Different Chronic Illnesses Demand Different Connected Health Strategies [Reblog]

From a May 2015 post at The cHealth blog

….

We made a decision some years ago to build the case for connected health around the management of these illnesses because:

1. They are costly. By some estimates these chronic diseases account for 70% of U.S. health care costs.
2. They have a significant lifestyle component. This backdrop seems an ideal canvas for connected health interventions because they involve motivational psychology, self-tracking and engagement with health messages. These chronic illnesses pose a unique challenge in that the lifestyle choices that accelerate them are for the most part pleasurable (another piece of cheese cake? spending Sunday afternoon on the couch watching football, smoking more cigarettes and drinking more beer.) In contrast, the reward for healthy behavior is abstract and distant (a few more minutes of life sometime down the road or an avoided heart attack or stroke). This combination of lack of symptoms and the uphill battle around lifestyle improvement makes these illnesses uniquely challenging.
3. They are mostly amenable to tracking some objective bit of information about you (e.g. your blood pressure, blood glucose or activity level) in order to make you more aware and, hopefully improve your lifestyle in order to improve your health.

 

 

ocused on these illnesses and the attendant challenges, we developed programs for home blood pressure monitoring, home glucose monitoring and various activity challenges (nothing on cholesterol just yet). By iteration, trial and error, we’ve become comfortable with the psychology around these illnesses and how it affects both our ability to manage patients and the patient’s ability to improve these conditions.

Because these conditions are silent and because most people would rather not be reminded that they have an illness, we found that a strong engagement platform is needed to get people’s attention. We also found that we need to create tools that nudge people to adopt and sustain a healthy lifestyle rather than ignore our natural tendencies to ignore these silent conditions and engage in unhealthy behaviors.

Read the entire blog post here 

[ Press release] Does illness make people lonely?

Does illness make people lonely? 

From the 11 February 2015 Concordia University press release

Concordia University study has discovered a new link between chronic disease and social isolation

Montreal, February 11, 2015 — Difficult circumstances often bring people closer together. But a new Concordia study published in Health Psychology has found that the onset of chronic illness often results in sufferers feeling lonelier — even for those who have had a steady partner for 50 years or more.

Researchers at the Personality, Aging, and Health Lab at Concordia took on the study because they found that, while plenty of research examined the effect of loneliness on illness, there was a lack of empirical evidence about whether or not illness contributes to loneliness.

“We were surprised by the amount of literature that examined whether people who are lonely are more likely to get sick,” says Meaghan Barlow, the study’s first author. “Yet none of them asked the opposite question: ‘Do sick people get lonely?’”

The new study reveals that they often do when they advance in age, and that it happens regardless of being in a long-term relationship when faced with a bleak diagnosis. “The quality of our social ties plays a role when it comes to coping with the effects of serious disease in later life. And just having a partner around may not be enough,” Barlow says.

…

“Putting a halt to socializing only contributes to a downward spiral,” Barlow says. “Dealing with a chronic illness shouldn’t prevent you from still trying to get out there if you can.”

Naturally, the challenge for society is to help an aging population find motivation to stay engaged, which means recognizing that the psychological side effects of disease can be offset with an increase in inspiring activity.

“The fact that loneliness can lead to further complications means that measures can be taken to prevent the effects from looping back around,” Barlow says. “Finding different ways to connect with other people also means you are less likely to blame yourself for being sick, and you can’t count on a partner to fill that gap.”

..

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New Report Provides High-Impact Recommendations to Improve Prevention Policies in America

From the 29 January 2013 Trust for America’s Health news release 

Trust for America’s Health (TFAH) has released A Healthier America 2013: Strategies to Move from Sick Care to Health Care in Four Years – which provides high-impact recommendations to prioritize prevention and improve the health of Americans.

The Healthier America report outlines top policy approaches to respond to studies that show 1) more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented, and 2) that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents.

“America’s health faces two possible futures,” said Gail Christopher, DN, President of the Board of TFAH and Vice President – Program Strategy of the W.K. Kellogg Foundation.  “We can continue on the current path, resigning millions of Americans to health problems that could have been avoided or we invest in giving all Americans the opportunity to be healthier while saving billions in health care costs.  We owe it to our children to take the smarter way.”

The Healthier America report stresses the importance of taking innovative approaches and building partnerships with a wide range of sectors in order to be effective.  Some recommendations include:

• Advance the nation’s public health system by adopting a set of foundational capabilities, restructuring federal public health programs and ensuring sufficient, sustained funding to meet these defined foundational capabilities;
• Ensure insurance providers reimburse for effective prevention approaches both inside and outside the doctor’s office;
• Integrate community-based strategies into new health care models, such as by expanding Accountable Care Organizations into Accountable Care Communities;
• Work with nonprofit hospitals to identify the most effective ways they can expand support for prevention through community benefit programs;
• Maintain the Prevention and Public Health Fund and expand the Community Transformation Grant program so all Americans can benefit;
• Implement all of the recommendations for each of the 17 federal agency partners in the National Prevention Strategy; and
• Encourage all employers, including federal, state and local governments, to provide effective, evidence-based workplace wellness programs…..

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Stress in America 2011

From the 3 February Full Text Report summary

Stress in America 2011

Source:  American Psychological Association

From press release:

The American Psychological Association’s (APA) newly released report, Stress in America™: Our Health at Risk, paints a troubling picture of the impact stress has on the health of the country, especially caregivers and people living with a chronic illness such as obesity or depression.

