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Alzheimers Disease
Impact of Chronic Illness

Alzheimer's disease - a degenerative disease of
the brain and a major source of impairment
among older people.
Two forms of the disease exist early-onset
(uncommon, & typically occurs before 60 y.o.) &
late-onset (usually begins after 60 y.o.)
Risk-factors: early-onset genetic defect; lateonset protein involved in cholesterol metabolism
Environmental factors also contribute to the risk
of developing AD
The behavioral risks for AD are similar to those for
CVD & cancer, & the behaviors that offer
protection are also similar

AD is difficult to diagnose because many of the of
symptoms of Alzheimers overlap with symptoms of
other illnesses
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
Helping the Patient
AD is presently incurable, & drugs have only limited
ability to slow the progression of the disease
Symptoms of the disease can be managed by
changing situations in patients' environment that
prompt undesirable behavior

Several psychological interventions can be
used to enhance memory and to help
patients cope with depression and problems
of disorientation
Helping the Family
The symptoms of Alzheimer's disease are
particularly distressing to family members.
Emotional outbursts, suspiciousness, anger,
& agitation by a previously gentle, loving
person can baffle family members & 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 & upset, and lose the ability
to perform routine self care
People who care for Alzheimer's patients must
have the time, energy, & skills to perform
appropriate care, & they must also care for
Caring for Alzheimer's patients is particularly
stressful, & support groups & other psychosocial
interventions often help caregivers cope with
the strain of living with an Alzheimers patient

Traditionally, Type 1 diabetes was called juvenileonset diabetes & Type 2 diabetes was referred to
as adult-onset diabetes
Nowadays: insulin-dependent (IDDM) or Type 1 and
noninsulindependent (NIDDM) or Type 2
Both types of diabetes mellitus require changes in
lifestyle, including the frequent monitoring of blood
glucose and strict compliance to treatment
The Physiology of Diabetes
Diabetes mellitus is caused by an insulin deficiency
The islet cells of the pancreas produce glucagon,
which stimulates the release of glucose, & insulin
which allows cells to use glucose

If the islet cells do not produce adequate insulin,
excessive sugar accumulates in the blood & urine
Patients' inability to regulate blood sugar often causes
other health problems such as CVD, retina damage, &
kidney diseases.
If unregulated, diabetes may cause blindness, coma,
& even death
The Impact of Diabetes
diagnosis of Type I diabetes affects both the child and
the parents. The child is labeled as sick or different,
faces a lifetime of coping with chronic disease. Insulin
injections & careful monitoring of diet are necessary.
Parents must be constantly vigilant to ensure that
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 & oral
medication. The lives of Type 2 diabetics
are not drastically changed by the disease,
although some patients refuse to comply to
their treatment regimen and become either
aggressive toward others or slip into a
chronic depression

Health Psychology's Involvement with Diabetes
involvement in both investigating and treating
Research has concentrated on
1. stress as a factor in the development of diabetes
and in the regulation of glucose metabolism
2. The ways that diabetics conceptualize their
3. The dynamics of families with diabetic children
4. reasons for noncompliance.
Finding ways to help people with diabetes
manage their care is an important goal

The death rate from asthma is not high, but it is the
largest cause of disability among children
The Disease of 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
may be due to genetic vulnerability that makes the
immune system of some infants respond with an
allergic reaction to certain substances in the
People with this vulnerability & 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
& dirt which leaves their immune systems
underprepared to deal with these substances
In addition to environmental triggers &
underdeveloped immune systems, risk factors for
asthma include sedentary lifestyle & obesity
Managing Asthma
Like diabetes, asthma can be managed, but it
requires daily attention to symptoms & frequent
contact with the health care system

Managing asthma requires various
medications as well as learning personal
triggers and avoiding them
Drugs for asthma often have unpleasant
side effects, e.g. weight gain and lack of
Asthma attacks can cause respiratory
failure, which may be fatal, making the
experience frightening & dangerous
Also like diabetes, teaching self-care skills is
a major goal


Acquired immune deficiency syndrome (AIDS) is a disorder
produced by human immunodeficiency virus (HIV) which
causes the immune system to lose its effectiveness &
leaves the body defenseless against bacterial, viral, fungal,
parasitic, cancerous, and other opportunistic diseases
Incidence & Mortality Rates for HIV/AIDS
Although AIDS may not be a new disease, its existence was
not known until early 1980s, when it began to spread & kill
In 1992, the CDC changed the definition of AIDS, bringing
uniformity to the definition
Mortality rates from HIV have declined dramatically
Part of the drop in mortality rates results from antiretroviral
drugs that prolong the lives of infected people


