and cost (eg, US dollars) is objective, and neither is particularly variable or controversial. In contrast, QOL is a subjective concept that is measured using an array of rather diverse assessment. Defined most broadly, QOL encompasses not only disease symptoms and functional consequences (eg, impairment in activities of daily living [ADLs]), but also subjective life satisfaction, happiness, and the overall value one places on life at any given time.The Impact of Chronic Illness Assignment Paper

Regardless of how one assesses QOL, the purpose of this type of assessment is nearly always to assess the functional and subjective impact of chronic illness and its treatment on the person. This is a valuable endeavor, because the very same disease process can have quite different effects on different people. Although it is important to monitor disease and treatment effects using objective measures such as laboratory data, only the patient’s perspective, or that of a valid proxy, provides a full understanding of the effect of disease or treatment on the patient.

In this article, we review 2 major types of QOL instruments (generic, targeted) and discuss their relative strengths and weaknesses. We then describe an example of a hybrid of these 2 approaches, the Functional Assessment of Chronic Illness Therapy (FACIT) system of health-related quality of life (HRQOL) measurement. This system, which combines a core general measure with supplemental targeted measures, capitalizes on the strengths of each type of instrument. The FACIT system is an example of a modular approach to assessment that can be adopted by professionals interested in evaluating HRQOL. We also describe the methodology used in FACIT scale development to show characteristics that are desirable in HRQOL measures. Finally, we point out several new developments in measurement that promise to significantly advance the field.The Impact of Chronic Illness Assignment Paper

Elderly people experience a variety of chronic diseases because of biological degeneration, with health problems being almost inevitable in the last period of human life. The most frequent degenerative diseases leading to reduced quality of life (QoL) are cancer, hypertension, osteoporosis, and diabetes mellitus [1, 2]. Cancer is a leading cause of death in Thailand, with age-adjusted mortality rates of 89.7 per 100,000 in males and 67.2 per 100,000 in females. Liver cancer is the most prevalence cancer in men and the third most common cause of cancer in females [3]. Cancer survivors are affected physically, psychologically, socially, and spiritually [4], similar to the lower levels of quality of life seen in breast cancer survivors, which is a major cause of death among women [5].The Impact of Chronic Illness Assignment Paper

The quality of life in chronic illnesses can vary with age, especially for senior adults. Chronic conditions affect seniors’ mobility and consequently their physical and functional status [6, 7], emotional balance, and self-esteem decline because of their dependence on others. These, in turn, contribute to the reduction in the quality of life for seniors [8]. Review articles have shown consistently negative relationship between multiple chronic diseases and quality of life [9]. The presence of chronic illness was related to unhappiness and psychological distress, resulting in low quality of life for both men and women [10]. Nevertheless, there is inconsistency in research findings. Öztürk and colleagues found no association between chronic diseases and physical mobility, functional independent activities, and type of chronic conditions in either gender [11]. Despite these inconsistent findings, degenerative diseases still have a significant influence on quality of life.

Behavioral risk factors, such as smoking and alcohol abuse, are another important influence on quality of life. Empirical studies clearly show that alcohol and smoking habits have negative consequences for health-related quality of life by reducing life expectancy and creating psychological problems [12–14]. A cross-sectional study conducted in five regions in China found that lifestyle factors, particularly smoking and alcohol drinking, had a strong association with health-related quality of life [15]. The majority of studies related to chronic diseases and lifestyle behaviors have been conducted in developed countries. Less is known about the influence of lifestyle factors, including smoking and alcohol drinking, and chronic illnesses of aging on the quality of life in developing nations.The Impact of Chronic Illness Assignment Paper

Thailand, a low-middle income country in Southeast Asia, faces a growing burden of chronic diseases in its older population. Chronic diseases have become a major burden on the government’s budget, accounting for 60 million Baht (approximately US $2 million) in 2004 [16]. The major proportion (80%) of the health budget is allocated to inpatient care for complex chronic diseases [16]. Despite this, there have been few, if any, studies in Thailand on the effects of chronic diseases and lifestyle behaviors (smoking and alcohol abuse) on quality of life. This study aimed to explore the effects of chronic disease, smoking, and alcohol drinking on quality of life among Thai seniors in three regions, North region, Northeast region, and Central region. The outcomes may help to identify factors to enhance quality of life and understand gender-specific influences on quality of life among Thai seniors.The Impact of Chronic Illness Assignment Paper

