Coping with life transitions in Coping with life transitions in young adults with celiac young adults with celiac

diseasedisease

Presented byPresented byDr Suzanne Dupuis-Blanchard, PhD RNDr Suzanne Dupuis-Blanchard, PhD RN

Canadian Celiac Association National Conference - Moncton, NBCanadian Celiac Association National Conference - Moncton, NBMay 26May 26thth, 2007, 2007

Overview of sessionOverview of session

Notions on transitionsNotions on transitionsCoping with transitionsCoping with transitionsExamplesExamples College / universityCollege / university Social relationshipsSocial relationships TravelTravel

Forum for discussionForum for discussion

What is a transition?What is a transition?

When one’s current reality is disruptedWhen one’s current reality is disrupted

A passage from one state to anotherA passage from one state to another

Can last 6-12 monthsCan last 6-12 months

Crisis likely to occur at 6 monthsCrisis likely to occur at 6 months

Types of transitionsTypes of transitions

Developmental Developmental (ex: life cycle)(ex: life cycle)

Situational Situational (ex: changes in role, relocation)(ex: changes in role, relocation)

Health-illness Health-illness (ex: illness, rehab)(ex: illness, rehab)

Organizational Organizational (ex: change in the environment)(ex: change in the environment)

For young adultsFor young adults

Developmentaltransitions

Situationaltransition

Health/illnesstransition

Result of these…

STRESSSTRESS

Factors that influence transitionsFactors that influence transitions

Personal conditionsPersonal conditions Meaning and expectations attached to the Meaning and expectations attached to the

transitiontransition Cultural beliefs and attitudesCultural beliefs and attitudes Level of knowledgeLevel of knowledge Prior transition skillsPrior transition skills Support (family and friends)Support (family and friends) Economic securityEconomic security

Community conditionsCommunity conditions Level of support (work, health professionals)Level of support (work, health professionals) Advice and answers to questionsAdvice and answers to questions

Societal conditionsSocietal conditions Stereotypes and marginalizationStereotypes and marginalization

Process of transitionsProcess of transitions

Resolution of uncertainty and reconstructionResolution of uncertainty and reconstructionof realityof reality

InitiatingtransitionReality Disrupted

reality Uncertainty Realityreconstructuring

Foundidentity

To facilitate transitionsTo facilitate transitions Awareness that changes are occurringAwareness that changes are occurring

Engagement in the process of transitionEngagement in the process of transition

Realization that changes and differences in Realization that changes and differences in identities, roles, relationships, abilities and identities, roles, relationships, abilities and patterns of behavior will or are happeningpatterns of behavior will or are happening

Recognition of emotions: anxiety, insecurity, Recognition of emotions: anxiety, insecurity, frustration, depression, low self-esteem and frustration, depression, low self-esteem and lonelinessloneliness

Coping with transitionsCoping with transitions

Awareness that previous reality is no longer Awareness that previous reality is no longer availableavailableConfronting circumstancesConfronting circumstancesAcknowledging the irreversibilityAcknowledging the irreversibilityEngaging in information seekingEngaging in information seekingDeciding to pursue health behaviours Deciding to pursue health behaviours (conviction)(conviction)

Prior coping strategiesPrior coping strategies

Two levels of adaptationTwo levels of adaptation

BehaviouralBehavioural ActionsActions

CognitiveCognitive How you thinkHow you think

ExamplesExamples

Transitions in young adultsTransitions in young adults Going away to college / universityGoing away to college / university

CookingCookingNew friends / partiesNew friends / parties

Ongoing social relationshipsOngoing social relationshipsFriendsFriendsWorkWorkDating / Life partnerDating / Life partner

Family lifeFamily lifeTravelTravel

Doctor: “Oh, you just have to eliminate Doctor: “Oh, you just have to eliminate gluten from your diet; it’s simple, no gluten from your diet; it’s simple, no medication, no surgeries, a diet is all you medication, no surgeries, a diet is all you need”.need”.

Here’s how to survive…Here’s how to survive…

College / UniversityCollege / University

Learn to cook gluten-free; get familiar with food Learn to cook gluten-free; get familiar with food ingredient lists; plan for leftovers; freeze ingredient lists; plan for leftovers; freeze Plan ahead for lunch: sandwich, salads, soupsPlan ahead for lunch: sandwich, salads, soupsGoing out? Bring your own bread and cookiesGoing out? Bring your own bread and cookiesAsk, ask, askAsk, ask, askPractice explaining celiac disease in simple wordsPractice explaining celiac disease in simple wordsLiving in dorms: meet with food services; special Living in dorms: meet with food services; special permission for toaster in room; more space; kitchenettepermission for toaster in room; more space; kitchenette

Social relationshipsSocial relationships

Plan ahead; call and askPlan ahead; call and askDon’t become a “closet” celiacDon’t become a “closet” celiacMake suggestions: pick the restaurant; Make suggestions: pick the restaurant; bring a food you can eatbring a food you can eatWhen in doubt: askWhen in doubt: ask

TravelTravelPlan ahead; check web sites for information on Plan ahead; check web sites for information on stores, restaurantsstores, restaurantsBring food with you; peanut butter, bread, fruits, Bring food with you; peanut butter, bread, fruits, vegetablesvegetablesStop by a restaurant when not busy and ask Stop by a restaurant when not busy and ask questions for future mealsquestions for future mealsFind grocery stores; locate health food storesFind grocery stores; locate health food storesRent a room with kitchenetteRent a room with kitchenetteContact local Celiac chapterContact local Celiac chapter

Other tips…Other tips…

Keep a food diary for ideasKeep a food diary for ideas

Beware of hidden contaminationBeware of hidden contamination

Don’t let celiac disease define who your are!Don’t let celiac disease define who your are!

The importance of being gluten-The importance of being gluten-free…free…

To prevent complicationsTo prevent complications Neurological manifestations (migraines, Neurological manifestations (migraines,

tingling)tingling) CancerCancer OsteoporosisOsteoporosis DepressionDepression InfertilityInfertility

Take a deep slow breath…Take a deep slow breath… There is no cure, but there is no need for There is no cure, but there is no need for

prescribed medication;prescribed medication; There is no cure, but you know recovery is There is no cure, but you know recovery is

possible;possible; There is no cure, but you know that you alone There is no cure, but you know that you alone

are in charge of that recovery;are in charge of that recovery;How much better can it get?How much better can it get?

Take charge of your health…Take charge of your health…

…and spread the ‘gluten’ news to family members

In a study of 13 000 people (adults and children):

- 1:133 (with no risk factors) had CD- 1:22 (first degree relative) had CD- 1:39 (second degree relative) had CD

Reference: Treem, W.R. (2004). Emerging concepts in celiac disease. Current Opinion in Pediatrics, 16, 552-559.

Forum for discussionForum for discussion

Do you have any suggestions or Do you have any suggestions or comments that could help the person comments that could help the person sitting next to you?sitting next to you?

Thank you!

Dr Suzanne Dupuis-Blanchard, PhD RNSchool of Nursing

Université de MonctonMoncton, NB E1A 3E9Phone: (506) 858-4260

suzanne.dupuis-blanchard@umoncton.ca