Health Psychology An Introduction to Behavior and Health 8th Edition by Linda Brannon – Test Bank

Health Psychology An Introduction to Behavior and Health 8th Edition by Linda Brannon – Test Bank

CHAPTER 11

Living with Chronic Illness Lecture Outline

I. The Impact of Chronic Illness Chronic illnesses present a major problem, affecting not only the patient but also friends and family members. The diagnosis of a chronic disease may be conceptualized as a crisis or as a transition in the person’s life. Adjustment to the illness often changes the way patients see themselves, produces financial strain, and disrupts established patterns of personal and social behaviors. A. Impact on the Patient Chronically ill patients must cope not only with the symptoms of their illness but also manage the stress of treatment, live as normal a life as possible, and face the possibility of death. Dealing with the health care system is often a negative factor for people with chronic illness, not only because of frequent contacts but also because health care providers typically concentrate on the physical aspects of the illness and fail to provide help in coping with the long-term disruption of the patient’s life. Support groups can be valuable for people with chronic illness, providing information as well as emotional support. Patients with chronic illness must cope with the loss of health and the possibility of death, but many people manage to find some positive aspect in this process. B. Impact on the Family Chronic illness requires adaptation for families as well as for individuals. For families with chronically ill children, parents must adapt to treatment and face the loss of their children’s health. For adults, a chronically ill family member presents the need for caregiving, which alters relationships with family members. Feelings of grief and loss are common, and family members benefit from finding positive ways to deal with these emotions. II. Living with Alzheimer’s Disease Alzheimer’s disease is a degenerative disease of the brain and a major source of impairment among older people. Two forms of the disease exist: one that typically occurs before age 60 and the other that usually begins after age 60. The early-onset variety, which is caused by a known genetic defect, is uncommon. The more common late-onset type seems to be related to apolipoprotein ϵ, a protein involved in cholesterol metabolism; the ϵ4 form is a risk factor for the development of the tangles of neurons that are the basis for Alzheimer’s disease. Environmental factors also contribute to the risk of developing this disease. Indeed, the behavioral risks for Alzheimer’s disease are similar to those for cardiovascular disease and cancer, and the behaviors that offer protection are also similar. In the United States, as many as 50% of the people over age 85 exhibit symptoms of Alzheimer’s disease. The disease is difficult to diagnosis because many of the symptoms of Alzheimer’s overlap with symptoms of other illnesses. These symptoms include memory loss, language problems, agitation and irritability, sleep disorders, suspiciousness and paranoia, incontinence, sexual disorders, wandering, depression, and loss of ability to perform routine self-care. A. Helping the Patient Alzheimer’s disease is presently incurable, and drugs have only limited ability to slow the progression of the disease. Symptoms of the disease can be managed by changing those situations in the patients’ environment that prompt undesirable behavior. In addition, several psychological interventions have been used to enhance memory and to help patients cope with depression and problems of disorientation. B. Helping the Family The symptoms of Alzheimer’s disease are particularly distressing to family members. Emotional outbursts, suspiciousness, anger, and agitation by a previously gentle, loving person can baffle family members and disrupt normal family functioning. As the disease progresses, care is required because the Alzheimer’s patient may wander away from home at any time of the day or night, become disoriented and upset, and lose the ability to perform routine self care. People who care for Alzheimer’s patients must have the time, energy, and skills to perform appropriate care, and they must also care for themselves. Caring for Alzheimer’s patients is particularly stressful, and support groups and other psychosocial interventions often help caregivers cope with the strain of living with an Alzheimer’s patient. III. Adjusting to Diabetes Type 1 diabetes was called juvenile-onset diabetes and Type 2 diabetes was referred to as adult-onset diabetes, but with increased obesity among American youth, many children as young as 8 or 9 years old are now developing Type 2 (adult-onset) diabetes. Thus, the terms insulin-dependent or Type 1 and noninsulin-dependent or Type 2 are the current terminology. Both types of diabetes mellitus require changes in lifestyle, including the frequent monitoring of blood glucose and strict compliance to treatment regimen. (See Table 11.2 for characteristics of both types of diabetes.) A. The Physiology of Diabetes Diabetes mellitus is a disorder caused by an insulin deficiency. The islet cells of the pancreas produce glucagon, which stimulates the release of glucose, and insulin, which allows cells to use glucose. If the islet cells do not produce adequate insulin, excessive sugar accumulates in the blood and urine. Patients’ inability to regulate blood sugar often causes diabetics to