The World Health Organization (WHO) defines health as not merely the absence of disease or infirmity, but a state of complete psychical, mental and social well being.1The definition of Quality of Life (QoL) is more complex. According to WHO, QoL is defined as individuals’ perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns.2 QoL is the feeling of overall life satisfaction, as determined by the mentally alert individual whose life is being evaluated.3 This appraisal is subjective, and encompasses all domains of life, including elements of a biopsychosocialspiritual model.4 The use of the term subjective has different connotations to different people and can be perceived as not reliable because it is not objective. Subjective can be synonymous with self-perceived meaning that a person primarily gives information about himself.The Impact of Chronic Illness Assignment Paper

Other definitions of QoL suggest that it is a global personal assessment of a single dimension which may be causally responsive to a variety of other distinct dimensions: it is a unidimensional concept with multiple causes.5 Therefore, it encompasses the entire range of human experience, states, perceptions and spheres of thought concerning the life of an individual or a community. Both objective and subjective QoL can include cultural, physical, psychological, interpersonal, spiritual, financial, political, temporal and philosophical dimensions. QoL implies a judgment of value placed on the experience of communities, groups such as families or individuals.6

Finally, it is suggested that QoL can theoretically encompass a wide ranging array of domains and components. These involve functional ability including role functioning (functional ability in different roles like in physical activities and achievement beliefs), the degree and quality of social interaction, psychological well-being, somatic sensations, happiness, life situations, life satisfaction and need for satisfaction.7 It also reflects life experiences’, significant life events and the current phase of the life and the factors defining QoL in this respect further include sex, socioeconomic status, age and generation.8 QoL is thus a complex collection of interacting objective and subjective dimensions: encompasses the individual’s perspective, is assessed through the eye of the experiencer,9 and is likely to be mediated by cognitive factors.The Impact of Chronic Illness Assignment Paper

Patrick and Erickson (1993) define health-related quality of life (HRQoL) as the value assigned to duration of life as modified by the impairments, functional states, perceptions and social opportunities that are influenced by disease, injury, treatment or policy.6 A main topic in HRQoL includes patients’ appraisal of their current level of functioning, as well as satisfaction with it, compared to what they believe to be ideal. An important aspect in HRQoL study is how the manifestation of an illness or treatment is experienced by an individual. Patients’ heath status assessment includes personal experiences which are affected by health care interventions as well as changes over time with a chronic disease and no particular treatment. For example, evaluation of HRQoL over time after disease such as stroke, for individuals who have completed treatment and rehabilitation and are living with the effects of this disease The Impact of Chronic Illness Assignment Paper

Increasing Low-cost, Convenient Sites of Care

As Americans assume more financial responsibility for their care, there is heightened consumer demand for access to low-cost, convenient care. In addition to the traditional physician’s office setting, alternative sites, such as urgent care centers, retail clinics and in-home care are options that can help meet primary and preventive care needs and prevent unnecessary and costly visits to emergency departments.

Our 1,100 MinuteClinic locations treat common illnesses and minor injuries, and place a strong emphasis on wellness and prevention, offering help with issues like weight management and smoking cessation. In addition to being convenient, MinuteClinic services cost up to 80 percent less than alternative sites such as the emergency room.

“Our nurse practitioners are making a big difference,” said Merlo. “We often hear from patients who initially came in for a vaccination or an acute illness, and after seeing that we also offer weight-loss and or smoking-cessation programs, returned to make lasting changes in their lives.”The Impact of Chronic Illness Assignment Paper

For the tens of thousands of Americans who require intravenous therapy, CVS Health provides in-home infusion care services offered by Coram. By providing in-home therapy for conditions including cystic fibrosis, rheumatoid arthritis and cancer, we can lower the cost of care while increasing convenience and comfort for the patient.