The Stress in America survey, which was conducted online by Harris Interactive on behalf of APA among 1,226 U.S. residents in August and September, showed that many Americans consistently report high levels of stress (22 percent reported extreme stress, an 8, 9 or 10 on a 10-point scale where 1 is little or no stress and 10 is a great deal of stress). While reported average stress levels have dipped slightly since the last survey (5.2 on a 10-point scale vs. 5.4 in 2010) many Americans continue to report that their stress has actually increased over time (39 percent report their stress has increased over the past year and 44 percent say their stress has increased over the past 5 years). Yet stress levels exceed people’s own definition of what is healthy, with the mean rating for stress of 5.2 on a 10-point scale— 1.6 points higher than the stress level Americans reported as healthy.

While 9 in 10 adults believe that stress can contribute to the development of major illnesses, such as heart disease, depression and obesity, a sizeable minority still think that stress has only a slight or no impact on their own physical health (31 percent) and mental health (36 percent). When considered alongside the finding that only 29 percent of adults believe they are doing an excellent or very good job at managing or reducing stress, APA warns that this disconnect is cause for concern.

“America has a choice. We can continue down a well-worn path where stress significantly impacts our physical and mental health, causes undue suffering and drives up health care costs. Or we can get serious about this major public health issue and provide better access to behavioral health care services to help people more effectively manage their stress and  prevent and manage chronic disease,” says psychologist Norman B. Anderson, PhD, APA’s CEO and executive vice president. “Various studies have shown that chronic stress is a major driver of chronic illness, which in turn is a major driver of escalating health care costs in this country. It is critical that the entire health community and policymakers recognize the role of stress and unhealthy behaviors in causing and exacerbating chronic health conditions, and support models of care that help people make positive changes.”

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• Stressed women know it. Stressed men … not so much. (psychologytoday.com)

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Majority Of Homeless People Have Chronic Health Conditions

From the 26 August 2011 Medical News Today article

More than eight out of 10 homeless people surveyed by researchers at St. Michael’s Hospital and elsewhere have at least one chronic health condition and more than half have a mental health problem. People who are “vulnerably housed” – meaning they live in unsafe, unstable or unaffordable housing – had equally poor, and in some cases worse, health, the survey found. The underlying cause for these health issues is poverty, said Dr. Stephen Hwang, the principal investigator of the study and a physician-researcher at the hospital’s Centre for Research on Inner City Health

“Poor housing conditions and poor health are closely linked,” said Dr. Hwang. “We need to treat both problems.” …

Read the article

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5 rules for living well with a chronic illness

From a 5 May 2011 KevinMD.com posting by Carolyn Thomas

Dr. Aletta shares these five rules for living well in spite of a chronic illness like cardiovascular disease:

1. Be confident you have the right doctor. When you have a chronic illness, your relationship with your doctor is second only to your spouse or your parents. Being honest (and you must be honest!) with that person means you need to be able to trust them to hear you. If you don’t have that kind of relationship, get a second opinion. Shop around.

“In my own chronic illness career, I fired three highly recommended specialists because they were jerks. Thankfully, I’ve also had wonderful physicians who literally saved my life and my mind.”

2. Define your circle of support carefully. Isolation leads to depression, and it is so easy to isolate when you feel lower then dirt. People may surprise you. Peripheral friends may step up and be terrific supports, while others you thought you could count on can’t be there for you. If someone inside the circle asks, “How are you?” – tell them the truth. When someone outside the circle asks you the same question, lie. Say, “I’m fine!” and change the subject. Too often they can’t handle the truth and they suck any energy you have taking care of them. If someone asks if they can help, say yes. Accepting help is a gift to them. Trust that someday you will be on the giving end. One big way someone can help is to go to doctor’s visits with you. The extra eyes and ears take the pressure off you when the news is emotionally laden and important, even if the news is good!

“A patient of mine found her mother would get hysterical at any medical news, so it was better to keep her at arm’s length. But my patient’s mother could do laundry for her, and that made both of them happy.”

3. Protect your health as you would a small child. You are more than your illness. That part of you that functions well needs you to advocate for it. Of course, there are the basics of getting plenty of sleep, exercise and eating smart. In addition to all that, I suggest learning a new set of signals that are your clues for when you’re wearing your health thin.

“For me, it’s lowered ability to concentrate, tension in my neck and shoulders, irritability and loss of my usually dependable sense of humor. When those yellow lights are blinking, it’s time for me to stop, assess and make changes. When I ignored those signals in the past, I relapsed. Looking back I can see where I ran the red lights. So be a fierce protector of your health. Set limits and find the courage to say ‘No’!”

4. Create a new measuring stick. Your self-esteem lies in the standards with which you measure yourself as you go through life. To thrive with chronic illness, throw out the old and rethink your standards. If you are used to defining yourself by your 50-hour work week, for instance, you may feel lousy about yourself because now you can’t manage it. But finding a new standard can be tough.

“One technique I use with patients is to have them ask themselves what is reasonable? Is it reasonable to do it all yourself or is it more reasonable to delegate? Is it reasonable to register the kids in travel hockey, or is it more reasonable to stay local? In my own life and in my work I find that those who thrive despite chronic illness creatively find opportunity in their new reality.”

This is where a lot of courage is needed. Courage to address old pressures to be a certain way, and to imagine value in doing things differently.

5. Have dreams and strive for them. You had ambitions to get a degree or a promotion, to see the world or save it, to get married or have kids. Now you’re thinking, do I have to give all that up? No, you don’t. It’s imperative for your spirit that you have goals for living, big and small.

“What might change with the reality of chronic illness is the path and timing. As we reach for the stars, let’s appreciate the ground we stand on. Mindfulness has a real place in keeping depression at bay for everyone. Sometimes our dreams are right before our eyes.”

Read the entire article

 

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