Patricia M. Melanson

Emotions, Coping, and Psychological Well-Being in Elderly People with Arthritis

Rheumatoid arthritis, the most destructive and crippling of allforms of arthritis, poses a number of stressful demands on individuals. In a sample of elderly women (N = 59) and men (N = 19) with rheumatoid arthritis, the relationship between social economic status, severity of impairment, sex, stress emotions, type of coping strategy, and psychological well-being was explored. Path analysis results indicated that higher social economic status was directly related to greater use of confrontive types of coping strategies. Severity of impairment had a direct, negative influence on psychological well-being, but sex was not an important factor Optimistic coping strategies were used most often and emotive coping strategies the least.

Confronting life with rheumatoid arthritis

Background.  Older people with rheumatoid arthritis are confronted with a variety of chronic stressors on a daily basis. Living with rheumatoid arthritis means learning to cope with physical limitations, fatigue, losing mobility and independence, pain, uncertainty and role changes related to periods of exacerbation and remission. There is a paucity of literature that addresses the stress and coping processes over time for older people who have had rheumatoid arthritis since midlife. Aim.  The purpose of this study was to identify and describe, at three points in time and over two 6-month intervals, the illness-related stressors perceived by older people diagnosed with rheumatoid arthritis since midlife; their stress-related emotions and the coping strategies they used to manage the illness-related stressors. Methods.  A longitudinal, descriptive design was used to assess older peoples perceptions of illness-related stress, their stress emotions and the coping strategies used to manage the illness-related stressors. Findings.  The majority of participants most frequently identified physical limitations as their illness-related stressors, harm as the stress emotion they experienced, and use of confrontive coping strategies to manage the stress associated with rheumatoid arthritis. Conclusions.  The findings provide nurses with a better understanding of the experiences, emotions and coping strategies used by older people to manage the adversity of rheumatoid arthritis in daily living.

The effects and expense of augmenting usual cancer clinic care with telephone problem-solving counseling.

This study was done to assess the effectiveness and efficiency of individualized, problem-solving counseling provided by baccalaureate nurses over the telephone to prevent the onset of depression in persons with breast, lung, or prostate cancer. Of 175 persons randomized, 149 completed the 8-month follow-up. The primary outcome measures were changes in the Jalowiec Coping Scale, the Centre for Epidemiologic Studies in Depression Scale, and the Derogotis Psychosocial Adjustment to Illness Scale. In addition, expenditures for peoples use of all health and social services were computed at baseline and follow-up. Telephone counseling improved the use of more favorable coping behaviors, prevented a clinically important but not statistically significant decline into depression, and poor psychosocial adjustment in a group of people with mixed cancer. These results were associated with a greater total per person per annum expenditure for use of all other health and social services in the community compared with the control group. In a situation of limited resources and a service producing more effect for more costs, one needs either to examine what services to forgo to offer this service or to carefully target the new service to those most likely to benefit.

Prevalence, correlates, and costs of patients with poor adjustment to mixed cancers.

Approximately 2% to 3% of the Canadian society has experienced cancer. Literature indicates that there is poor adjustment to chronic illness. Individuals with poor adjustment to chronic illness have been found to disproportionately use more health services. The purpose of this study was to determine the prevalence, correlates, and costs associated with poor adjustment to mixed cancer. A consecutive sample (n = 171) of breast, lung, and prostate cancer patients at the Nova Scotia Regional Cancer Center were surveyed. Twenty-eight percent of the cancer group showed fair to poor adjustment to illness using the Psychological Adjustment to Illness Self-report Scale Psychological Adjustment to Illness Self-Report Scale raw score. Poor adjustment was moderately correlated with depression (r = 0.50, P < .0001) and evasive coping (r = 0.38, P < .0001) and unrelated to demographic variables. Depression explained 25% of the variance in poor adjustment to illness in regression analysis. Cancer patients with fair to poor adjustment to illness had statistically significantly higher annual healthcare expenditures (P < .002) than those with good adjustment to illness. Expenditure findings agree with previous literature on chronic illnesses. The prevalence of fair to poor adjustment in this cancer population using the Psychological Adjustment to Illness Self-Report Scale measure is similar to that reported for chronic illness to date, suggesting that only those with better adjustment consented to this study.