HIV patients

These measures of subjective health status ask the individual to rate their own health, and are in contrast with any measures of mortality, morbidity and functioning that are usually completed by careers, researchers or observers. But, even though these type of measures enable individuals to rate their own health, they do not allow them to choose the dimensions in which to rate it. It is important to consider how one set of individuals, who happen to be researchers, know what is important to the quality of life of another set of individuals? So with this in mind, researchers have developed individual quality of life measures that ask the subjects to rate their own health in their own personally defined dimensions. An example of this is the ‘Schedule for Evaluating Individual Quality of Life’ devised by McGee in 1991. This asks subjects to select five areas of their lives that are important to them, and then rate them in terms on importance and how satisfied they currently are with each dimension.

Quality of life measures such as subjective health measures and simple/composite scales play a central role in many debates within health psychology, medical sociology, primary care and clinical medicine. Many funded trials are now required to include a measure of quality of life among their outcome variables. The concept of quality of life can become very important to patients with serious diseases such as HIV. In 1988, George noticed that even though there were many reports of high levels of psychological distress and psychiatric symptomatology in HIV patients, there wasn’t much literature on any intervention studies. One popular method was invented by Beck in 1976. He created the ‘Cognitive-Behavioural Model of Treatment’ in order reduce stress and improve coping skills and quality of life of diagnosed patients.

There is a substantial body of evidence that suggests that this type of therapy can benefit patients with psychological symptomatology. This model contains three assumptions, the idea that thoughts can determine emotion and behaviour, that unrealistic and negative thoughts can result in an emotional disorder, and that decreasing negative, unrealistic thoughts and increasing positive, realistic thoughts can reduce emotional symptomatology. A common misapprehension is that this type of therapy just simply encourages positive thinking, but it does, in fact, comprise of a number of techniques that address dysfunctional cognitions and behaviours within a structured therapy session. These techniques come into action in circumstances such as, dealing with helping the HIV positive patients to face their realities.

This can be hard, so a technique called ‘decatastrophisation’ is used that attempts to separate the reality from the accompanying global negative feelings and allows the patient to explore alternative ways of coping. It also plays a major part in preventing anxiety or a severe depressive response. Hawton and Kirk in 1989, and Selwyn and Antoniello in 1993, commented on the model by stating that the problem-solving approach does aim to support individuals in making informed decisions about their present difficulties, and to provide them with the general skills and strategies required to deal with any future problems.

George examined HIV patients six to twelve months after they had received individual, cognitive-behavioural interventions, and found a significant reduction in stress and many improvements in the levels of anxiety and depression. In 1990, Hedge, James and Green also reported increases in self-esteem and decreases in anxiety and depression after studying an intervention aimed at increasing coping skills. Fawzy, Namir and Wolcott in 1989, Moulton in 1990 and Lamping in 1993, all stated that this type of group intervention was successful in reducing distress and improving the patient’s quality of life.

There is a growing awareness among health care specialists that quality of life is an important health outcome in chronic diseases such as cancer. Relaxation training is seen as a promising intervention that is widely used as it helps to decrease anxiety, pain and nausea from treatments such as chemotherapy. In 1986, Bridge, Benson, Pietroni and Priest found that combinations of relaxation training with stress management and blood pressure monitoring were proven to be useful in the treatment of essential hypertension. This, combined with improvements in physical fitness, can visibly improve the patients’ quality of life.

A popular time of life to consider a quality of life is old age, where death seems easier, as the elderly are generally more prepared to face the prospect of it. They tend to typically die from degenerative diseases such as cancer, a stroke or heart failure. The terminal phase of illness is also often shorter and generally dignified. In contrast to other age groups, health goals for the elderly have always been more focused on the reduction of mortality than on improving their quality of life.

But, statistics compiled over the past fifteen years suggest that progress has been made in this area. People aged sixty-five and up have experienced more active days over the years, emphasising the fact that the importance of improving their quality of life has taken precedence in general health policy concerns. ‘Ageism’, a term coined by Butler in 1969, is generally used when elderly people are referred to as sick, sedentary, sexless, senile and impoverished individuals, and can be damaging.

This can be helped by a positive attitude from the medical profession, and can sometimes help to improve the elderly population’s ideas about their quality of life and how important it is to them in their final years. This concept can be carried out by advising them to compensate for any physical impairment brought about by the ageing process by pacing their daily routine. Sexual labels can also be hurtful, such as an elderly man’s interest in sexual matters being labelled as ‘a dirty old man’.

Reports made by Kinsey in 1948 and 1953 showed that most females maintained an interest in sexual relations until their sixties, and males in sound physical health were found to expect adequate sexual performance beyond eighty years of age. Despite these facts, the for-mentioned labels can result in elderly individuals being shamed into concealing their sexuality or sexual interest to the point where they begin to see themselves as sexless beings. The expression of love, emotional bonding and sexual activity in later life can help to improve their ideas of their quality of life.

So, to conclude, the concept of quality of life is broad, but well documented. There are many different definitions and ideas about what the term actually means or represents. It also means different things to different people, and is used in different contexts in different societies and professions. But it is mainly used in the medical profession, in areas such as chronic illness or the elderly, as they have many reasons to reflect on their lives before they move onto the next stage. Quality of life is a well-known, well-used term that refers to the idea of making an individual’s life as comfortable and enjoyable as possible in many different types of circumstances.

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