Technology Can Engage Patients and Improve Care Delivery

“Imagine a future in which you could have your child’s earache diagnosed by a physician, then have a prescription written, filled and delivered to your home in under two hours, all through your smartphone,” Merlo said. “There are regulatory issues to be worked out, but that scenario is not far off.”

This type of care, known as telehealth, could be a boon to those in rural areas who experience difficulty accessing affordable care. CVS Health is working with three telehealth companies to test different ways of using the technology – both through mobile devices as well as through MinuteClinic. In one MinuteClinic telehealth study, 95 percent of patients were highly satisfied with the experience. One-third even said they preferred it to a doctor visit.The Impact of Chronic Illness Assignment Paper

Reimaging the Role of the Health Care Professional

As the physician shortage grows, Americans will increasingly rely on extended care teams, including pharmacists, nurse practitioners, and physician assistants. Pharmacists play an essential role, working closely with physicians, care teams and patients to drive the use of the highest-value drugs, ensure patients understand how to take them, support patients during care transitions, and intervene when prescriptions are not filled or problems arise.

Our Pharmacy Advisor program facilitates face-to-face and telephone counseling by our pharmacists to help participating members with chronic illnesses adhere to their prescribed medications and manage their conditions. The program has resulted in significant improvements in adherence, with fewer gaps in therapy.The Impact of Chronic Illness Assignment Paper

Merlo concluded with a call to action for providers and payers alike. “Working together, we can reduce the impact of chronic illness and help millions of Americans on their path to better health. I cannot imagine a more exciting or fulfilling purpose than that.”

A chronic physical disease not only has direct consequences for the chronically ill person but can also distort the life of the healthy partner. This study of a representative sample of chronically ill persons and their partners in the Netherlands presents quantitative information on the proportion of partners who experience consequences in 4 distinguished areas (personal life strain, social relations, financial burden, and intrinsic rewards) and provides insight into the factors related to this. Data were derived from a subsample (N = 1,093) of participants in the Dutch Panel of Patients With Chronic Diseases. Linear regression analysis was used to determine the relative effect of caregiving and of disease characteristics to explain the variance in the 4 impact factors. The most prevailing consequences, experienced by more than half of the partners, were related to personal life strain and intrinsic rewards. An impact on social relations and financial situation was reported by 20% of the partners. The regression analyses showed that the time spent on caregiving is the main predictor for all 4 impact measures in this study. However, the findings also make clear that the impact on the partner’s life does not arise entirely from the amount of caregiving. An independent effect of specific disease characteristics is observed in addition to the effect of caregiving; that is, we found that physical impairments in the patient are related to higher personal life strain and higher financial burden whereas social impairments are related to higher impact on all 4 factors. When the patient’s disease is accompanied with fatigue, the partner reports higher impact on personal life, on social relations, and on intrinsic rewards, and pain significantly affects the partner’s social relations. Partners of patients with cancer, musculoskeletal, or digestive disorders are more vulnerable for the consequences of the chronic disease. The impact on female partners is higher for all 4 impact factors. The findings make clear that living with a chronically ill person has an impact on the partner’s life that goes beyond the consequences of caregiving.The Impact of Chronic Illness Assignment Paper

Interviews were conducted with patients aged between 45 and 85 years who had one or more of the index conditions and family carers from the Australian Capital Territory and Western Sydney, Australia (n = 66). Content analysis guided the interpretation of data.

The affordability of medical treatments and care required to manage illness were identified as the key aspects of economic hardship, which compromised patients’ capacity to proactively engage in self-management and risk reduction behaviours. Factors exacerbating hardship included ineligibility for government support, co-morbidity, health service flexibility, and health literacy. Participants who were on multiple medications, from culturally and linguistically diverse or Indigenous backgrounds, and/or not in paid employment, experienced economic hardship more harshly and their management of chronic illness was jeopardised as a consequence. Economic hardship was felt among not only those ineligible for government financial supports but also those receiving subsidies that were insufficient to meet the costs of managing long-term illness over and above necessary daily living expenses.The Impact of Chronic Illness Assignment Paper

This research provides insights into the economic stressors associated with managing chronic illness, demonstrating that economic hardship requires households to make difficult decisions between care and basic living expenses. These decisions may cause less than optimal health outcomes and increased costs to the health system. The findings support the necessity of a critical analysis of health, social and welfare policies to identify cross-sectoral strategies to alleviate such hardship and improve the affordability of managing chronic conditions. In a climate of global economic instability, research into the economic impact of chronic illness on individuals’ health and well-being and their disease management capacity, such as this study, provides timely evidence to inform policy development.

