Addressing Despondency in Chronic Care

Heart Disease A sense of futility and deep despondency are the primary drivers of the patient's approach to his self-care. These emotions are mirrored by his wife, and further complicated by the exhausting circumstances of being a primary caregiver to a depressed and declining patient. It is doubtful that either the patient or his wife are getting enough sleep, eating well -- within the dietary restrictions -- or following a healthy regimen of moderate exercise.

The pattern of behaviors described and observed indicate that both the patient and his wife are overwhelmed by difficulties of managing the disease and the centrality of the disease in their life. To address head-on the emotional fatigue and hopelessness that the couple face, it is imperative to provide examples of other patients and their spouses who have or are successfully dealing with the same disease at a comparable level of severity.

Examples must show individuals in situations that are sufficiently close to those currently being experienced by the couple in order for them to recognize and accept the parallels. The purpose of this approach is to begin to instill some hope with respect to their capacity to manage their situation. The second component of this situation is to provide information at a level and of a kind that is understandable and relevant to the situation the couple face.

The focus of the teaching plan is on lifestyle changes since this is the way that the patient -- and with the support of his wife -- can influence the progression of the disease. The third component of the treatment plan is to ensure that the primary physician is aware of all the medications that the patient is taking, to consider if any changes in medication are indicated as a result of new research or available drugs.

Following this review, the patient will scheduled for in-home visits by a counselor or nurse (because of the patient's age and depression, he is not likely to be a good candidate for telemedicine -- at least via smartphone). In addition, the patient's wife needs respite from her home care duties. The treatment plan needs to include investigation into the options for respite care, and perhaps, establishing or reestablishing community connections that can support the couple. These connections could be organized through faith-based agencies or service organizations in the community.

Lifestyle Changes The patient must accept that he will not improve if he does not address the following issues: Regular moderate exercise Reducing salt in his diet Losing weight Managing stress Lifestyle.