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Elder Care News
Congestive Heart Failure Leads to Disability,
Nursing Homes for Senior Citizens
Prevalence of condition imposes significant
burden on families, health care system and long-term care facilities:
U-M researchers
 Jan. 7, 2008 Okay, modern medicine is allowing
millions of senior citizens that have survived heart attacks or other
cardiovascular disease to live much longer. But, eventually, most of
these patients ease into congestive heart failure, which presents new
challenges in the effort to extend life even more. New research shows
these CHF patients are most likely to experience disability and need
nursing home care.
A new study from the
University of Michigan Health System and the VA Ann Arbor Healthcare
System sheds light on the degree of disability among people with CHF, as
well as the implications for the health care system, community care
facilities, families and the patients themselves.
In particular, the study found that CHF patients
were much more likely to be disabled than people without the condition.
They were found to be much more likely to have difficulties with
activities of daily living, such as grocery shopping and walking across
the room. And they were more likely to require care from nursing homes
and family members.
The prevalence of congestive heart failure imposes
a substantial burden on patients, families and the long-term care
system, says lead author
Tanya Gure, M.D., a lecturer in the
Division of Geriatric Medicine at the U-M Health System.
The degree of disability in this group is quite
high, and their caregiving needs are extensive. We need to make sure, in
the medical community and society in general, that we are adequately
meeting their health and social needs.
The study appears in the January issue of the
Journal of General Internal Medicine. It is based on data from the
2000 data of the Health and Retirement Study, a national survey
conducted by
U-Ms Institute for Social Research and funded by the National
Institute on Aging. Data in the new study are based on responses from
10,626 survey respondents ages 65 and older.
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About Congestive Heart Failure |
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By American Heart Association
Congestive heart failure (CHF), or heart failure,
is a condition in which the heart can't pump enough blood to the body's
other organs. This can result from
● narrowed arteries that supply blood to the
heart muscle coronary artery disease
● past heart attack, or myocardial infarction, with scar tissue that
interferes with the heart muscle's normal work
● high blood pressure
● heart valve disease due to past rheumatic fever or other causes
● primary disease of the heart muscle itself, called cardiomyopathy.
● heart defects present at birth congenital heart defects.
● infection of the heart valves and/or heart muscle itself endocarditis
and/or myocarditis
The "failing" heart keeps working but not as
efficiently as it should. People with heart failure can't exert
themselves because they become short of breath and tired.
As blood flow out of the heart slows, blood
returning to the heart through the veins backs up, causing congestion in
the tissues. Often swelling (edema) results. Most often there's swelling
in the legs and ankles, but it can happen in other parts of the body,
too. Sometimes fluid collects in the lungs and interferes with
breathing, causing shortness of breath, especially when a person is
lying down.
Heart failure also affects the kidneys' ability to
dispose of sodium and water. The retained water increases the edema.
How do you diagnose and treat congestive heart
failure?
Your doctor is the best person to make the
diagnosis. The most common signs of congestive heart failure are swollen
legs or ankles or difficulty breathing. Another symptom is weight gain
when fluid builds up.
>>
More at American Heart Association
Related AHA publications:
●
Heart and Stroke Facts
●
Living With Congestive Heart Failure brochure
●
About Heart Transplants booklet
● "What
Is Congestive Heart Failure?" and "How
Can I Live With Heart Failure?" in Answers By Heart kit
AHA Scientific Statements:
●
Heart Failure
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Among the findings:
(Note: All of the items below cite the CHF number first, followed by the
percentage of people with coronary heart disease but no CHF, then people
without coronary heart disease)
>>> People with CHF were much more likely to
receive informal (unpaid) home care from a relative or another unpaid
person (42 percent) than the other groups (18 percent and 11 percent).
>>> Formal (paid) in-home care also was more
common; it had been utilized by 13 percent of people with CHF, compared
with 4 percent and 2 percent in the other groups.
>>> Ten percent of people with CHF were in a
nursing home in the prior two years, compared with 3 percent and 2
percent.
>>> People with CHF were much more likely to have
difficulty with activities of daily living. For example, in the category
of walking across the room, about 42 percent of people with CHF
reported limitations, compared with 21 percent and more than 12 percent.
>>> Activities such as grocery shopping were found
to be much more difficult for people with CHF than others: more than 35
percent of people with CHF reported a limitation related to grocery
shopping, compared with more than 14 percent and 8 percent.
>>> Geriatric conditions, clinical conditions which
are highly prevalent in older adults such as urinary incontinence,
dementia and injury due to falling were more common in people with CHF. In the CHF group, 36 percent had experienced urinary incontinence,
compared with 23 percent and 19 percent in the other groups.
An estimated 5.3 million Americans currently have
heart failure, according to the American Heart Association. Within six
years of having a heart attack, about 22 percent of men and 46 percent
of women will be disabled with CHF.
In addition to her appointment in the Division of
Geriatric Medicine, Gure also was a member of the RWJ Clinical Scholars
Program at U-M while working on this study. Along with senior author
Kenneth M. Langa, M.D., Ph.D., Gure is affiliated with the VA Center for
Practice Management & Outcomes Research at the VA Ann Arbor Healthcare
System and the U-M Division of General Internal Medicine. Other authors
of the paper are Mohammed U. Kabeto, M.S., of the U-M Division of
General Internal Medicine; and Caroline S. Blaum, M.D., M.S., of the U-M
Division of Geriatric Medicine and the VA Geriatric Research, Education
and Clinical Center.
Funding came from the National Institute on Aging,
a Paul Beeson Physician Faculty Scholars in Aging Research award
(Langa), the VA Center for Practice Management & Outcomes Research and
the RWJ Clinical Scholars Program (Gure), and the Ann Arbor VA Geriatric
Research, Education and Clinical Center (Blaum).
Reference: Journal of General Internal Medicine,
Jan. 2008,Volume 23, Issue 1, Degree of Disability and Patterns of
Caregiving among Older Americans with Congestive Heart Failure.
Original report written by: Katie Vloet
Photo of Dr. Tanya Gure and patient by Scott
Soderberg, University of Michigan
For more information about geriatric medicine at U-M.
For more information about the Health and Retirement Study .
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