develop other health problems such as cardiovascular disease, retina damage, and kidney diseases. If unregulated, diabetes may cause blindness, coma, and even death. B. The Impact of Diabetes The diagnosis of Type 1 diabetes affects both the child and the parents. The child is labeled as sick or different, and he or she faces a lifetime of coping with a chronic disease. Insulin injections and careful monitoring of diet are necessary. Parents must be constantly vigilant to ensure that their child complies with a difficult treatment regimen. Although Type 2 diabetes does not usually require insulin injections, it does demand lifestyle changes such as diet and oral medication. The lives of most Type 2 diabetics are not ordinarily drastically changed by the disease, although some patients refuse to comply with their treatment regimen and become either aggressive toward others or slip into a chronic depression. C. Health Psychology’s Involvement with Diabetes Health psychologists are involved in both investigating and treating diabetes. Research has concentrated on stress as a factor in the development of diabetes and in the regulation of glucose metabolism, the ways that diabetics conceptualize their disease, the dynamics of families with diabetic children, and reasons for noncompliance. Finding ways to help people with diabetes manage their care is an important goal for health psychologists. IV. The Impact of Asthma About 7.7% of adults in the United States have asthma, but the rate is the highest among African Americans and for children and adolescents between ages 5 and 17. The death rate from asthma is not high, but it is the largest cause of disability among children. A. The Disease of Asthma Asthma is a chronic disease that causes constriction of the bronchial tubes, preventing air from passing freely. People with asthma may go for long periods of time without any problems in breathing, but an attack may occur at any time. The disease of asthma may be due to genetic a vulnerability that makes the immune system of some infants respond with an allergic reaction to certain substances in the environment. People with this vulnerability and who are exposed to these substances develop asthma, whereas other people do not. Another view, the hygiene hypothesis, holds that asthma is a result of the cleanliness that has become common in modern societies. In hygienic environments, infants encounter too little bacteria and dirt, which leaves their immune systems underprepared to deal with these substances. In addition to environmental triggers and underdeveloped immune systems, risk factors for asthma include a sedentary lifestyle and obesity. B. Managing Asthma Like diabetes, asthma can be managed, but it requires daily attention to symptoms and frequent contact with the health care system. Managing asthma requires a variety of medications as well as learning personal triggers and avoiding them. Drugs for asthma often have unpleasant side effects, such as weight gain and lack of energy, conditions that make adherence difficult. Asthma attacks can cause respiratory failure, which may be fatal, making the experience frightening and dangerous. Also like diabetes, teaching self-care skills is a major goal for health psychologists. V. Dealing with HIV and AIDS Acquired immune deficiency syndrome (AIDS) is a disorder produced by the human immunodeficiency virus (HIV), which causes the immune system to lose its effectiveness and leaves the body defenseless against bacterial, viral, fungal, parasitic, cancerous, and other opportunistic diseases. A. Incidence and Mortality Rates for HIV/AIDS Although AIDS may not be a new disease, its existence was not known until the early 1980s, when it began to spread and kill people. In 1992, the CDC changed the definition of AIDS, bringing uniformity to the definition but also increasing the number of cases. However, since 1993, mortality rates from HIV/AIDS have declined dramatically in the United States. Part of the drop in mortality results from antiretroviral drugs treatments that prolong the lives of infected people. Another part of the drop comes from behavioral changes that led to a sharp decline in incidence of HIV. Because people are now living longer with HIV, the prevalence of the disease continues to rise (see Figure 11.1). B. Symptoms of HIV and AIDS HIV progresses over a decade or more. During the first phase, people often experience symptoms similar to influenza, which persists for up to a few weeks. The next phase shows no symptoms, but the person’s immune system is being destroyed. When the destruction of CD4+ cells affects the person’s ability to fight infection, the person becomes vulnerable to opportunistic infections, experiencing symptoms such as fever, fatigue, night sweats, loss of appetite, loss of weight, persistent diarrhea, white spots in the mouth, and painful skin rash. As the person’s CD4+ count continues to drop to the level that characterizes AIDS, the person is vulnerable to the variety of opportunistic diseases. Pneumocystis carninii pneumonia, tuberculosis, toxoplasmic encephalitis, and Kaposi’s sarcoma are infections that cause death among AIDS patients. C. The Transmission of HIV AIDS spreads only through direct contact. No evidence exists that any sort of casual contact spreads the infection. The main routes of infection are from person to person during sex, from mother to child during pregnancy or birth, and from direct contact with blood or blood products. Exposure to infected blood through transfusions is no longer a major source of HIV transmission. 