Are Psychosocial Factors Associated With the Pathogenesis and Consequences of Cardiovascular Disease in the Elderly?

Stuart‐Shor, Eileen M.; Buselli, Elizabeth F.; Carroll, Diane L.; Forman, Daniel E.

doi:10.1097/00005082-200307000-00003

Cited by 11 publications

(9 citation statements)

References 83 publications

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“…Reasons for noncompliance by older adults with heart failure may include confusion due to the complexity of dosing regimens, adverse side effects of the medications, cognitive impairment, depression, social isolation, and lack of a support system, the cost of medication [63][64][65]. At least some of these difficulties can be addressed by first identifying those patients most likely to fall into this category, then tailoring a medication regimen that facilitates compliance.…”

Section: Hypertension and Heart Failure In Elderly Patientsmentioning

confidence: 99%

Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies

2007

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The renin-angiotensin-aldosterone system (RAAS) is critical in regulating systemic blood pressure, water and electrolyte balance, and pituitary gland hormones. These physiologies appear to be primarily mediated by the angiotensin II/AT(1) receptor subtype system. Overstimulation of this system can predispose cardiovascular disease (CVD) characterized by excessive vasoconstriction, fibrosis, and cardiac remodeling. If untreated, the patient typically displays a continuum of pathophysiologic conditions progressing from atherosclerosis to left ventricle hypertrophy (LVH), coronary thrombosis, myocardial infarcts, with heart failure as an endpoint. Intervention with antihypertensive therapy is necessary to inhibit this progression. RAAS blocking drugs appear to be the most effective approach. Diastolic heart failure patients benefit from treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin AT(1) receptor blockers (ARBs). Elderly CVD patients evidence age-related changes in body composition that alter the distribution and half-life of medications, thus presenting special challenges to treatment. The presence of comorbidities such as diabetes, renal dysfunction, liver insufficiency further complicates any therapeutic strategy. In addition, noncompliance because of cognitive impairment, depression, confusion due to the complexity of dose regimens, and lack of an appropriate social support system can disrupt positive outcome. The present review discusses the roles of an overactive RAAS and sympathetic nervous system as primary contributors to CVD. In addition, treatment strategies are discussed, focusing on middle aged and elderly hypertensive and heart failure patients.

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Section: Hypertension and Heart Failure In Elderly Patientsmentioning

confidence: 99%

Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies

2007

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“…Depression is much more than an emotional response, however, as depression affects behavior and both cognitive and physical health [7]. Depression is now clearly linked with an increased susceptibility for acquiring other serious health problems [8, 9], and with a higher risk of death from suicide and other causes [10]. …”

Section: Introductionmentioning

confidence: 99%

A Hope Intervention Compared to Friendly Visitors as a Technique to Reduce Depression among Older Nursing Home Residents

Wilson

Marin

Bhardwaj

et al. 2010

Nursing Research and Practice

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Depression is common among older persons. An experimental study was undertaken to test the impact of a four-week hope program on depressed nursing home residents. Residents aged 65 or older, who met the criteria for this pilot study and agreed to participate, were randomly assigned to (a) an intervention group, and provided with weekday hope interventions mainly involving positive messages and pictures or (b) a modified control group, and provided with a friendly weekday greeting. The structured hope intervention was not proven effective for reducing depression or raising hope. Instead, a significant reduction in depression among the control subjects was found, as well as a nonsignificant increase in their level of hope. Although these findings suggest friendly visitors may be a more efficacious nonpharmacological approach for reducing depression, further investigations are needed to confirm this and to explore the impact of other hope interventions.

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Section: Introductionmentioning

confidence: 99%

“…The importance of psychosocial factors to medical illness (Freedland & Carney, 2000;Stuart-Shor et al, 2003;Thommessen et al, 2001;Willis et al, 1997), and mental illness (Grace & O'Brien, 2003) have been shown. Factors specifically associated with recidivism in elderly samples include increasing age and comorbidity (Gubler et al, 1996), depression, anxiety, and social isolation (Stuart-Shor et al, 2003), and injury, for example falls (Weir & Culmer, 2004). The main domains of assessment that appear to be important for determining biopsychosocial risk are: Severity of illness (Naughton et al, 1999), number of medications, risk of falls (Weir & Culmer, 2004), cognition, everyday functioning, psychopathology, and social support (Emlet, 1996;Lichtenberg, 1999;Philp, 1994).…”

Section: Introductionmentioning

confidence: 99%

Psychosocial Profile of Elderly Patients Discharged from a Community Hospital

Preyde

Chapman²

2007

Social Work in Health Care

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Social workers have historically been an advocate for vulnerable groups. One such vulnerable group is elderly patients who have been shown to have multiple, chronic health problems. The current fiscal environment favors shortened lengths of stay, potentially leaving these vulnerable patients at risk for adverse outcomes upon discharge, especially Hospital (Ontario, Canada). The objectives were to (1) estimate the number of elderly people who indicate biopsychosocial risk for adverse outcomes, (2) determine the specific risks and their severity, and (3) estimate the number of readmissions to hospital within three months after discharge. Standardized, self-reported scales were used to measure risks in elderly patients at discharge from acute care medical and surgical units. The sample included 62 patients with a mean age of 79 years. At discharge almost 40% of the patients were considered at risk for adverse outcomes, 11% indicated depression, 45% indicated psychological distress, 13% showed cognitive impairment, and 62.5% (35/56) had at least one nutritional concern. Over the three-month follow-up period, there were 23 readmissions, 8 ED visits (not mutually exclusive), and 7 outpatient visits. The mortality rate over the three-month period was 5% (3/62). Many elderly patients who were discharged from hospital to home experienced several challenges medically, psychologically and some also experienced social adversities. The implication is that these patients may benefit from a more comprehensive discharge plan than is currently practiced that addresses their challenges.

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Are Psychosocial Factors Associated With the Pathogenesis and Consequences of Cardiovascular Disease in the Elderly?

Cited by 11 publications

References 83 publications

Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies

Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies

A Hope Intervention Compared to Friendly Visitors as a Technique to Reduce Depression among Older Nursing Home Residents

Psychosocial Profile of Elderly Patients Discharged from a Community Hospital

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