ObjectiveThe purpose of this study was to investigate the relationship between knowledge on arterial hypertension (AH) and its management, and adherence to pharmaceutical treatment.MethodsThe study included 233 patients diagnosed with AH and treated with hypotensive drugs for at least 1 year. The 8-item © Morisky Medication Adherence Scale (MMAS-8) and the Hypertension Knowledge-Level Scale (HK-LS) were used.ResultsSixty-three percent of the patients had a low level of knowledge on AH, with the smallest proportion of correct answers provided for items related to non-pharmaceutical treatment, diet, hypertension definition, and drug adherence. When compared to patients with a high level of knowledge, those with a low knowledge had lower scores in the MMAS (6.45±1.45 vs 7.08±1.04; P=0.038). Multiple-factor analysis showed that statistically significant independent determinants of good adherence included a high level of knowledge (β=0.208; P=0.001), non-pharmaceutical treatment (β=0.182; P=0.006), and frequent blood pressure measurements (β=0.183; P=0.004). The most significant factor in MMAS was knowledge in the “drug adherence” domain (ρ=0.303; P<0.001).ConclusionPatients’ knowledge on hypertension is a significant independent determinant of good adherence. Other independent determinants include non-pharmaceutical treatment and regular blood pressure measurements.Implication for practiceThe identification of knowledge deficits as a factor contributing to lack of adherence and poor hypertension control remains a key challenge for multidisciplinary team caring for patients with hypertension.

BackgroundFrail older people are at high risk of developing adverse outcomes, such as disability, mortality, hospitalization, and institutionalization. Previous research suggests that the Tilburg Frailty Indicator (TFI) is a valid and reliable instrument for measuring frailty. The aim of this study was to adapt and to test the reliability of the Polish version of the TFI.MethodA standard guideline was used for translation and cultural adaptation of the English version of the TFI into Polish. The study included 100 Polish patients (mean age 68.2±6.5 years), among them 42 men and 58 women. Cronbach’s alpha was used for analysis of the internal consistency of the TFI.ResultsThe mean total TFI score was 6.7±3.1. Forty patients scored ≥5, which corresponded to being frail. Cronbach’s alpha reliability coefficients of the instrument ranged from 0.68 to 0.72 and item-total correlation ranged from 0.12 to 0.52.ConclusionThe TFI is valid and reproducible for assessment of frailty syndrome among a Polish population. The Polish adaptation of the TFI proved a useful and fast tool for assessing frailty.

BackgroundLow adherence to hypertension (HT) management is one of the major contributors to poor blood pressure (BP) control. Approximately 40%–60% of patients with HT do not follow the prescribed treatment. The aim of the study was to analyze the relationship between selected variables and adherence to hypotensive pharmacological treatment. Besides socioclinical variables, the study focused on the role of illness acceptance.Participants and methodsThe study included 602 patients with HT. Adherence and acceptance of illness were assessed using the following validated instruments: the Acceptance of Illness Scale (AIS) and the Morisky Medication Adherence Scale (MMAS).ResultsThe high-adherence group comprised a significantly higher percentage of patients with high illness acceptance scale scores than that of patients with low-to-moderate scores (42.4 vs 31.8%; P=0.008<0.01). The odds ratio (OR) showed that high adherence to pharmacological treatment was >1.5 times as likely to occur in the high acceptance group as in the low-to-moderate acceptance group (OR =1.58, 95% CI 1.14–2.19). Spearman’s rank correlation coefficients showed statistically significant correlations between adherence and sex (men ρ=−0.101; P=0.012), age >45–66 years (ρ=0.098; P=0.015), higher education level (ρ=0.132; P=0.001), grade ESC of HT (ρ=−0.037; P=0.057), receiving one-tablet polytherapy (ρ=0.131; P=0.015), and illness acceptance (ρ=0.090; P=0.024).ConclusionAcceptance of illness is correlated with adherence to pharmacological treatment, and consideration should be given to more widespread assessment of illness acceptance in daily practice. Male sex, age >45–66 years, duration of illness grade ESC of HT, and receiving one-tablet polytherapy are significant determinants of adherence to pharmacological treatment in HT.