1. Male-Male Sexual Contact Male-male sexual contact continues to account for the largest number of HIV infections in the United States, as anal intercourse is an especially risky behavior, particularly for the receptive partner, and oral sex may also be risky. 2. Injection Drug Use Sharing unsterilized needles is a practice that allows the direct transmission of blood from one person to another. Injection drug use is the second most frequent source of HIV infection in the United States and affects African Americans and Hispanic Americans more often than Whites. 3. Heterosexual Contact Heterosexual contact is the leading source of HIV in Africa and the fastest growing source in the United States, and women are at greater risk from this mode of transmission than men. Research suggests that lack of information about HIV transmission is not the reason for failure to take adequate precautions. Instead, unsafe sexual behaviors are related to unrealistic trust in one’s sexual partners and a failure to understand how risky some behaviors are. 4. Transmission during the Birth Process Children born to HIV infected mothers have a risk for contracting the virus during the birth process or from breastfeeding. These children usually suffer from a variety of developmental difficulties. Women who undergo antiretroviral therapy have a very low rate of transmission, but others have a higher rate. D. Psychologists’ Role in the AIDS Epidemic Psychologists have been involved in primary prevention by formulating strategies to change risky behaviors and in secondary prevention by helping people who are HIV positive to lead healthier lives. 1. Encouraging Protective Measures Except for children, people have some control over their risks for HIV. Health care workers such as nurses, dentists, and doctors should protect themselves against blood entering their body through an open wound. More common risks come from sexual contact and from sharing needles with an infected person. Limiting the number of sexual partners, using condoms, and avoiding contaminated needles are the behaviors that will protect the largest number of people from HIV infection. However, changing sexual behavior is a challenge because some cultural traditions allow men to control sexual interactions, putting women in jeopardy. 2. Helping People with HIV Infection A significant number of people who engage in high-risk behaviors have never been tested for HIV, and psychologists can play a role in encouraging testing. A positive diagnosis of HIV can lead to anger, anxiety, and depression. Interventions can help HIV positive people adhere to medication, adopt a healthier lifestyle, and find meaning in the experience of HIV. VI. Facing Death People prefer a long life, but they also express preferences to be in control over the end of their lives, including when and how they will die; that is, most want to die a “good death.” A. Adjusting to Terminal Illness Most chronic illnesses allow people time to adjust to their conditions and even to die a “good death.” Elizabeth Kübler-Ross proposed stages of dying—anger, denial, bargaining, depression, and acceptance—but research has failed to confirm that people with terminal illness progress through those stages. However, people do experience these reactions. A more useful conceptualization involves the notion of the dying role, which is an extension of the sick role (see Chapter 3) and includes both privileges and responsibilities. The key elements are settling practical, relational, and personal issues. Barriers to a good death include impediments from a health care system oriented toward cures and a lack of access to palliative care. B. Grieving People who are dying experience loss and bereavement, just as their friends and family do. Thus, a process of adaptation occurs during terminal illness and during bereavement. Although a stage theory of bereavement has been proposed, little evidence supports the notion that grieving occurs in a fixed sequence. Bereavement inevitably includes negative emotions, which people have difficulty accepting as normal and pushes grieving people to return to “normal.” Grieving should not be rushed. Exploring Health on the Web Coping with chronic disease and the specific diseases reviewed in Chapter 11 are topics covered on many websites on the Internet. http://www.cdc.gov/nccdphp/ The National Center for Chronic Disease Prevention and Health Promotion is sponsored by the Centers for Disease Control and Prevention. This webpage presents information about chronic disease, including cardiovascular disease, cancer, diabetes, and other disorders. The site offers options for exploring risk behaviors, types of prevention efforts, targeted populations, and related links. http://www.healthfinder.gov You can lead your students to expand their knowledge of each of the topics in this chapter by accessing this website. Choose the health library option, then diseases & conditions, and then the letter of the alphabet that each starts with. AIDS, Alzheimer’s disease, and asthma are all under the A choice. Each has information and links to other sites that cover these topics. This website is an especially good place to start searching for information about HIV/AIDS. http://www.lung.org/lung-disease/asthma/ The American Lung Association has a special section that offers information about asthma, from scholarly articles to tips about how to read a peak flow meter.