Impact of Disease on Family Members
Discussion Question Click here to read the following article from the South University Online Library on the impact of disease on family members: Golics, C. J., Basra, M. K. A., Finlay, A. Y., & Salek, S. (2013). The impact of disease on family members: A critical aspect of medical care. Journal of the Royal Society of Medicine, 106(10), 399–407. After reviewing the article, which factor do you feel has the most impact on family members? Please support your response with examples from readings.Impact of Disease on Family Members What are some of the reasons it is important to include the support persons in the plan of care? The impact of disease on family members: a critical aspect of medical care. Images Chart Chart Color Photograph Chart Chart Authors: Golics, Catherine Jane1 Basra, Mohammad Khurshid Azam2 Finlay, Andrew Yule2 Salek, Sam Source: Journal of the Royal Society of Medicine. Oct2013, Vol. 106 Issue 10, p399-407. 9p. 1 Color Photograph, 4 Charts. Document Type: Article Abstract: Most existing health-related quality of life research concerns the impact of disease on patients. However, in several medical specialties including dermatology, oncology, and physical and mental disability, studies have been carried out investigating the impact of disease on the lives of families of patients.
The aim of this paper is to review the literature which relates to the impact of disease on family members of patients. The OVIDSP Medline was selected as the primary database, Searches were limited to sources published in English. 158 papers were identified for review. The definition of “family” varied across the literature, and a broad definition was accepted in this review. This review shows that a wide variety of aspects of family members’ lives can be affected, including emotional, financial, family relationships, education and work, leisure time, and social activities. Many of these themes are linked to one another, with themes including financial impact and social impact being linked to emotional impact. Some positive aspects were also identified from the literature, including family relationships growing stronger. Several instruments exist to measure the impact of illness on the family, and most are disease or specialty- specific. The impact of disease on families of patients is often unrecognized and underestimated. Taking into account the quality of life of families as well as patients can offer the clinician a unique insight into issues such as family relationships and the effect of treatment decisions on the patient’s close social group of partner and family. [ABSTRACT FROM PUBLISHER] Copyright of Journal of the Royal Society of Medicine is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder’s express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) Impact of Disease on Family Members
When serious illness or disability strikes a person, the family as a whole is affected by the disease process and by the entire health care experience.3 Patients and families have different needs for education and counseling. Because each person in a family plays a specific role that is part of the family’s everyday functioning, the illness of one family member disrupts the whole family. When a family member becomes ill, other family members must alter their lifestyle and take on some of the role functions of the ill person, which in turn affects their own normal role functioning. If the person who does most of the family’s cooking has surgery and can’t shop or prepare meals for several weeks, other family members must take on this responsibility in addition to the tasks they already do. When a working parent is up most of the night trying to console a child with an ear infection, the parent not only loses sleep, but must either arrange for emergent child care or take a day off from work. If a man who is the primary income producer in a family has a heart attack, his wife may have to return to work, increase working hours if she is already employed, or become the family’s breadwinner. Middle aged adults whose children have just left home may need to alter their plans and goals to accommodate care needs for aging parents.
Illness may cause additional strain as the result of economic problems and interruptions in career development. If the patient is a young child, there may be additional strain to the family if there are siblings whose needs must also be met. Illness in the middle stage of family life, when adolescents are trying to break away from family ties and parents are going through their own mid-life transitions, may put further strain on what is already a time of potential family turmoil. Illness in later age may have an impact not only on grown children but also on the older couple who had anticipated a time of enjoyment together and are less able to care for each other because of their own physical limitations associated with aging.
The extent of family disruption depends on the seriousness of the illness, the family’s level of functioning before the illness, socioeconomic considerations, and the extent to which other family members can absorb the role of the person who is ill. In some instances, a major illness brings a family closer together; in others, even a minor illness causes significant strain. It is important to identify what the illness means, not only to the individual but also to the family. Asking them what they consider major problems and how they plan to handle specific situations can help you assess the meaning of the patient’s illness to the family.Impact of Disease on Family Members
To achieve effective patient teaching outcomes, you should make the family part of your teaching plan. For example, if your patient’s wife does all the cooking in the home, it is vital to include her in diet teaching. Involving family members may be an important future source of support for the patient as he or she works at behavioral change. Obviously it will be difficult for a husband to be supportive of his wife’s blood pressure treatment program if he does not understand the reasons for the recommendations and the consequences of not carrying them out.
Long-term illness, even in the most stable and supportive families, brings changes in family relationships. Illness produces disequilibrium in the family structure until adjustments can occur. If the nurse does not recognize the change, what it might mean to the patient and family, and how it might affect the patient’s willingness and ability to carry out health care recommendations, the goals of the teaching process will be diminished. When teaching the patient and family, it is important to identify patterns of relationships and to be alert to attitudes of family members. You may be able to identify resources within the group and help family members mobilize their resources to help the patient. It’s also important to be alert to some of the factors in family members that act as a barrier to education. Illness in a family member tends to raise the anxiety of all those close to the patient. Anxiety may be misinterpreted by the health professional as lack of interest or as reluctance to provide the patient with help and support. The more you are aware of these reactions and help family members deal with their feelings, the better able you will be to teach family members about the patient’s condition and treatment and to mobilize their support.Impact of Disease on Family Members
Leo Tolstoy’s observation in Anna Karenina that “happy families are all alike, but every unhappy family is unhappy in its own way”1 is an important reminder to both health services researchers and healthcare providers to recognize the often complex “ripple effects” of an illness throughout a family. An acute or chronic illness in a spouse, parent, or a child will almost certainly affect how one spends one’s time, for instance missing work or giving up leisure activities in order to provide direct care, emotional support, or transportation to the doctor. In addition, a growing body of research suggests that illness in one family member may also have important effects on the health and happiness of other family members.
