Heart failure in frail, older patients: We can do ‘MORE’

Samala, Renato V.; Navas, Viviana; Saluke, Emily; Ciocon, Jerry O.

doi:10.3949/ccjm.78a.11085

Cited by 11 publications

(8 citation statements)

References 32 publications

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“…Additionally, both HF and FS can adversely affect the course of concurrent diseases, and increase the risk of falling, disability, hospitalization, and death. 37 As regards this study, it should be emphasized that a longer duration of HF was correlated with increased frailty. Further, higher NYHA classes, reflecting the clinical severity of HF, were correlated with increased frailty among the study patients.…”

Section: Discussionmentioning

confidence: 65%

Frailty syndrome and self-care ability in elderly patients with heart failure

Uchmanowicz¹,

Wleklik²,

Gobbens³

2015

CIA

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BackgroundChronic heart failure is a serious medical condition. Recently, there has been an increasing interest in frailty syndrome and self-care levels among patients with cardiovascular conditions. Demonstrating the influence of frailty syndrome on self-care could improve the quality of self-care and prevent the adverse effects of frailty syndrome. The purpose of this study was to assess the influence of frailty syndrome on the self-care capabilities of patients with chronic heart failure, and to identify factors associated with frailty.MethodsThe data were collected between January and July 2014. The study included 110 patients with chronic heart failure who were hospitalized in the cardiology clinic. Frailty syndrome was assessed using the Tilburg Frailty Indicator, a self-report questionnaire, and self-care behavior was assessed using the European Heart Failure Self-Care Behavior Scale.ResultsFifty-four percent of the study patients were male and 46% were female. The mean age was 66±11 years, the mean Tilburg Frailty Indicator score was 7.45±3.02 points, and the mean self-care level was 27.6±7.13 points. Correlation analyses showed that patients with higher scores in the social components of the frailty scale had better self-care capabilities. Frailty was associated with age, education, duration of heart failure, number of hospitalizations, and New York Heart Association class. The effects of these patient characteristics differed across components of frailty (physical, psychological, social).ConclusionThe social components of frailty syndrome adversely affect the ability to self-care in elderly patients with heart failure. It is relevant to use a multidimensional measurement of frailty.

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Section: Discussionmentioning

confidence: 65%

Frailty syndrome and self-care ability in elderly patients with heart failure

Uchmanowicz¹,

Wleklik²,

Gobbens³

2015

CIA

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“…Therefore, although a rare disease, pediatricians and other primary care physicians have an obligation to be aware of the signs and symptoms of Hunter syndrome and methods and tools to effectively establish a diagnosis. Mnemonics are commonly employed in clinical medicine as screening tools or to guide clinical management [2, 13], and here, we describe the development of a simple mnemonic screening tool that may aid pediatric specialists and primary care physicians in the recognition and diagnosis of Hunter syndrome.…”

Section: Introductionmentioning

confidence: 99%

Development of a mnemonic screening tool for identifying subjects with Hunter syndrome

Cohn¹,

Morin

Whiteman³

2013

Eur J Pediatr

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The Hunter Outcome Survey (HOS), an international, long-term observational registry of patients with Hunter syndrome, was used to develop a simple mnemonic screening tool (HUNTER) to aid in the diagnosis of Hunter syndrome. Data regarding the prediagnosis prevalence of ten specific signs and symptoms present in individual patients enrolled in the HOS were used to develop the HUNTER mnemonic screening tool. A total score of 6 or greater using a weighting scheme in which certain manifestations were assigned a weight of 2 (facial dysmorphism, nasal obstruction or rhinorrhea, enlarged tongue, enlarged liver, enlarged spleen, joint stiffness) and others assigned a weight of 1 (hernia, hearing impairment, enlarged tonsils, airway obstruction or sleep apnea) correctly identified 95 % of patients who had no family history of Hunter syndrome or who were not diagnosed prenatally. No association between age at diagnosis and HUNTER score was found. Conclusion: The HUNTER mnemonic appears to be a useful screening tool. Further validation in the clinical setting will be necessary to confirm its utility.

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“…Heart failure patients have the difficult task of self-care maintenance, which includes taking medications, eating a low-sodium diet, exercising, engaging in preventative behaviors, and monitoring for signs and symptoms of a worsening condition. 8 This atypical presentation can make it difficult for older patients to recognize worsening heart failure. 5 Self-care maintenance and management require considerable time and effort; therefore, patients do not always comply with the recommended self-care activities.…”

mentioning

confidence: 99%

“…6 Older adults, those 65 years or older, may have even more difficulty managing heart failure. 8 Psychosocial factors such as depression and social isolation can impact decision making necessary in self-care management. Age-related factors such as atypical symptom presentation, comorbidities, frailty, and impaired cognition impact the patients' ability to effectively engage in self-care.…”

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confidence: 99%

Self-care in Older Adults With Heart Failure

Zavertnik¹

2014

Clinical Nurse Specialist

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RN, DNP, ACNS-BC, CNEPurpose:The aims of this integrative review were to examine the evidence specific to self-care in older adults, 65 years or older, with heart failure and to indicate best nursing practice interventions for use in this population. Assessment: Self-care is a complex set of activities involving self-care maintenance and self-care management. Age-related and psychosocial factors impact older patients' ability to engage effectively in self-care practices. Although self-care processes are the focus of the investigation, few studies provide implications specific for the older adult population. Limited research on heart failure self-care in the older adult meets the age criterion of 65 years or older. Methods:A comprehensive search of the literature was performed using Medline, CINAHL, and the Cochrane Library, as well as an ancestry approach of reference lists of selected studies. Eligible studies were randomized controlled trial, qualitative, quantitative, and mixed-method design studies on older adults with heart failure related to self-care for the years 2002Y2012. Findings: Three themes of self-care were noted in the selected studies: patient-related factors, patient education, and telemonitoring. The patient-related factors identified were barriers to self-care such as age-related symptoms, cognitive factors, and social issues. The interventions promoting self-care were patient education (self-care knowledge) and telemonitoring (augmenting symptom recognition). Patient education tailored to older adults may be beneficial. Telemonitoring is an appropriate self-care enhancement tool for selected older adults. More emphasis needs to be placed on interventions to assist older adults with heart failure in symptom recognition and early notification of healthcare providers. Conclusions:As the population ages, a need for evidence-based care for older adults with heart failure is warranted. Heart failure self-care interventions do not address the special considerations of the older heart failure patient. To determine the best approaches for promoting effective self-care, older adults with heart failure need to be studied as a cohort. Clinical Relevance: Older adults with heart failure face many challenges engaging in self-care practices. These older adults need individualized self-care instructions and home care follow-up. Identifying special needs of the patient, such as sensory or cognitive impairment, is necessary when providing instructions and follow-up care for the older adult. KEY WORDS: heart failure, integrative review, older adult, self-care Heart Failure Self-care and the Older Adult Riegel and Dickson 4 describe heart failure self-care as maintenance, which refers to maintaining physiologic stability, symptom monitoring and treatment adherence,

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Heart failure in frail, older patients: We can do ‘MORE’

Cited by 11 publications

References 32 publications

Frailty syndrome and self-care ability in elderly patients with heart failure

Frailty syndrome and self-care ability in elderly patients with heart failure

Development of a mnemonic screening tool for identifying subjects with Hunter syndrome

Self-care in Older Adults With Heart Failure

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