Caregiving experts discuss coping mechanisms
Coping mechanisms can also be described as 'survival skills'. They are strategies that people use in order to deal with stresses, pain, and natural changes that we experience in life. Coping mechanisms are learned behavioural patterns used to cope. We learn from others ways to manage our stresses. There are negative coping mechanisms and positive coping mechanisms. As caregivers, we have seen many people use their coping mechanisms to benefit them in a positive way. However, we are not always able to cope with the difficulties that we face. We experience a range of emotions throughout our lives, some good, some not so good. Our behaviours are usually a result of how we handle our emotions. If we are able handle our emotions positively, our behaviour will likely be positive. If we do not handle our emotions in a positive way, our behaviour will likely be negative.
Chronic illness on the rise
The figures tell the story. Life expectancy at birth in Canada is 82 for women and 77 for men. And those numbers will keep rising. Advances in medication and new drugs are keeping us going when we'd have died younger in years gone past. But while we're getting older, we're more likely to suffer from those chronic conditions of old age. According to the Heart and Stroke Foundation, 29% of all deaths in Canada were related to chronic heart disease, and the Canadian Cancer Society attributes 30% of all deaths in Canada to some form of cancer. It doesn't make life any easier. People with a chronic illness have to deal with pain, disability, periods off work, loss of employment, loss of independence, social isolation, and possibly death from their condition. It means the future is uncertain. You don't know what's around the corner – will you get better or worse, will you be cured, can you get help, is there treatment? What's also uncertain is how people will react to living with a chronic condition. Some people sink into depression and despair, while others remain optimistic and positive and even thrive. What makes one person despair and another adapt? And what can we learn from it? A team of psychologists from the Netherlands set out to find out. They trawled though a decade of scientific research on how patients react to chronic disease, and what coping mechanisms helped them adapt. They published their findings in the latest edition of the UK journal The Lancet.
Caregivers advise: Keep active
Physical activity makes a big difference, the researchers found. After an acute illness, there's normally a 'slow-down' period of tiredness, lethargy, and immobility (caused by chemicals called cytokines released by the disease), and it's beneficial – helping to conserve energy and promote healing. The symptoms often improve once a person starts taking medications. But the effects of these cytokines can linger, impairing mobility and metabolism. So physical exercise tailored to a person's individual ability is needed to maintain muscle strength and balance, especially in musculoskeletal conditions like arthritis, and diseases of metabolism like diabetes and heart disease. It also helps lift mood.
It's important to talk openly and acknowledge the condition, rather than pretend it doesn't exist, the researchers say. Chronic illness is often accompanied by depression and anxiety, but people who are open and communicate their feelings tend to need less treatment, report fewer symptoms and retain more independence and physical function.
The more actively people manage the condition themselves, the better they do. 'Self-management' is the buzz word, and it involves becoming informed about their condition, making their own decisions about treatment (with the help of their physicians and caregivers), and setting their own management goals (what they'll eat, how they'll keep fit, how they'll manage their medications and side effects) rather than passively accepting whatever treatment is doled out to them. However, people do seem to have an in-built resistance to taking control of their own health. Most patients seem to prefer to adopt the sick role, and blame doctors, nurses and others if they don't get better. And people are often loath to make lifestyle changes. They are better at keeping medical appointments and taking mediations than adhering to diet and exercise programs. So only about a quarter of people with a chronic disease achieve self-management of their illness; this figure should be higher. Those who do self-manage report fewer symptoms and fewer disease complications, say the researchers.
Changing the way they think about their life can also help a person adapt. Developing an improved appreciation of life and an enhanced sense of purpose, and strengthening personal relationships, will elevate mood and reduce depression. Good support from family and friends helps, and so does having a good GP and specialist and other health workers. Ideally doctors should be open-minded and non-judgemental, and they should acknowledge the frustrations and limitations of medical knowledge in treating chronic disease.
The good news
In about 30 per cent of cases, people with chronic conditions don't make the transition well; they become depressed and deteriorate. But most people eventually adjust, and in fact they tend to achieve a quality of life that is remarkably similar to that of healthy people, say the researchers. Some find the illness helps them grow as individuals, endowing them with more courage, resilience, patience, tolerance, compassion and empathy. So when your grown children come to visit you, enjoy their company, drink the tea they make you, smile and tell them you're doing fine, with no plans to cut them out of their inheritance – at least not just yet.