Are older patients’ cardiac rehabilitation needs being met?

Abstract

Aims. The primary aim of this study was to examine the needs of older people in relation to cardiac rehabilitation and to determine if these were currently being met. A secondary aim was to compare illness representations, quality of life and anxiety and depression in groups with different levels of attendance at a cardiac rehabilitation programme.Background. Coronary heart disease accounted for over seven million cardiovascular deaths globally in 2001. Associated deaths increase with age and are highest in those older than 65. Effective cardiac rehabilitation can assist independent function and maintain health but programme uptake rates are low. We have, therefore, focussed specifically on the older patient to determine reasons for the low uptake.Design. Mixed methods.Methods. A purposive sample of 31 older men and women (≥65 years) completed three questionnaires to determine illness representations, quality of life and anxiety and depression. They then underwent a brief clinical assessment and participated in a face-to-face audio-taped interview.Results. Quantitative: Older adults, who did not attend a cardiac rehabilitation programme, had significantly poorer personal control and depression scores (p < 0·01) and lower quality of life scores than those who had attended. Few achieved recommended risk factor reduction targets. Qualitative: The three main themes identified as reflecting the views and experiences of and attendance at the cardiac rehabilitation programme were: ‘The sensible thing to do’, ‘Assessing the impact’ and ‘Nothing to gain’.Conclusions. Irrespective of level of attendance, cardiac rehabilitation programmes are not meeting the needs of many older people either in terms of risk factor reduction or programme uptake. More appropriate programmes are needed.Relevance to clinical practice. Cardiac rehabilitation nurses are ideally placed to identify the rehabilitation needs of older people. Identifying these from the older person’s perspective could help guide more appropriate intervention strategies.

Participating or not in a cardiac rehabilitation programme: factors influencing a patient’s decision

“…Appropriate solutions could be set up by national healthcare systems to promote the accessibility of CR for this patient group. 17 Women mentioned specific barriers to attend the CR programme. Grace et al 24 identified barriers similar to those reported in our study, more common among women than among men e.g.…”

“…[9][10][11][12][13][14][15][16][17][18][19] The English version of the questionnaire is in the online supplementary material (available in French and Dutch upon request). Patients were asked to fill out the questionnaire during an outpatient consultation and to return it after completion.…”

Factors influencing participation in cardiac rehabilitation programmes after referral and initial attendance: qualitative systematic review and meta-synthesis

“…44 Health professionals were seen to be excessively intense, 35 judgmental, 45 and lacking in cultural sensitivity. 32,46 Services were perceived as poorly organized, 35 too narrowly focused, 45 badly timed, 47 generally unsuitable, 30 not beneficial, [35][36][37] less effective than surgery, 37 and among men, too standardized to meet the needs of individuals. 48 Clinical Rehabilitation 0(0) Services and staff were not seen to provide women with the social support they needed for prevention, 29,45 the encouragement needed to participate, 49 care that met women's needs, 45 including understanding of cultural norms, 50 or harnessing women's expertise in their own care.…”

Tool validation: Health professionals’ perception of the role for a cardiac rehabilitation program

“…These activities include planned physical training activities [8] , social meetings with individuals of similar health conditions [9] , and patients' psychological condition [6] .…”