QUALITY OF LIFE AND PSYCHOLOGICAL ASPECTS IN PATIENTS WITH CHRONIC LEG ULCER

Prema definiciji kožni vrijed (rana) je prekid anatomskog i funkcionalnog kontinuiteta tkiva. S obzirom na tijek cijeljenja, rane mogu biti akutne i kronične. Kada govorimo o utjecaju rane na kvalitetu života i psihološki status osobe, u prvom redu mislimo na utjecaj kronične rane (vrijeda). Kronične rane su one koje ne zarastaju unutar predviđenog razdoblja u korelaciji s etiologijom i lokalizacijom rane (najkraće razdoblje - 6 tjedana). Kronične rane su rastući socioekonomski problem u razvijenim zemljama i javljaju se u 1-2 % populacije. Procjenjuje se da će taj broj rasti s obzirom na starenje populacije te porast incidencije dijabetesa i pretilosti. Kronične rane imaju veliki utjecaj na kvalitetu bolesnika samih, ali i njihovih obitelji te uzrokuju različite psihološke i socijalne reakcije. Među najčešćim psihološkim reakcijama na kronične bolesti, pa tako i kronične rane, jesu depresivnost, anksioznost, agresivnost i frustracija. Danas se mnogo govori i o utjecaju stresa i negativnih emocija na sporije cijeljenje rana. U nekoliko istraživanja pokazano je da su depresija, anksioznost i ljutnja negativno povezani sa cijeljenjem rana, dok su prihvaćanje i aktivno suočavanje sa stresom pozitivno povezani s brzinom cijeljenja rana.Wound represents a disruption of anathomic and physiologic continuity of the skin. Regarding to the healing process, wounds can be classified as acute or chronic wounds. Quality of life is primarily concerned with the impact of chronic wounds. A wound is considered chronic if healing does not occur within expected period of time regarding to its etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones which include ischaemic, neurotrophic and hypostatic ulcer and two separate entities: diabetic foot and decubital ulcers. An 80 percent of chronic wounds localized on lower leg are result of chronic venous insufficiency, in 5-10 percent cause is of arterial etiology, whereas the remainder is mostly neuropathic ulcer. Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Chronic wounds affect the elderly population and it is estimated that 1-2 percent of western population suffer from it. This estimate is expected to rise due to an increasing population of the elderly and the diabetic and obesity epidemic. The WHO definition of health is “A state of complite physical, mental and social well-being and not merely the absence of disease or infirmity”. Based on this definition, quality of life in relation to health may be defined as “the functional effect of an illness and it’s consequent therapy upon a patient, as perceived by the patient”. The domains that contribute to this effect are physical, psychological and social functioning. The patient’s own perceptions of an illness were found to play an important role in explainig quality of life. Chronic wounds significantly decrease the quality of life in a number of ways such as reduced mobility, pain, unpleasant odor, sleep disturbances, social isolation and frustration, and inability to perform everyday duties. Among the most common psychological reactions to chronic diseases, including chronic wounds, are depression, anxiety, aggression and frustration. Psychological factors may not only be a consequence of delayed healing, but may also impact on wound healing. Anxiety and depression have direct influences on endocrine and immune function. About the impact of disease on quality of life and individuals’ perceptions of illness, there are questionnaires and methods to analyze this, but the challenge is to move from a focus on wound management to understanding the specific needs of each individual within the context of their life