Common chronic illnesses

While many illnesses can be considered chronic, there are 12 major chronic conditions that are a significant burden in terms of morbidity, mortality and healthcare costs in Australia, including: The Impact of Chronic Illness Assignment Paper

  • heart disease
  • stroke
  • lung cancer
  • colorectal cancer
  • depression
  • type 2 diabetes
  • arthritis
  • osteoporosis
  • asthma
  • chronic obstructive pulmonary disease (COPD)
  • chronic kidney disease
  • oral disease.
Common stresses of chronic illness

Chronic or long-term illness and its treatment pose special problems. You need to learn how to:

  • live with the physical effects of the illness
  • deal with the treatments
  • make sure there is clear communication with doctors
  • maintain emotional balance to cope with negative feelings
  • maintain confidence and a positive self-image.The Impact of Chronic Illness Assignment Paper

Stress can build and can shape your feelings about life. Prolonged stress can lead to frustration, anger, hopelessness, and, at times, depression. The person with the illness is not the only one affected; family members are also influenced by the chronic health problems of a loved one.Chronic conditions and lifestyle behaviors have a detrimental influence on the quality of life for seniors because of physical disability and emotional concerns. This study aimed to assess the influence of chronic illness, smoking, and alcohol use on quality of life among Thai seniors. A cross-sectional study was conducted in three communities, selected purposively from the North, Northeast, and Central regions, and 1278 senior participants were recruited. Binary logistic regression was used to predict the influence of factors on quality of life with adjusted covariates. Most participants were aged 60–70 years and married, earned 500–1,000 Baht/month (US $17–$35), had one chronic illness, and were nonsmokers and nondrinkers. Surprisingly, there appeared to be no link between chronic conditions and quality of life. Current drinkers were more likely to have a high quality of life, with Odds Ratios of 2.16 for men and 2.73 for women. Seniors of both genders who were current drinkers were more likely to accept death and dying and this improved their quality of life. Social participation in alcohol consumption may encourage seniors to share their concerns about death and dying and eventually accept this as a foundation of life.The Impact of Chronic Illness Assignment Paper

Previous studies have assessed family quality of life in individual disease areas and specialties. The aim of this study was to investigate the impact of disease on family members of patients over a wide range of specialties and identify key impact areas. This information is essential in order to reveal the extent of this impact and to allow strategies to be developed to support the family members of patients with chronic disease. Semi-structured interviews were carried out with 133 family members of mostly chronically ill patients from 26 medical specialties. Family members were invited to discuss all areas of their lives that had been affected by having an unwell relative. Thematic analysis was carried out using NVivo9® software. Most family members were female (61%), the partner or spouse of the patient (56%), or the parent (22%). Their mean age was 56.1 years (range: 21-85 years) and the mean duration of the patient’s disease was 8.9 years (range: 1 month to 60 years). Ten key themes of family quality of life were identified from interviews. The median number of themes reported by family members was six (range: 1-10). The key themes included: emotional impact (mentioned by 92% of subjects), daily activities (91%), family relationships (69%), sleep and health (67%), holidays (62%), involvement in medical care and support given to family members (61%), work and study (52%), financial impact (51%), social life (37%), and time planning (14%). Relationships between the themes were identified. This large scale multi-specialty study has demonstrated the significant, yet similar, impact that illness can have on the quality of life of patients’ family members. Family quality of life is a previously neglected area of health care which needs to be addressed in order to provide appropriate support for the patient and the family unit.The Impact of Chronic Illness Assignment Paper