In this issue, Stang and colleagues2 report the results of an interesting study that specifically analyzes the cost of illness from the “family perspective,” that is, the sum total of healthcare and productivity costs for patients and their families, when at least 1 family member suffers from migraine headaches. Using administrative data that allowed the linking and aggregation of healthcare utilization for all family members, the authors found that total unadjusted annual healthcare costs for families with at least 1 migraineur were about 70% higher ($11 669 vs $6838) than in a comparison sample of matched families with no migraine sufferers. Outpatient and pharmacy costs for both migraine and non-migraine-related healthcare and medications were identified as the main source of increased healthcare costs for migraine families. The possible ripple effect of migraine in 1 family member on the health of others in the family is suggested by the 25% increase in healthcare costs that was found for the spouse or mother of migraine sufferers, although these unadjusted estimates did not account for significant differences in the characteristics of migraine and non-migraine families. When adjusting for differences in household size, geographic region, total number of comorbidities, and specific comorbid conditions, families with a migraineur incurred approximately 36% higher total annual healthcare costs compared to families without a migraineur, although we are unable to assess whether these additional adjusted costs are due to healthcare for the migraine sufferer or other family members.
Given the complexity of family interactions, one should be cautious in drawing firm conclusions on causality from this cross-sectional study. As the authors note, migraine headache may simply be an indicator of other medical conditions that are the “true” cause of the increased healthcare costs in families with a migraineur. In addition, it is possible that greater levels of illness in other family members led to increased rates of migraine headaches in those at risk for the condition, rather than the migraine headaches in one family member leading to greater illness and subsequent healthcare utilization in others. Impact of Disease on Family Members
Stang and colleagues make an important contribution by emphasizing the family perspective, as the impact of illness on other family members is likely to grow in importance in the coming decades. The aging of the baby-boom generation will lead to an increasing number of older individuals with chronic disease who will require daily help with disabilities. For instance, the prevalence of Alzheimer’s Disease (AD) in the United States is projected to more than triple (from about 2.3 to 8.7 million cases) in the next 50 years due to aging of the population and a large increase in the “oldest-old” (age 85 or older) who are at highest risk for AD.3,4 The time demands on families of providing care to this increasing number of older individuals will be significant. We have used the nationally representative Health and Retirement Study5 (http://hrsonline.isr.umich.edu) to estimate the time and societal costs associated with caregiving for various chronic diseases.6-10 The additional time that families spent providing care to older individuals with chronic illness ranged from about 4 hours per week for diabetesrelated care to more than 40 hours per week for severe dementia. Using conservative estimates for the value of an hour of a caregiver’s time, the total annual societal cost for this care giving time was approximately $60 billion per year, including about $6 billion per year for diabetes, $6 billion per year for stroke-related disabilities, $10 billion per year for depression, and $18 billion per year for dementia. Given the magnitude of the cost of informal care giving for chronic disease in older individuals, it is important to include estimates of these costs when evaluating the cost effectiveness of clinical and policy interventions aimed at improving care for these increasingly common conditions.
In addition to the significant time associated with providing care to ill family members, a number of studies have identified negative health effects associated with care giving, especially among caregivers for elderly individuals with dementia and cancer. The negative health effects that have been shown associated with dementia care giving include increased rates of depression and anxiety,11-13 and poorer self-rated health status.12 These negative health effects may be due, in part, to poorer health behaviors (less physical activity, sleep, and rest) among dementia caregivers.12,14,15 A recent study showed that individuals who reported “strain” associated with their caregiving had significantly higher rates of mortality over 4 years of follow-up.16
However, the complex social interactions within families, in general, and families with an ill member, in particular, are made clear by a number of studies that have found evidence for beneficial physical and mental health effects (for instance, lower rates of anxiety, depression, and mortality) associated with care giving.12,17-19 Potential explanations for these positive health outcomes associated with care giving include stress reduction resulting from mutual affection, interdependence, and companionship that may protect individuals against the adverse consequences of care giving.17,19 Future research aimed at identifying key variables that mediate when family care giving leads to positive rather than negative health outcomes for caregivers will be extremely important for aging baby-boomers, their families, and policy-makers addressing the design of the Medicare and Social Security programs. Impact of Disease on Family Members
In light of the findings of Stang and colleagues, as well as other studies of the potential negative health effects of care giving, what should healthcare providers do for the families of their patients? At a minimum, physicians and other healthcare providers should be alert to the increased risk for depression in the family caregivers of their patients, and take note of their mood during healthcare visits. The American Medical Association’s Caregiver Self-Assessment Tool 20 may help identify depressed caregivers who could benefit from referral to caregiver support programs.21 Physicians should also be aware of public and private resources designed to provide information and support for caregivers, and make referrals to such programs when appropriate. National organizations such as the National Alliance for Care giving (www.care giving.org) and the Alzheimer’s Association (www.alz.org) can provide caregivers with information on support programs in their local communities. While healthcare providers are already challenged to provide high-quality care in the limited time they have to see their patients, understanding the possible ripple effect of a patient’s illness across a family and broadening their focus to include an assessment of the well-being of family caregivers, will likely pay dividends both for the caregivers themselves, as well as the patient.Impact of Disease on Family Members