Friday, March 9, 2012

Coping with Illness

Photo by Judy Baxter
People of all ages and life situations are at risk for illness and injury.   But as we age we experience greater risk.  Whether the illness happens suddenly as with a fall or more slowly as with memory problems, the affected person and his or her family members must find methods for coping.

Course materials for the Nursing Learning Network identify the following tasks that ill people face:
  1. Change in body image
  2. Reality of their own mortality
  3. Coping with altered relationships with others
  4. Dealing with an altered level of dependency
  5. Adjusting to physiological changes
  6. Grieving for their losses, such as their former self or former lifestyle
  7. Fear of recurrent problems
  8. Illness occurs with other stressors, such as disrupted household routines, neglected or increased financial needs, and shifting workplace responsibilities

Not every illness nor every person will face all eight of these tasks. However, even just facing one can be daunting.  Our physical, emotional and social resources are compromised when we are ill.   Conceptualizing the illness and responding effectively requires an enormously complex set of relationships internally for ill people themselves and externally for them and their supporters. 

The ways in which patients cope can vary from person to person and from day to day. Dr. JoAnn LeMaistre discusses these adjustments in her book After the Diagnosis.  Some of these coping strategies include the following:
  1. Crisis.  The response during the initial stages of acute illness is often very chaotic, focusing on the self and surviving.  They also may be in denial and attempt to maintain day-to-day responsibilities.
  2. Isolation.  The ill person and their family members may show exhaustion from the initial adrenaline rush of an acute illness. Those adjusting to chronic illness will go through a period of isolation as well.     Those who are ill may need concerned friends and family to initiate communication and offer concrete assistance.    
  3. Anger.  This can be a very destructive coping stage if the person stays stuck here for too long or if the ill person entertain thoughts of suicide.  Statistics for suicide show that older white men are at the highest risk for completing suicide, especially in the wake of a diagnosis of terminal illness or after experiencing a disability that challenges their sense of self. Their depression often goes undiagnosed.
  4. Reconstruction.  The ill person rebuilds their life in several arenas: self-image, day-to-day routine, relationships with family, friends and co-workers. 
  5. Intermittent Depression.  As people adjust to illness over time, they may experience depression when their expectations for recovery or for adjusting do not meet the realities.  
  6. Renewal.  The acutely ill person or the chronically ill person starts to function with their altered reality. 

Critical care nurses have the opportunity to intervene when family members are reeling from the onset of an acute health crisis.  Even though training materials are directed to health care professionals, family members might benefit from reviewing some of these descriptions of managing emotionally and communicate effectively with each other and with health care professionals during in a hospital stay.  

For example, the mnemonic NURSE outlines the ways that a trained, caring nurse will help the ill person and family members adjust emotionally to the illness: Naming the patient's and the family members' emotional state. Understanding the predicament and feelings.  Respecting the family's emotions by acknowledging them with compassion. Supporting the family members efforts to cope. Exploring the family members feelings by asking them to amplify them.

If you are supporting someone who has fallen ill, realize that spouses, parents (if still living) and children often struggle more to cope than siblings or friends.  Research conducted on the emotional responses of hospitalization for those 70 and older shows that these factors pose a greater risk for depression: being 75+, being single, having a low level of education, having a cognitive dysfunction, suffering from a severe medical illness (particularly myocardial infarction), having a renal disease or a neurological disease, having a family history of mental illness, being severely disabled.

Even though illnesses strain our mind, body and soul, they also present opportunities for friends and family members to strengthen relationships.  Fortunately, the professions of nursing, psychology and social work offer a rich set of resources to help the unitiated through the challenges presented by illness.  May this post find you and your relatives in good health. Or if you are suffering ill health, may you and your loved one enjoy a speedy recovery.

What adjustments have you made when ill? Or what adjustments have you seen others make when they are ill?  What can we do to support older adults who are coping with illness?  Please leave a comment below.

Hospital-induced Delirium

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