Previous studies have assessed family quality of life in individual disease areas and specialties. The aim of this study was to investigate the impact of disease on family members of patients over a wide range of specialties and identify key impact areas. This information is essential in order to reveal the extent of this impact and to allow strategies to be developed to support the family members of patients with chronic disease. Semi-structured interviews were carried out with 133 family members of mostly chronically ill patients from 26 medical specialties. Family members were invited to discuss all areas of their lives that had been affected by having an unwell relative. Thematic analysis was carried out using NVivo9® software. Most family members were female (61%), the partner or spouse of the patient (56%), or the parent (22%). Their mean age was 56.1 years (range: 21-85 years) and the mean duration of the patient’s disease was 8.9 years (range: 1 month to 60 years). Ten key themes of family quality of life were identified from interviews. The median number of themes reported by family members was six (range: 1-10). The key themes included: emotional impact (mentioned by 92% of subjects), daily activities (91%), family relationships (69%), sleep and health (67%), holidays (62%), involvement in medical care and support given to family members (61%), work and study (52%), financial impact (51%), social life (37%), and time planning (14%). Relationships between the themes were identified. This large scale multi-specialty study has demonstrated the significant, yet similar, impact that illness can have on the quality of life of patients’ family members. Family quality of life is a previously neglected area of health care which needs to be addressed in order to provide appropriate support for the patient and the family unit.The Impact of Chronic Illness Assignment Paper

The course and outcome of severe chronic illness are decisively affected by social and emotional variables. The conceptual approach of this article emphasizes an understanding of the individual, the family, and health care personnel as all facing a series of adaptive tasks in relation to the illness. Each of the three phases of the illness–the diagnostic, chronic, and end stage–poses special tasks and requires different defenses and coping capacities from the patient, family, and health care personnel. These are discussed as interdependent factors in a holistic framework.The Impact of Chronic Illness Assignment Paper

When serious illness or disability strikes a person, the family as a whole is affected by the disease process and by the entire health care experience.3 Patients and families have different needs for education and counseling. Because each person in a family plays a specific role that is part of the family’s everyday functioning, the illness of one family member disrupts the whole family. When a family member becomes ill, other family members must alter their lifestyle and take on some of the role functions of the ill person, which in turn affects their own normal role functioning. If the person who does most of the family’s cooking has surgery and can’t shop or prepare meals for several weeks, other family members must take on this responsibility in addition to the tasks they already do. When a working parent is up most of the night trying to console a child with an ear infection, the parent not only loses sleep, but must either arrange for emergent child care or take a day off from work. If a man who is the primary income producer in a family has a heart attack, his wife may have to return to work, increase working hours if she is already employed, or become the family’s breadwinner. Middle aged adults whose children have just left home may need to alter their plans and goals to accommodate care needs for aging parents.The Impact of Chronic Illness Assignment Paper

Illness may cause additional strain as the result of economic problems and interruptions in career development. If the patient is a young child, there may be additional strain to the family if there are siblings whose needs must also be met. Illness in the middle stage of family life, when adolescents are trying to break away from family ties and parents are going through their own mid-life transitions, may put further strain on what is already a time of potential family turmoil. Illness in later age may have an impact not only on grown children but also on the older couple who had anticipated a time of enjoyment together and are less able to care for each other because of their own physical limitations associated with aging.

The extent of family disruption depends on the seriousness of the illness, the family’s level of functioning before the illness, socioeconomic considerations, and the extent to which other family members can absorb the role of the person who is ill. In some instances, a major illness brings a family closer together; in others, even a minor illness causes significant strain. It is important to identify what the illness means, not only to the individual but also to the family. Asking them what they consider major problems and how they plan to handle specific situations can help you assess the meaning of the patient’s illness to the family.The Impact of Chronic Illness Assignment Paper

To achieve effective patient teaching outcomes, you should make the family part of your teaching plan. For example, if your patient’s wife does all the cooking in the home, it is vital to include her in diet teaching. Involving family members may be an important future source of support for the patient as he or she works at behavioral change. Obviously it will be difficult for a husband to be supportive of his wife’s blood pressure treatment program if he does not understand the reasons for the recommendations and the consequences of not carrying them out.The Impact of Chronic Illness Assignment Paper

