Living with long conditions

Question 1

What is multimorbidity?

Answer 1

Multiple health conditions with no index condition that is the primary focus.

Question 2

What is the prevalence of multimorbidity?

Answer 2

Greater in deprived areas, older people and women.

Question 3

What is the challenges of NHS with chronic care?

Answer 3

High service demand due to aging population. There is also worse health outcomes associated with chorinc illness, partly due to loss of income. Greater amount of money and resources to be allocated to incurable conditions.

Question 4

What is the burden of multimorbidity?

Answer 4

Reduced quality of life and functional abililty for ADL, more frequent hospital visits that are longer stays, polypharmacy, fragmented care and higher mortaility rate.

Question 5

What is the burden of self-management?

Answer 5

It requires motivation which is enabled by economic, socio-cultural and material conditions in their environment. Psychological factors like low confidence may limit this.

Question 6

What is the significance of diagnosis?

Answer 6

Legitimisation -> stigma of the diagnosis. It allows patient to enter into sick role.

Question 7

What is enacted stigma?

Answer 7

Discrimination due to status

Question 8

What is biographical disruption?

Answer 8

Diagnosis of a chronic illness impacts your self concept as an individual and hopes and dreams for the future.

Question 9

What is the limitation of biographical disruption?

Answer 9

Does not take into account the normalisation of chronic illness, and the impact of age and class.

Question 10

What is biographical reinforcement?

Answer 10

Chronic illness reaffirms preconceptions about your self identity eg a gay patient with HIV may feel self affirmed about negative conceptions

Question 11

What is biographical continuity?

Answer 11

Chronic illness diagnosis is anticipated eg older people may expect multiple morbidity at their age.

Question 12

What is biographical flow?

Answer 12

Chronic illness diagnosis is expected. Eg older stroke survivors consider their stroke as part of old age.

Question 13

What is the shifting normalities theory?

Answer 13

Chronic illness impacts identity and there is a process of normalisation. It includes:
-> Disrupted normality
-> Struggling normality
-> Fluctuating normality
-> Return to normality
-> Continuing normality
-> Re-modelling of normality

Question 14

What is the illness narrative?

Answer 14

Patients diagnosed with chronic illness may attribute their illness and its genesis to past biographical events. For example a patient who had performed hard labour as a long term career that attributes their arthritis to their job.

Question 15

How do people make sense of symptoms and illness?

Answer 15

By creating an illness narrative, remodelling their normality when there is a biographical disruption.

Question 16

How can chronic illness impact your life?

Answer 16

Restricted lives, social isolation, burden on others, and being discredited.

Question 17

How does chronic illness cause loss?

Answer 17

There is a loss of self esteem concerning control and independence, loss of financial stability, loss of family role and loss of future hopes and dreams.

Question 18

How are people with chronic illnesses supported?

Answer 18

Self management through disease education programmes, personalised care planning, information seeking and shared decision making.

Question 19

How does information seeking behaviour occur for diabetic patients?

Answer 19

Using sources like social media, laymans, diabetes groups and books.

Question 20

How does living with diabetes vary?

Answer 20

Due to disease duration, social support, educational level, marital status, symptom management, age and gender.

Question 21

What is the burden of treatment for chronic disease?

Answer 21

Financial, treatment costs, managing medication, administrative tasks of arranging appointments, changing lifestyle, navigating healthcare and time and expense for travelling to appointments.

Question 22

How do people seek out and use information?

Answer 22

Seek out information through books, articles on the internets, diabetes group and other diabetic patients or health professionals. They use this information to self manage their care.

Question 23

What influences mental health and well being?

Answer 23

Life factors like work, education and parenting.
Denial
Feelings of burnout, distress, depression
Failings of professional care due to lack of empathy, blame, continuity of care