Chronic Illnesses: A European Perspective

Article excerpt

Summary

Chronic illnesses, a worldwide burden, concern not only the affected individuals but also their caregivers, 80% of them are women. In this paper gender-specific aspects of chronic illnesses are discussed especially from a European perspective. Epidemiological and symptomatologic differences as well as associated psychological factors are pointed out. Older persons respectively aged women have an increased risk for developing dementia, especially Alzheimer's disease. The most conspicuous discrepancy is demonstrated for rheumatism, women comprise 70% of the recorded cases. Concerning coronary heart diseases women's symptoms are more subtler than men's. Some studies maintain that the psychological aspects of osteoporosis, especially anxiety and depression, strike women harder than men. Facing these aspects quality of life (subjective state of well-being vs. objective medical parameters) and psychological interventions are figured out to be very important in chronic illnesses.

Key words: Chronic illness, Human Sex Differences, Caregivers, Dementia, Heart Disorders, Osteoporosis, Arthritis, Quality of life

The United States National Center for Health Statistics defined chronic illness as a condition that persists for a long time, at least three months, that cannot be cured but must be managed (see Cronan & Bigatti in this volume). Many people with chronic illnesses are aged and have more than one chronic illness. Statistics in Austria show that almost 70% of health care costs are allotted to the treatment of chronic illnesses and of those with multimorbidity (Kryspin-Exner, 1999). Furthermore, chronic illness is not limited to a particular set of symptoms over a certain period, as illnesses may change their appearance over time. Studying changes that occur over time in both physical condition and the predisposing and resulting psychological factors will provide physicians and psychologists with more information to prepare or intervene with future patients.

A distinction must be made between chronic mental and physical impairments and deficits; that is, between psychic disorders and health related problems. Unfortunately, these two aspects are not independent, but it remains necessary to separate them in the study of chronic illnesses. Ehlert (1998) and Bengel, Baumeister, Hofler and Harter (2002) provide examples of how this separation can be accomplished: Epidemiological research has indicated that the percentage of "psychic disorders" in the general population is 15 to 20%. In general practices, the percentage of patients with psychological disorders is 25%. In general hospitals 30% of the cases were judged to be psychologically based (Ehlert, 1998). In rehabilitation centers, the percentage of psychic disorders is 40% (Bengel et al., 2002). The data also provide some evidence of the psychological impact of somatic illnesses, affecting primarily anxiety disorders, alcohol and drug dependence, and depression. However, these data provide little information about how patients cope with diseases. Furthermore, these rates are based on evaluation with typical diagnostic criteria (ICD10) and do not take into account how people feel, assess their mood state, or consider how they perceive their health. Thus, comparisons of objective medical data with self-estimation of well-being in somatic illnesses are needed.

There is a paucity of research on the factors discussed above in women. In 2000, the delegates at an European Institute of Women's Health (EIWH) conference unanimously agreed that gender should be an important consideration in all health programs and that it should be included in the new Public Health Program and the 6th Research Framework Program. In March 2001, EIWH tabled amendments on gender in the European Parliament. These amendments stated that gender should be considered in data collection processes, as part of research criteria, and that it should be considered as a determinant of health. …