Long-term illness, even in the most stable and supportive families, brings changes in family relationships. Illness produces disequilibrium in the family structure until adjustments can occur. If the nurse does not recognize the change, what it might mean to the patient and family, and how it might affect the patient’s willingness and ability to carry out health care recommendations, the goals of the teaching process will be diminished. When teaching the patient and family, it is important to identify patterns of relationships and to be alert to attitudes of family members. You may be able to identify resources within the group and help family members mobilize their resources to help the patient. It’s also important to be alert to some of the factors in family members that act as a barrier to education. Illness in a family member tends to raise the anxiety of all those close to the patient. Anxiety may be misinterpreted by the health professional as lack of interest or as reluctance to provide the patient with help and support. The more you are aware of these reactions and help family members deal with their feelings, the better able you will be to teach family members about the patient’s condition and treatment and to mobilize their support.The Impact of Chronic Illness Assignment Paper

Effects on the individual

In general, most people will experience increased fatigue (mental and physical) and some slowing down in the speed with which they process information, plan and solve problems. They may experience changes to their behaviour and personality, physical and sensory abilities, thinking and learning. ABI can also cause difficulties with motivation, insight, problem-solving, body temperature control, and hypersensitivity to sound, light and movement.

The effects of a brain injury can be differentiated as primary effects (things that happen to the brain as a result of the trauma) and secondary effects (things that might happen afterwards).The Impact of Chronic Illness Assignment Paper

Primary effects

A closed head injury will effect the brain of a child differently to how it effects the brain of an adult. The reasons are not fully understood. Often young children have a better capacity to survive a closed head injury because a child’s skull is soft and the bones are not fully fused. When the bones are not fused they can provide a greater cushion for the brain upon impact.

Sometimes when the head is hit from one direction the brain is pushed into the skull on the opposite side. This push of the brain against the skull is called contre-coup damage. Contre-coup damage is far less common in children than in adults.

When there is a specific point of injury to the brain the injury is described as focal damage. Focal damage may occur if there has been penetration of the brain, such as may occur in a depressed skull fracture. Focal damage is relatively uncommon in children as compared to adults because of the differences in the anatomy of the brain between adults and children.The Impact of Chronic Illness Assignment Paper

Secondary effects

In children as well as in adults, bleeding may occur either in the brain itself or in the spaces surrounding the brain.

Secondary effects may develop following the initial injury caused by a trauma. One effect that is more common in children than adults is widespread swelling of the brain.

Bleeding in the brain is described as a haematoma. In children, because the injury is usually more diffuse, large haematomas within a particular part of the brain do not occur very often.The Impact of Chronic Illness Assignment Paper

Effects on those close to the child / young person

The effects on a family

When a family member suffers a brain injury, people have to come to terms with the changes to the family caused by the injury, as well as the changes to the person.

A family member can be anyone who has a primary relationship with the person with the brain injury. A family member can be a mother or father, or a sibling or a very close friend or an aunt or a girlfriend or boyfriend. When a person is involved in a traumatic event, many people will be distressed. It is important they receive the respect they deserve – anyone who loves the injured child will be hurt as well, and their recovery is closely linked to the recovery of the child.

There is enormous stress on everyone who is close to an injured child. People feel pain, anger, confusion and grief, as well as regret about how and why the event occurred. Blame will neither change the situation nor help a person to adjust to the trauma and stress of the event.The Impact of Chronic Illness Assignment Paper

Help for families

Some family members or friends or whole families may wish to seek the assistance of psychologists or social workers to enable them to adjust to the trauma and the radical changes that may need to be made. Talking to an outside person may give a fresh perspective to the situation and can be non-judgmental. Some people find this useful.

For information about how a brain injury can affect the other members of the family see the BrainLink Services website (www.brainlink.org.au) or call BrainLink on 1800 677 579.

