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Quality of life,health status,health-related quality of life are all used interchangeably to discuss the effects of diseases,such
as rheumatoid arthritis,on functioning and sense of well-being.
Quality of life refers not only to health status,but also to environmental and economic factors (e.g., income,education)
that can affect well-being.
Different conceptual frameworks guide how quality of life is defined and measured. Researchers who are interested in
the evaluation of the quality of medical care outcomes tend to place greater emphasis on the development of measures that
focus on overall well-being.
While,those operating from a medical ethics perspective tend to develop measures assessing the importance that an individual
places upon his/her quality of life
Many patients with the more severe type of RA feel ill,much as though they have a chronic bad flu. Patients feel
tired,have no energy,feel nauseated,lose their appetite,and sometimes even lose weight. These symptoms are typical of RA and
are called constitutional features.
Many patients with RA feel unwell,but patients with moderate or severe disease feel the most unwell. Like extra-articular
features,the severity of these symptoms helps to separate RA from other forms of arthritis.
Hardly any one of us thinks about joint disease until pain,stiffness,and loss of function pointedly catches our attention.
To live a normal life joints must function perfectly. Even minor joint disease causes dramatic changes. A joint disease
such as RA,which affects the whole system,may limit quality of life.
When you feel ill,nauseous,and tired,it is difficult to be cheerful,let alone accomplish what you want to accomplish.
Interactions with your family,and friends,at the job,can become difficult.
Most of us are saddened by the difference between what we want to do and what we actually can accomplish. This feeling
is much more pronounced in patients with RA. Patients may wonder why me ? Patients who think the disease cannot
be controlled will also have a sense of hopelessness which can lead to depression.
When the focus is on the impact of a disease or medical condition on functional health status and well-being as perceived
and reported by the patient,health-related quality of life (HRQL) generally is considered the most appropriate aspect of quality
of life for investigation.
HRQL encompasses emotional, physical, social and subjective feelings of well being that reflect an individual's
subjective evaluation and reaction to his/her illness.
Traditionally,outcomes in health care have largely been determined by the objective evaluation (e.g.,measurable changes
in health parameters,disease status,cost of care). It has become clear that the perspective study of the patient is also a
critical variable.
Evaluations of medical/health-related outcomes from the patient's perspective are being done more. Such assessments potentially
are of use to clinicians, researchers and policy makers since they offer a profile of the current state of an individual who
is experiencing a certain illness or chronic disease.
This provides additional information beyond that offered by traditional medical and clinical measures,and, is valuable
in helping to understand the wide variability in individual responses to similar conditions.
HRQL measures are also valuable in evaluating the effects of treatment,as well as the cost effectiveness of treatments.
It seems particularily appropriate to measure HRQL in arthritis patients because of the chronic debilitating nature of
this disease likely takes a considerable toll on HRQL.
Chronic diseases such as RA has a substantial effect on health,fitness,and physical,emotional,and social functioning.
HRQL is likely to be a good indicator of both the global effects of arthritis on a patient's life,as well as the effects of
treatment.
The Arthritis Impact Measurement Scale (AIMS) is a prime example of an arthritis-specific HRQL instrument that has been
developed. The AIMS measuress physical,social,and emotional well-being along 9 dimensions including dexerity,mobility,pain,physical
and social activity,and depression and anxiety.
There is a great deal of information suggesting that arthritis has a devastating effect on HRQL. Data from 32,322 adults
in 11 states from the 1998 (BRFSS) Behavioral Risk Factor Surveillance Survey indicates that adults with arthritis report
significantly greater HRQL impairement compared to adults without arthritis.
Specifically,those who have arthritis reported fair to poor health approxiamately three times more often
than did those without arthritis (28.6% vs. 8.3%), they also reported a significantly greater number of days when physical
and mental health were not good,and when usual activities were limited.
Assessment of HRQL provides a way for rheumatoligists and arthritis researchers to better understand the effect of this
chronic disease on overall functioning and well-being. Discussing the results of an HRQL assessment with a patient can stimulate
a conversation that focuses explicitly on the impact his/her condition has had on the way he/she lives his/her life.
As a result of the HRQL assessment,it is possible to identify significant areas of patient's lives that have suffered
and to help patient's focus more acutely on their treatment and self-management efforts so they can "reclaim" their former
lives.
This awareness, in conjunction with a clear discussion of what treatment may do to improve their HRQL,is vital in providing
the comprehensive care required to adequately address a disorder as complicated and muti-faced as rheumatoid arthritis. Those
with the more severe disease tend to have the worst HRQL.
