Elders Delay Responding to Heart Failure Symptoms?

¶ … Elders Delay Responding to Heart Failure Symptoms?

"Heart failure (HF) is the most common admission diagnosis in the United States for persons over 65 years of age, with readmission often occurring within 60 days of discharge… Part of the reason for repeated admissions is that patients delay responding to their HF symptoms" (Byrnes et al., 2009, p. 252-253).

"The specific aims of this study were to (a) describe the experience of and the cognitive and emotional response to the symptoms of decompensated HF, (b) determine the influence of sociodemographic, clinical, cognitive, emotional, and social contextual factors on symptom duration during this time, and (c) describe self-care behaviours prior to seeking care for decompensated HF" (Byrnes et al., 2009, p. 255).

Hypothesis

"We propose that delay in seeking care is due to the difficulty that HF patients experience in discerning the quality and meaning of their symptoms" (Byrnes et al., 2009, p. 255).

Study Methods

This study was conducted on a convenience sample of adult men and women who were hospitalized in Philadelphia and New York with a diagnosis of decompensated HF. The mean age of the sample was 75.9 years. 48% were female and 85.7% were non-Hispanic White.

Data for this study was gathered using the Heart Failure Somatic Perception Scale, the Response to Symptoms Questionnaire, the NYHA Functional Class and Specific Activity Scale, and the Charlson Comorbidity Index. Interviews were also conducted with each participant in order to determine length of symptoms and other medical details. Each interview was recorded and transcribed in verbatim for analysis and comparative purposes.

Quantitative data was analyzed using the Statistical Package for the Social Sciences software version 14.0. Qualitative data was analyzed using Atlas.ti version 5.0.67. The connections between the duration of HF symptoms, perceptions of symptom distress, and cognitive and emotional factors were analyzed using Pearson correlations.

Key Findings

The most frequently reported HF symptoms were dyspnea, dyspnea on exertion, and fatigue. Close to half of all participants experiencing dyspnea waited three days or longer before seeking medical attention, while 11.8% waited two weeks or more.

The delay in seeking medical attention was attributed to inadequate symptom experience and cognitive and emotional response. Over half of the participants did not realize that their symptoms were associated with HF or did not realize how serious their symptoms were. Only 76.6% of participants experienced feelings of fear regarding their symptoms.

Byrnes, J., Hoke, L., Jurgens, C.Y., & Riegel, B. (2009). Why do elders delay responding to heart failure symptoms? Nursing Research, 58(4), 274-282.

Young Women with Type 1 Diabetes' Management of Turning Points and Transitions

Problem Statement

"Diabetes is a significant chronic illness and a growing public health concern. It represents a considerable personal and public burden" (Cox et al., 2007, p. 266).

Statement of Purpose

"The aim of the current study was to develop a substantive theory of how women with type 1 diabetes managed turning points and transitions in their lives" (Cox et al., 2007, p. 267).

Research Question

"How (do) women with type 1 diabetes manage turning points and transitions in their lives?" (Cox et al., 2007, p. 267). A turning point was described as an event that fundamentally changes the path or meaning of one's life. A transition was defined as a period of time in which one adjusts to this new path or life meaning.

Study Methods

Data for this study was collected primarily through formal interviews with 20 women conducted over a period of 18 months. Additional data was collected through informal interviews and a variety of literature. Each formal interview ran for 30 to 140 minutes and was recorded for further analysis. The researchers also recorded their thoughts and observations at the end of each interview.

The data was analyzed by transcribing in verbatim each of the recorded interviews. The researchers then analyzed each line of each interview using open coding and theoretical coding techniques, as well as comparative analysis and visual data analysis.

Key Findings

The findings of this study revealed that women with type 1 diabetes struggle with "being in the grip of blood glucose levels (BGLs)" (Cox et al., 2007, p. 269). This impacts how the women experience turning points and transitions in three major ways.

The first is the "impact of being susceptible to fluctuating BGLs" (Cox et al., 2007, p. 269). These fluctuations were found to have a strong impact on the women's daily activities and their responses to health care professionals and people in their social networks.