Another part of the drop comes from lifestyle 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 go up
The HIV & AIDS Epidemics
have been produced by (1) male-male sexual contact,
(2) injection drug use, (3) heterosexual contact, & (4)
transmission from mother to infant during the birth
Currently, the percentage infection due to male-male
sexual contact is dropping significantly, while
incidence resulting from heterosexual contact is rising
Nevertheless, a death rate from AIDS is much more
likely among men than women


Symptoms of HIV & AIDS
HIV progresses over a decade or more
During the 1st phase, people often experience
symptoms similar to influenza, which persists for
to a few weeks
The next phase shows no symptom, but the
persons immune system is being destroyed
When the destruction of certain cells affects the
persons 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, &
painful skin rash


As their count continues to drop to the level that
characterizes AIDS, the person is vulnerable to the
variety of opportunistic diseases
pneumonia, tuberculosis, toxoplasmic encephalitis, &
Kaposi's sarcoma are infections that cause death among
AIDS patients
The Transmission of HIV
AIDS spreads only through direct contact. No evidence
exists that any sort of casual contact spreads the
The main routes of infection are from person to person
during sex, from mother to child during pregnancy or
birth, & 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
Among gay and bisexual men, unprotected anal
intercourse is an especially risky behavior, particularly
for the receptive partner, & oral sex may also be risky
2. Injection Drug Use
Sharing unsterilized needles is a practice that allows
direct transmission of blood from one person to
Needle exchange programs can help control this
3. Heterosexual Contact
Women are at greater risk from this mode of
transmission than men, & this mode of transmission is


Research suggests that unsafe sexual behaviors
are related to unrealistic trust in one's sexual
partners and failure to take adequate precautions
rather than a lack of information about HIV
4. Transmission during the Birth Process
Children born to HIV infected mothers have a risk
for contacting 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


Primary prevention formulating strategies to
change risky behaviors
Secondary prevention helping people who are
HIV +ve to lead healthier life
1. Encouraging Protective Measures
Except for children, people have some control
over their risks for HIV.
Health care workers e.g. nurses, dentists, &
doctors should protect themselves against blood
entering their body through an open wound.
More common risks come from sexual contact &
from sharing needles with an infected person

Prevention of THE AIDS

Limiting the number of sexual partners, using
condoms, & avoiding contaminated needles are
the behaviors that will protect the largest number
of people from HIV infection
2. Helping People with HIV Infection
A significant number of people who engage in
high-risk behaviors have never been tested for
HIV, so testing should be encouraged
A +ve diagnosis of HIV can lead to anger, anxiety,
& depression
Interventions can help HIV +ve people adhere to
medication, adopt a healthier lifestyle, & find
meaning in the experience of HIV


Chronic illnesses/diseases present a major problem,
affecting not only patient but friends and family
members as well
The diagnosis of a chronic disease may be
conceptualized as a crisis or transition in the person's
Adjustment to the illness often changes the way patients
see themselves, produce financial strain, and disrupts
established patterns of personal and social behaviors
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 a normal life as possible, and face the
possibility of death.


Dealing with the health care system is often a
negative factor for ppl with CI, not only because
of frequent contacts but also because health
care providers typically concentrate on the
physical aspects of the illness & fail to provide
help in coping with the long-term disruption of
the patient's life
Support groups can be valuable for ppl with CI,
providing information as well as emotional
Patients with CI must cope with the loss of
health & the possibility of death, but many ppl
manage to find some +ve aspect in this process


Impact on the Family
CI requires adaptation for families as well as for
For families with chronically ill children, parents must
adapt to treatment and also to the loss of their
children's health.
For adults, a chronically ill family member presents the
need for caregiving, changing relationship with family
Recommendations: trying to be flexible, finding ways to
express their negative emotions, joining support groups
Feelings of grief and loss are common, & family
members profit from finding +ve ways to deal with
these emotions


Facing Death
Dying is the final phase of many chronic diseases,
& people with these diseases consider their deaths
Elizabeth Kubler-Ross proposed stages of dyingdenial, anger, bargaining, depression, &
acceptance but research has failed to confirm
that people with terminal illness progress through
those stages. However, ppl do experience these
People who are dying experience loss and
bereavement, just as their friends & family do.
Thus, a process of adaptation occurs during
terminal illness and during bereavement.