Heart Failure in Older Adults: Providing Nursing Care to Improve Outcomes

Abstract

Heart failure continues to be a challenge for older patients and their health care providers. This article is based on work by advanced practice nurses in a nursing study funded by the National Institute of Nursing Research of the National Institute of Health. Mary Naylor, RN, PhD at the University of Pennsylvania School of Nursing through grant #1RO1-NR04315 is using a transitional care model to provide advance practice nurse intervention for older adults with heart failure in a randomized controlled trial. Effects of the intervention being addressed include quality of life, functional status, rehospitalizations, and costs of care. Working with the patient in the acute hospital setting and following patients to the home care setting for 3 months, the advance practice nurse develops a visit pattern and intervention plan individual to the patient's needs. Key to a successful intervention plan is the right treatment for systolic versus diastolic failure. Although the patient's symptoms and some physical findings may be similar, the drugs used to treat systolic versus diastolic heart failure are different. Thus the nursing interventions to promote symptom management and avoid rehospitalizations have a different approach. In this article, care of elderly individuals with systolic versus diastolic heart failure is compared and contrasted using physical examination and diagnostic techniques, medication management, and nursing intervention. Case studies of a typical patient with systolic and diastolic heart failure will be used to illustrate the differences in approach to this common group of patients with complex needs.

A Qualitative Analysis of an Advanced Practice Nurse-Directed Transitional Care Model Intervention

“…Study subjects have included some of the most vulnerable elders, including those with complex comorbid conditions, and in a recent, randomized controlled trial, elders with cognitive impairment and their CGs, whose experiences were used for the analysis described in this article (M. D. Naylor et al, 2010). Findings from studies examining the APN-directed TMC and collaboration and consultation with national policy leaders have demonstrated that although the TCM consistently results in improved patient outcomes and reduced health care costs, greater clarity is needed about the specific factors and interventions that produce or inhibit quality outcomes (Bixby, Konick-McMahan, & McKenna, 2000;Brooten et al, 2002;Konick-McMahan, Bixby, & McKenna, 2003;McCauley, Bixby, & Naylor, 2006;M. D. Naylor, Hirschman, et al, 2007;M.…”

The Relationship Between Spirituality and Compliance in Patients With Heart Failure

“…These symptoms may include edema of the lower extremities and/or weight gain, shortness of breath at rest and/or increased respirations, and/or pulmonary crackles or rales. Jugular vein distention and increased abdominal girth may also be present 13 . Compliance was defined as “an active, intentional, and responsible process of care, in which the individual works to maintain his or her health in close collaboration with health care personnel.” 14 Compliance with HF regimens was operationally defined as the sum score on a revised form of the Heart Failure Compliance Questionnaire (HFCQR).…”

Front Loading Visits: A Best Practice Measure to Decrease Rehospitalization in Heart Failure Patients

“…Already, more than 14 million older Americans are reporting chronic conditions such as heart disease (U.S. Census Bureau, 2006). Heart failure is now the leading cause of hospitalization among older adults (Konick-McMahan & McKenna, 2003). The challenges of implementing practice change in this already burdened industry is also discussed.…”