The Bouverie Centre offers specialist counselling for families affected by acquired brain injury, they can be contacted on 03 9385-5100.The Impact of Chronic Illness Assignment Paper

Taking care of friends and siblings

Some behaviour by the child with injury may disturb other children. They may already be distressed about what has happened and worried about the outcome. Often children feel enormous guilt when a sibling or friend has been injured. For no logical reason, they may even feel responsible. Some children will want to visit their sister or brother and some may withdraw. Either of these responses is fine. The best environment around the child with the injury is one that is stress free and as peaceful as possible.

There is no single right way to react to a traumatic event. People – adults and children, may not have a choice on how to react. Everyone is affected and everyone is on a path to recovery from that trauma.The Impact of Chronic Illness Assignment Paper

Parent of a child with ABI

‘He used to do really well at school. Then his marks dropped, his friends changed and he started sneaking out at nights, drinking and goodness knows what else. Finally he was kicked out of school. We didn’t realise, for some time that all these problems were caused by his injury. He couldn’t keep up at school, kept getting lost, didn’t understand what the teacher was asking him to do. So he used to spit the dummy.

Now we have a plan. We get help from a psychologist and the school has been fantastic. He’s doing much better – not the same, but much better.’

Adolescent with ABI

“I got sick with meningitis.  I recovered from that but I have never got back to being the same.  I spend all my time at home and I no longer see my old friends.  Sometimes people ask when will I get better but I don’t think I will ever get better. ”The Impact of Chronic Illness Assignment Paper

Having a long-term, or chronic, illness can disrupt your life in many ways. You may often be tired and in pain. Your illness might affect your appearance or your physical abilities and independence. You may not be able to work, causing financial problems. For children, chronic illnesses can be frightening, because they may not understand why this is happening to them.

These changes can cause stress, anxiety, and anger. If they do, it is important to seek help. A trained counselor can help you develop strategies to regain a feeling of control. Support groups might help, too. You will find that you are not alone, and you may learn some new tips on how to cope.

You may be able to manage your illness better if learn more about it. It is important to evaluate the information that you find, to make sure that it is reliable. It is also important to find a health care provider that you can trust.The Impact of Chronic Illness Assignment Paper

If I have a chronic illness, how can I make my life better?

The most important step you can take is to seek help as soon as you feel less able to cope. Taking action early will enable you to understand and deal with the many effects of a chronic illness. Learning to manage stress will help you to maintain a positive physical, emotional, and spiritual outlook on life.

A mental health provider can design a treatment plan to meet your specific needs. These strategies can help you regain a sense of control and improve your quality of life—something everyone deserves. If you are suffering from depression, your doctor may prescribe medications to help regulate your mood and make you feel better.The Impact of Chronic Illness Assignment Paper

What kind of help is available for someone with a chronic illness?

There is help available for people suffering from stress due to chronic illnesses. These include the following:

  • Support groups: Support groups are a useful sharing experience. They provide an environment where you can learn new ways of dealing with your illness from other people’s coping strategies. You may want to share your own approaches, too. You will gain strength in knowing that you are not facing hardships alone.
  • Individual counseling: Sometimes people have problems that are better addressed in a one-on-one setting. By taking part in individual counseling, you may more effectively express sensitive or private feelings you have about your illness and its impact on your lifestyle and relationships. There is a specific group of trained of mental health providers who have extensive training in coping with chronic illnesses.
  • Family and couples counseling: A chronic illness often affects the entire family. It is important to find a family or couples-trained mental health provider, who can help to address this dynamic issue.The Impact of Chronic Illness Assignment Paper
When should I seek help to cope with my chronic illness?

The following is a checklist of the sources and signals of stress that you may experience with chronic illness. Seek help from a mental health provider as early as possible to help you understand and cope with your illness better.

Your sources of stress:

  • Chronic illness
  • Uncertainty about the future
  • Unpredictability of the disease
  • Disability
  • Financial difficulties

Stress symptoms:

  • Irritability
  • Sadness
  • Loss of interest in things once enjoyed
  • Disturbed sleep
  • Fatigue
  • Body aches
  • Pain
  • Anxiety
  • Tension
  • Headaches
  • Cognitive issues
  • Difficulty in relationships The Impact of Chronic Illness Assignment Paper
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