Unfortunately,HRQL and tests such as "bone count" are time-consuming and clinicians may not be fully familiar with the
techinques so they are not commonly done. i.e.,The subjects are not included in general medical training.
Quality of life is a medical term used as a measure of how one functions and how she/he enjoy life. The term includes
a sense of happiness and our sense of wellbeing. A sense of wellbeing involve her/his ability to interact with their partner
and their family,to do the job at work,and to play with their children.
Quality of life is an overall assessment with which each of us can easily identify. Needless to say,a RA
patient's quality of life is profoundly affected and limited in most cases.
Since rheumatoid arthritis causes marked joint inflammation. The resulting pain,swelling,stiffness,and loss of function
will clearly add stress to the patient's life. If one finds moving,walking,or performing normal everyday activities difficult,
his/her quality of life will be changed.
Arthritis is the leading cause of disability in the U.S. In 1998, arthritis and other rheumatic conditions affected 43
million people – a number that is expected to climb to 60 million by 2020 as the "baby boom" generation ages. That’s
almost 20 percent of the population.
Arthritis conditions don’t usually cause death, but they do worsen health-related quality of life. Arthritis is the
leading cause of disability in the United States, limiting the everyday activities of more than 7 million Americans. Arthritis
results in 39 million physician visits and almost 2.5 million hospitalizations each year.
Findings on the impact of arthritis by the Centers for Disease Control and Prevention (CDC) show people with arthritis
have worse health-related quality of life than people without it, regardless of sex, age or education level. From 1996-98,
the CDC interviewed more than 32,000 people in 11 states about:
- Their general self-rated health.
- The frequency of days in which their physical health was not good.
- The frequency of days in which their mental health was not good.
- The frequency of days in which their usual activities were limited.
Overall, the CDC found about 29 percent of people with arthritis. Doctors had diagnosed most of these people (75 percent).
Others had symptoms of pain, aching, stiffness or swelling in or around a joint on most days for at least a month.
People with arthritis reported having fair or poor health about three times more often than did people without arthritis.
The CDC says "unhealthy days" are days in which physical and/or mental health was not good. Among arthritis sufferers, the
most unhealthy days were experienced by:
- Women.
- Younger people.
- People with less than a college education.
Depression is common in people with all types of arthritis, especially rheumatoid. For people with less education, unhealthy
days may reflect less access to health care or more physical labor, the CDC says.
Prevailing myths have portrayed arthritis as an inevitable part of aging that can only be endured. But the CDC says there
are effective interventions that are available to prevent or reduce arthritis-related pain and disability.
These include early diagnosis and appropriate management, including weight control, physical activity, physical and occupational
therapy and joint replacement, when necessary.
Not everyone who has arthritis suffers from debilitating depression. There are any number of theories why some people
become depressed,while others-given similar experiences-don't. Heredity may play a role,though that's not all that cetain;there
may be biochemical factors that predispose some people to depression.
It may be that certain people,due to a combination of environmental, experiential,and biochemical factors,tend to
interpret their experiences differently.
Psychologists used to think that people who were depressed demonstrated a bias to be pessimistic,that they felt helpless
and under-recognized the amount of control they had over events in their lives.
What research from the 80's seem to show is that it's not so much that depressed people underestimate or discount
the control they have-they seem to report fairly accurately how much control they have in a number of situations-it's that
people who are depressed overestimate how much control they have.
In other words,rose-coloured glasses may be useful for mental health. If you lose those rose-coloured glasses,well,it's
a cruel world. If you see it for what it is,you may get depressed.
Family and friends can help. first,recognize that someone suffering from depression may need professional help. One
of the commonest mistake says a Toronto geriatrician,is to urge someone's depressed to just "snap out of it-pull yourself
together".
The idea that people can be talked out of a severe depression comes from the misconception that depression is just
a psychological illness. Physical, chemical,neurotransmitters changes in the brain make it a physical illness as well. You
can try as hard as you want,and you're not going to try to get yourself out of a serious depression without help.
We tend to think each person has to take resposibility for his situation. Many people who are depressed know what
they need to do. It's not that they don't feel like it-they just can't bring themselves to do it.
Very often, they'll criticize themselves for not being able to,and they become even more depressed. Family and friends
have to walk a fine line. You can't brow beat people who are suffering from depression-it may only make it worse.
At the same time,the more people are able to maintain their involvement in valued activities and interests,the more
it's going to help. Every depressed person appreciates a pat on the back
They can help with chores,activities,express interest in the depressed person's life-style. A happy environment and
atmosphere is a great start.
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