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Congestive
Heart Failure leads to greater disability
among older adults
Newswise — Medical
breakthroughs in recent decades have allowed
heart attack survivors and other
heart-disease patients to live longer. But
as their hearts decline into congestive
heart failure, an increasing number will
experience disability and the need for
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-M’s
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.
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).
