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Psychological Issues in Advanced and Terminal Illness Average life expectancy in North America is 76 years. Leading causes of death in adults are chronic illness What are the leading causes of death across the life span?
Mortality Rates Leading causes of death < 1 year congenital abnormalities; sudden infant death syndrome (SIDS) Children > 1 year old Accidents (40% of all deaths) Cancer (especially leukemia) Adolescence Unintentional injury Homicide AIDS
Mortality Rates Leading causes of death Middle age Sudden death due to heart attack or stroke Cancer Elderly Heart disease Cancer Stroke
Potential Reasons for Gender Differences in Mortality Females are more hardy Males engage in riskier behaviours (factor after birth and infancy) Men engage in riskier sports Males tend to hold high stress or higher risk jobs Men tend to have poorer health habits (e.g., drink more alcohol) Social support may be more protective in women
Risk Factors Family history Marital status (adds 10 yrs in men; 4 yrs in women) Economic status Body weight Exercise Alcohol (add 2 years if drink 1-3 drinks/day)
Risk Factors - continued Smoking Disposition (add 2 yrs if reasoned, practical) Education Environment (add 4 yrs if rural) Sleep (more than 9 hours subtract 5 years) Temperature (add 2 yrs if thermostat is < 68) Health care – regular check ups add 3 yrs
Adapting Under GoodCircumstances First concern upon hearing diagnosis is fears about mortality. Optimistic but tentative about plans May try to normalize activities Risk is they may over-extend May have feelings of helplessness Risk is to become overly dependent
Three Themes of Adaptation Find meaning: why illness happened or rethink priorities Gain sense of control control symptoms and treatment Restore self-esteem Often by comparison with worse off others
Adapting Under BadCircumstances Relapse seen as a bad sign with poor prognosis Re-focuses one on the illness Need to undergo the coping process again but likely less hopeful than before.
Heart Disease Due to narrowing or blocking of the coronary arteries. Angina pectoris painful cramp in chest, arm, neck, or back due to brief blockage of oxygenated blood to the heart. More often during exercise, stress, cold temperature, digesting large fat meal. Little or no permanent damage
Heart Disease Myocardium Muscle tissue around the heart Myocardium infarction (heart attack) Prolonged blockage of blood to an area of the heart resulting in muscle tissue damage. Symptoms of a heart attack Pressure in chest, fullness, squeezing pain. Pain spreading to shoulders, neck, or arms Lightheadedness, fainting, sweating, nausea
Who Is At Risk of Heart Disease? Prevalence increases with age, particularly after 45 years of age Prior to 50s, 60s, men at greater risk than women but increases in women after menopause. More women than men are likely to die from a heart attack Blacks at higher risk, Asians at lower risk
Heart Disease Risk Factors High blood pressure Family history Cigarette smoking High LDL and total cholesterol levels Physical inactivity Diabetes Obesity Stress
Why high blood pressure a risk factor? Heart has to work harder. Since heart muscle is working harder, it can become enlarged. Wear and tear on the arterial wall can increase the likelihood of lipid and calcium deposits adhering to the arterial wall. This leads to hardening of the arteries.
Type A Behaviours Hostile, cynical Judgmental (opinionated) Competitive Time urgent Uses gestures while talking Nodding of head while others are talking Intense
Physiological Reactivity Physiological and cardiovascular reactivity to acute stress (“hot reactors”). Exaggerated increases in blood pressure, heart rate, catecholamines, corticosteroids High levels of these hormones can damage heart and blood vessels Presence of epinephrine (a catecholamine) increases the formation of clots.
When do heart attacks occur? Less likely during sleep. Among the employed, more often on a Monday between 6 and 11 am. In part due to waking and becoming active shortly after dreaming which increases BP. In part because of circadian rhythm effects, increases in arousal hormones and blood pressure.
Medical Treatment Initial treatment may involve clot-dissolving medication and close monitoring Balloon angioplasty Tiny balloon is inserted into blocked vessel and inflated to open blood vessel Bypass surgery Use grafted vessel (e.g., piece from leg) to bypass blockage in artery to the heart
Medical Treatment Medications (e.g., beta blockers, calcium channel blockers) to protect heart and improve function. Risk management Control of high blood pressure Control of lipid abnormalities
Rehabilitation Promote recovery and reduce risk of another attack Heart disease is chronic condition requiring ongoing management.
Rehabilitation Includes: Exercise Physiological and psychological benefits Weight management Smoking cessation Lipid and BP management include dietary changes to control lipids Reduce excessive alcohol intake Stress management
Rehabilitation Exercise is the key component but: 50% drop-out rate within first 6 months For those who continue benefits include: Improved self concept, perceived health, sexual activity, involvement in social activities. Those who stop are more likely to: Smoke, have poorer cardiac function, have higher body weight, be more sedentary, experience greater anxiety and depression.
Symptoms of a Stroke Sudden weakness or numbness of the face, arm, or leg (usually on one side of the body) dimness or loss of vision (usually one eye) Loss of speech or trouble talking or understanding speech Unexplained, severe headache Dizziness, unsteadiness, or sudden fall
What is a stroke? Tissue damage to area of the brain due to disruption in blood supply, depriving that area of the brain of oxygen.
Causes of Strokes1. Infarction – blockage in cerebral artery that cuts off or reduces blood supply a) Thrombosis – blood clot b) Embolus – piece of plaque becomes lodged in the artery.2. Hemorrhage – happens suddenly. Less frequent than infarction but more damaging and more likely to cause death.
Stroke Risk Factors Rare up to age 55, than risk increases sharply with age (doubling with each decade). More common in men but women more likely to die from them. Rates highest among blacks and lowest among Asians. Family history
Stroke Risk Factors High blood pressure Cigarette smoking Heart disease, diabetes, and their risk factors such as obesity and physical inactivity. High red blood cell count (making the blood thicker and likelier to clot). Mini-strokes – transient ischemic attacks (TIA)
Effects of a Stroke Some motor, sensory, cognitive, or speech impairment usually occurs Limitations may be permanent but lessen in severity over time. Younger patients recover better Impairments caused by hemorrhages more easily overcome than those caused by infarctions.
Effects of Stroke Motor impairments often due to paralysis on one side of the body (side opposite to brain damage). After about 6 weeks of rehab about 50% of patients can perform independently (many with cane or walker). Language, learning, memory, and perception problems depend on location of the injury.
Effects of Stroke Left-hemisphere damage more commonly associated with language problems called aphasia. Receptive aphasia – difficulty understanding verbal information. Expressive aphasia – difficulty producing and using language. Damage to right side of brain often associated with difficulties in visual processing and emotions.
Psychosocial Aspects of Stroke Denial is common Unclear whether psychological or physiological basis. This ambiguity also applies to depression when it occurs after a stroke. Less than ½ of the patients return to work following a stroke.