Impact of chronic illness on the patient's spouse

The spouse of a chronically ill person can experience a variety of undesirable reactions, such as anxiety, self-blame, or anger. Using a case example that involves Alzheimer's disease--a presenile condition--the author explains how social workers can help clients cope with and adjust to the problems created by a spouse's illness.

Successful 'normalizing' tactics of parents of chronically-ill children

To be or to parent a chronically-ill child is a difficult experience. Parents can initiate 'normalizing' tactics that alleviate the child's feeling of being different and enable a sense of control with the possibility to influence the quality of life of the child and the family. Following up among 20 parents of chronically-ill children, the author was able to identify a number of principles which underlined the 'normalizing' tactics. These principles, it is suggested, should be helpful to nurses and other health workers when guiding and advising parents and others who come into daily contact with chronically-ill children.

[Strategies for coping with chronic disease. Study of adult hemophiliacs]

The present study was performed to investigate the coping modes of 43 adult hemophiliacs. The individual experiences of the patients were taken into account by the biographic method. The evaluation was managed according to a categorial system which is primarily oriented at the "Daseinstechniken" as defined by Thomae (1968). Referring to the situative classes of "illness", "fields of education and profession" and "contact sphere" the patients' reaction patterns were more specific to the situation than to the personality. All in all "accepting the situation" turned out to be the most frequent form of reaction.

A sequential criterion analysis for assessing coping with chronic illness

A three-stage sequential criterion analysis based on the Goldfried-D'Zurilla behavior model is presented as a heuristic approach for studying chronic illness. The three interrelated stages consist of: (a) problem identification, (b) response enumeration, and (c) response evaluation. The utility of this systematic approach for understanding the adaptive process, helping to identify patients who might benefit from intervention, providing content for actual intervention, and reducing the myth of homogeneity among chronic patient populations for both clinicians and researches, is discussed. Examples of the utility of the criterion analysis are provided throughout the paper.

Life events, emotional support, and health of older people

The effects of life events, emotional support, interaction of life events and emotional support, and age on indices of physical and psychological health were examined within a hierarchical multiple-regression design. Fifty older people who were randomly selected from among the residents of a high-rise apartment building provided retrospective data on their life events and emotional support. These same subjects provided more recent data on their functional health, distress arising from chronic health problems, and four indices of morale (agitation, attitude toward own aging, lonely dissatisfaction, and a combined index of the morale dimensions). As expected, significant multivariate effects were demonstrated on all but two measures: distress arising from chronic health problems and attitude toward aging. Examination of the independent contributions to these effects showed variations depending on the health index of focus. Expected moderations of the effects of life events by emotional support effects were not demonstrated. Results are discussed in relationship to previous research and the theoretical expectation that emotional support would moderate the effects of life events on health.

Diagnosing mental illness in the elderly

Diagnosing mental illness in the elderly is difficult because changes in physical and psychologic functioning may mimic psychiatric disorders. The reverse is also true. Although chronologic age is not related directly to predisposition to mental illness, the stresses experienced by elderly persons as a result of declining health and loss of social status may result in mental disorders. Accurate diagnosis, which takes all these factors into account, is particularly important for the rational treatment of elderly patients.

The development of an impact-on-family scale: preliminary findings

While descriptions of the effects of chronic childhood illness on the family appear in the literature, there have been few attempts to develop a formal measure of this impact. As part of a longitudinal study of chronic illness in childhood, the development of a measure was undertaken. The conceptual framework and methodology employed in scale development are described. A 24-item scale is presented which elicits variability in response and which is internally consistent. A factor analysis reveals that 4 dimensions of impact are contained in the measure: Financial, Social/Familial, Personal Strain, and Mastery. Psychometric data were derived from administration of the instrument to 100 mothers of chronically ill children. The potential usefulness of the scale in health research is discussed.

The psychological management of the patient with chronic illness and his family

Chronic illness, whether physical or mental, has a profound psychological effect on the affected individuals and their families. It is necessary for the general practitioner to have a good grasp of these aspects of the care of such patients and their families, not only in order to be of assistance in alleviating the emotional stresses which chronic illness places on them, but also so as to ensure maximal compliance with the treatment regimen of the illness itself. Studies have demonstrated that the most important factor determining patient compliance is the quality of the doctor-patient relationship. Special mention is made of the 'illness solution' in families and the ways in which the general practitioner can deal with this situation.

Development of a social dependency scale

Social dependence was defined in terms of three capacities identified as necessary for the performance of an adult role. The three capacities are everyday self-care competence, mobility competence, and social competence. Measurement of these concepts was facilitated through the use of 12 6-point scales (4 for each capacity). Scores were then computed for each capacity (range 4-24) and for all three capacities together (range 12-72). Operationally, social dependence was defined as the sum of the individual's scores in the three areas: everyday self-care competence, mobility competence, and social competence. The revised instrument was tested on 60 subjects with advanced diseases to determine its reliability. The reliability coefficient alpha was .90, and the standardized-item alpha was .91.

Psychosocial problems of the aged: a shared medical responsibility

The respective roles of the psychiatrist and the family physician in dealing with the psychologic and some of the social problems of the aged are briefly outlined. By close cooperation of these two groups of physicians, many aged patients can be helped. More important is the fact that both groups of physicians can contribute to a change in attitude toward aging among the younger members of society. This offers hope that many of the psychosocial problems of the aged can be minimized or prevented.

The chronically Ill, handicapped, dying child and his family: need for total care and support

It is stressed that the best possible medical care is the basic need and an absolute pre-requisite for the total care of a family with a chronicall ill, handicapped or dying child. However, this is not enough. The family will need something more than just strict medical care. This paper is concerned with the "something more," stressing the family's need for measures helping them to work with the crisis reaction, elicited by the information they have received about the child's diagnosis and prognosis. The methods of bringing the family help is discussed in relation to the time-schedule of the disorder. The importance of how the first information is given is particularly stressed.

Temporal experience in the aged: body integrity and the social milieu

Variation in temporal experience among the aged has been found to be a function of a number of variables. The sociological and phenomenological literature suggest two as being of crucial importance: work and retirement and health and illness. These were investigated in the present study making use of a structured interview format with seventy male retirees. Differences in affect and temporal experience were examined using a 2 x 2 x 2 factorial design comparing groups in terms of Health, Willingness to Retire, and Time Since Retirement. In general, it was found that early in retirement those individuals who were healthy but had not wanted to retire resembled the chronically ill in terms of negative affect and temporal structure (that is, loss of a sense of future, constricted present, and "disconnected" past). Over time, however, these individuals restructured their world, reflecting a positive affect and a "full" temporal experience. This restructuration was in contrast to that which occurred in the chronically ill, who, irrespective of whether they wanted to retire or not, and irrespective of time since retirement, remained uniform in terms of negative affect and loss of temporal structure.