Dr Helen Noble, School of Nursing and Midwifery, Queen’s University Belfast
Dr Ian Walsh School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast.
The number of older adults with a chronic disease increases annually. Conditions include kidney disease, cardiac disease, dementia and chronic obstructive pulmonary disease. These lifelong illnesses impact heavily on physical and psychological wellbeing of patients and carers. Patients frequently suffer multiple comorbidities, a high symptom burden, may have a limited life expectancy and significant unmet palliative care needs. Management of these conditions is multifaceted, impacting carers involved in providing physical and psychological care and can include complex dietary and medication regimes, regular hospital visits and intensive treatment programmes. Additionally, carers may have their own health and social care needs and these should be addressed. Caregiver strain has been shown to adversely impact care recipient experience, as well as the sustainability of homecare. Despite growing recognition of the burden and adverse effects of chronic disease on carers, we must continue to do more to provide evidence that evaluates the effect of support interventions on their physical or psychosocial wellbeing. The development and evaluation of interventions responding to the psychosocial needs of carers has potential to improve clinical and individual outcomes for patients with a chronic disease. One such way may be through the combined use of Mindfulness approaches and arts-based therapies.
Mindfulness, as a therapeutic treatment, can positively impact holistic wellbeing. Paying attention to the present moment including thoughts and feelings, can improve mood, focus, resilience, coping and quality of life. It has been described as being able to give uninterrupted attention, without reproach and is concerned with developing non-judgmental awareness. Mindfulness is an approach that can positively influence wellbeing by paying attention to personal thoughts and feelings, with robust evidence to suggest it can improve quality of life. This has been demonstrated in research studies with groups of patients and carers, including those with cardiac and end stage kidney disease. Key to mindfulness is the learned ability to stand back from our thoughts and begin to identify regular, often destructive patterns such as rumination and catastrophizing. By using mindfulness techniques we can train ourselves or others to notice when thoughts are in control and accept that these thoughts, which are often harmful, are only events in our heads that need not control us.
Expressive arts therapies are widely utilized psychosocial interventions which promote psychosocial wellbeing and have potential to help carers adjust to and find meaning in challenging circumstances, improve coping skills, quality of life and well-being. The use of art can also help people express their experiences in illness and assist adjustment to difficult health challenges.
If we can find ways to bring these approaches together in supporting carers, it is likely that we can help carers build resilience, enhance their well-being and improve their coping skills. Offering supportive mechanisms to enable carers and patients to find meaning and satisfaction in their lives has the potential to change the face of caring and the subsequent impact on carers.
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