“It’s Somebody else’s responsibility”- perceptions of general practitioners, heart failure nurses, care home staff, and residents towards heart failure diagnosis and management for older people in long-term care: a qualitative interview study

Abstract

BackgroundOlder people in care-facilities may be less likely to access gold standard diagnosis and treatment for heart failure (HF) than non residents; little is understood about the factors that influence this variability. This study aimed to examine the experiences and expectations of clinicians, care-facility staff and residents in interpreting suspected symptoms of HF and deciding whether and how to intervene.MethodsThis was a nested qualitative study using in-depth interviews with older residents with a diagnosis of heart failure (n=17), care-facility staff (n=8), HF nurses (n=3) and general practitioners (n=5).ResultsParticipants identified a lack of clear lines of responsibility in providing HF care in care-facilities. Many clinical staff expressed negative assumptions about the acceptability and utility of interventions, and inappropriately moderated residents’ access to HF diagnosis and treatment. Care-facility staff and residents welcomed intervention but experienced a lack of opportunity for dialogue about the balance of risks and benefits. Most residents wanted to be involved in healthcare decisions but physical, social and organisational barriers precluded this. An onsite HF service offered a potential solution and proved to be acceptable to residents and care-facility staff.ConclusionsHF diagnosis and management is of variable quality in long-term care. Conflicting expectations and a lack of co-ordinated responsibility for care, contribute to a culture of benign neglect that excludes the wishes and needs of residents. A greater focus on rights, responsibilities and co-ordination may improve healthcare quality for older people in care.Trial registrationISRCTN: ISRCTN19781227

Care-seeking decisions for worsening symptoms in Heart Failure: a qualitative metasynthesis

“…Two studies were conducted with residents in aged care facilities [48] or long-term care [49]. The majority of studies were conducted in the United States (US) (n=17) and United Kingdom (UK) (n=11), with fewer studies conducted in Sweden (n=5), Canada (n=3), Australia (n=2), Thailand (n=1) and Ireland (n=1).…”

“…Perceived control was low in patients who accepted the limiting effects of symptoms as age related [62,48,66], attributed the unpredictable nature of symptoms to fate [55], or believed HF was inevitable due to a genetic predisposition [53]. For example, in cases where heart disease was part of cultural identity, patients accepted HF as a condition they must live with, and could do little about [53].…”

Community case management and unplanned hospital admissions in patients with heart failure: A systematic review and qualitative evidence synthesis

“…This theme was also apparent in the Nasstrom and the Close study where patients lived in sheltered/residential care respectively (Close et al., ; Näsström et al., ). This patient response does not seem to be location specific as this theme was also identified in the Lloyd Williams study where people attended a primary healthcare practice.…”

“…In the study by Close where participants were already living in care homes, the author commented that “Participants seemed to equate hospitals with danger zones, where the potential for illness was everywhere…. Moreover; patients felt that health and happiness were more easily achievable in the familiar setting of one's home” (Close et al., ).…”

“…Overall quality was satisfactory for all included studies (Appendix 2; CASP, ), where relevant study limitations are discussed with the appropriate section of the results. There were some issues of population sampling (Close et al., ; Young et al., ) and appropriate involvement of study personnel (Olbort et al., ; Peters‐Klimm et al., ). Only one study described the relationship between researcher and the participants (Close et al., ).…”