IntroductionElderly adults with heart failure (HF) may have problems with self-care behaviors because of cognitive deficits. Self-care deficits have been found to be significantly associated with negative health care outcomes among HF patients. The aim of this paper was to assess cognitive deficits and the level of self-care ability in elderly patients with HF, and to determine if a relationship exists between cognitive deficits and self-care.Materials and methodsThe study included 270 elderly patients (mean age: 72.5 years) with HF. We used the Mini Mental State Examination Scale (MMSE) to evaluate cognitive functioning, and the European Heart Failure Self-care Behavior Scale, revised into a nine-item scale (EHFScBS-9), to evaluate self-care behaviors. Associations between the variables were examined using multiple regression analysis.ResultsLower scores in both MMSE and EHFScBS-9 questionnaires were correlated with older age, living alone, lower education, longer duration of illness, higher number of rehospitalizations, as well as lower left ventricular ejection fraction and higher New York Heart Association (NYHA) class. The multiple regression analysis was used for evaluation of the impact of the following predictors: MMSE score, age, duration of illness, ejection fraction, number of hospitalizations, sex, residence, education, relationship status, and NYHA class on EHFScBS-9 score.ConclusionsElderly patients with HF may have worse self-care behaviors because of their cognitive deficits. Age was the strongest predictor of worse MMSE scores. Multidisciplinary health teams should pay attention to the special needs of elderly patients who live with their illness for many years and have no social support because of living alone.

Polish nurses' knowledge deficits in HF self-care principles may lead to problems in providing patients with adequate education.

Considering the increasing age of individuals affected with heart failure (HF), a specific approach to their treatment is required, with more attention paid to geriatric conditions such as poor mobility, multiple disabilities, and cognitive impairment. Frailty is a distinct biological syndrome reflecting decreased physiologic reserve and resistance to stressors. It was shown to occur frequently in patients with heart failure, with the prevalence ranging from 15 to 74 %, depending on the studied population and the method of assessment. We reviewed literature data on the influence of frailty, skeletal abnormalities, comorbidities and geriatric condition on diagnosis, treatment, and outcomes in elderly patients with HF. Identification of frailty in patients with HF is important from the clinical point of view, as this condition exerts unfavorable effects on the course of heart failure. Frailty contributes to a higher frequency of visits to emergency departments, hospitalizations, and mortality in patients with HF. Exercise may improve mobility, and nursing support can be implemented to help the patients adhere to medications. Therefore, frail patients should be diagnosed and treated according to available guidelines, and successfully educated about their condition.

The extent a patient accepts their chronic heart failure diagnosis has been shown to impact on their quality of life.

Background: Polypharmacy paves the way for non-adherence, adverse drug reactions, negative health outcomes, increased use of healthcare services and rising costs. Since it is most prevalent in the older adults, there is an urgent need for introducing effective strategies to prevent and manage the problem in this age group.Purpose: To perform a scoping review critically analysing the available literature referring to the issue of polypharmacy management in the older adults and provide narrative summary.Data sources: Articles published between January 2010–March 2018 indexed in CINHAL, EMBASE and PubMed addressing polypharmacy management in the older adults.Results: Our search identified 49 papers. Among the identified interventions, the most often recommended ones involved various types of drug reviews based on either implicit or explicit criteria. Implicit criteria-based approaches are used infrequently due to their subjectivity, and limited implementability. Most of the publications advocate the use of explicit criteria, such as e.g. STOPP/START, Beers and Medication Appropriateness Index (MAI). However, their applicability is also limited due to long lists of potentially inappropriate medications covered. To overcome this obstacle, such instruments are often embedded in computerised clinical decision support systems.Conclusion: Multiple approaches towards polypharmacy management are advised in current literature. They vary in terms of their complexity, applicability and usability, and no “gold standard” is identifiable. For practical reasons, explicit criteria-based drug reviews seem to be advisable. Having in mind that in general, polypharmacy management in the older adults is underused, both individual stakeholders, as well as policymakers should strengthen their efforts to promote these activities more strongly.