Quality of life in patients with chronic health conditions

SUMMARY: Six in ten Americans live with at least one chronic disease, like heart disease and strokecancer, or diabetes. These and other chronic diseases are the leading causes of death and disability in America, and they are also a top driver of health care costs. But what we most often overlook is the effect of chronic health conditions on the quality of life leading to depression and suicide.

Paul used to be an energetic and vibrant guy. He would go for long hikes in the woods and loved to travel the world. I met him in a photography class, and we formed a friendship based on our love of nature photography. Two years later, Paul had become a recluse and did nothing but sit at home and watch TV. I learned later that he was being treated for a severe form of COPD, which had affected his life so much his wife said, “he just doesn’t do the things he used to anymore”.

Paul is not alone. According to the CDC, in 2012, 25.5% of US adults had multiple (≥2) diagnosed chronic conditions among ten different conditions: arthritis, cancer, chronic obstructive pulmonary disease (COPD), coronary heart disease, current asthma, diabetes, hepatitis, hypertension, stroke, and weak or failing kidneys. Compared with adults without chronic conditions, adults with multiple chronic conditions have a worse health-related quality of life, higher health care costs, and increased risk of death. Using 2018 National Health Interview Survey (NHIS) data, we provide estimates of the prevalence of single and multiple chronic conditions among US adults.

Considering how painful and disabling chronic health conditions can be, it’s no surprise that people with chronic illnesses are two to three times more likely than the general population to suffer from depression.

Our healthcare system is designed to treat health conditions, not patients. What happens when someone loses the will to live because they are tired of dealing with chronic health conditions and prescription drugs that have nasty side effects?

The majority of chronic diseases hold the potential to worsen patients’ overall health by limiting their capacity to live well, determine their functional status, productivity, and contribute to high healthcare costs.

When my mother had cancer, she refused a second round of chemotherapy and decided to let nature take its course. When I tried to talk to her to get the treatment, she told me she was just “tired”. She was tired of fighting every day. She was tired of seeing multiple doctors and tired of going to an Oncologists office that was more like, as she called it, a “cancer store”.

When your chronic illness has put you through the wringer in terms of doctor and hospital visits, lab tests, imaging, medications, and other treatments, it’s only natural to feel defeated.  All of us have been there at some point – when you almost want to throw your hands in the air and let the quicksand pull you under.

In Pittsburgh, Pennsylvania, Vicki Helgeson, a psychologist at Carnegie Mellon University, has spent more than 25 years studying how people adjust to chronic illness. “Most people are amazingly resilient and find successful ways of coping with whatever stressors life throws their way,” she says. Still, a significant minority with the same severity of illness will suffer more, both physically and emotionally. Studies show that the factors that make the difference include gender, personality traits, and, perhaps most importantly, relationships with friends, family, and peers.

How patients fare after being diagnosed with chronic illnesses depends a lot more on them than on their doctors. The patient has to be taking medication, monitoring diet, exercising and following up with medical appointments, all of which can make a big difference in how well he or she does, both psychologically and physically.

Vicki Helgeson, a a psychologist at Carnegie Mellon University

Still, our healthcare system doesn’t take into account how people feel about their chronic health problems. Someone could, for example, decide that they can’t lower their A1C and gain weight after failing to lose weight. We think that medications can help, but social media is full of posts from people who report quality of life-altering side effects.

The US spends more on patient care than any other industrialized nation, but somehow our healthcare system is not even close to being in the top ten. We forget that behind every statistic is a person who may be scared and alone trying to fight their chronic illness every day. That needs to change.