Managing CHF and depression in an elderly patient: Being open to collaborative care.

Abstract

M urray and Lopez (1997) predict that by the year 2020 the top two contributors to the burden of disease worldwide will be ischemic heart diseases and depression. More than five million Americans suffer from Congestive Heart Failure (CHF;Miller & Missov, 2001). This disease accounts for greater than 20 billion dollars in annual medical costs (American Heart Association, 2001), perhaps because it requires so much inpatient care. Like many chronic diseases, CHF is debilitating over time and manifests both physically and emotionally. Patients experience increasing shortness of breath, difficulty lying down when sleeping because of fluid retention, and increasing fatigue. It is a deadly illness, as well. Poorly controlled symptoms often lead to depression for patients secondary to concerns about their quality of life, overall functioning, and mortality.Their families and friends often share these concerns.Many studies have shown that elderly patients hospitalized for CHF are likely to have comorbid diagnoses of major depression. In one outpatient study (Gottlieb, Khatta, Friedmann, Einbinder, Katzen, & Baker, 2004) 7% of patients with stable CHF were prescribed antidepressant medications and 48% scored in the depressed range on the Beck Depression Inventory (BDI). Moreover, the depressed patients reported significantly poorer quality of life than nondepressed patients. Lane, Chong, & Lip (2006) raised the concern that patients who are depressed are less likely to take their medications and modify their lifestyle appropriately, which increases the likelihood of recurrent cardiac events and death. HENRY'S STORYHenry lived in the same town his entire life, and loved his home and community. In fact, the cover of the town's commemorative book featured a picture of Henry and his two brothers as young boys sleeping on the banks of a canal on a hot summer day, with their fishing poles by their sides. The picture captures the simplicity and joy of their early life. Henry always took particular pride in the photograph, prominently

Finding the heart of medical family therapy: A content analysis of medical family therapy casebook articles.

“…The provider increases her impact on the patient through her participation in the patient's multisystemic experience. Providers acknowledge that they learn and are changed as a result of their interactions with patients as Clabby and Howarth (2007) illustrated by concluding that “Henry taught us much about trust, the human will, and the capacity for change (p. 464).”…”

“…Casebook authors suggest that this must be done with explicit questioning about functioning within each system. Clabby and Howarth (2007) Failure to ask patients about their experience in each system perpetuates the status quo which preferences the one-dimensional experience within the biological system. But, asking questions to elicit patient stories allows providers to understand the complexity of patient experience of both disease and treatment and to work within the multiple systems of the patient's experience.…”

“…All but two of the authors explicitly noted the benefit of helping patients rally their immediate and extended family members to provide support during times of distress and illness. For example, Clabby and Howarth (2007) wrote that "Dr. Howarth recognized that Henry's family needed to be involved directly in his care. He held two family meetings" (p. 459).…”

Medical Family Therapy: A Theoretical and Empirical Review

“…For example, casebook authors advocated for clinical observation and immersion to serve as the two main mechanisms for building MedFT skills. They targeted application of skills across certain diagnostic areas, including but not limited to, somatization disorders (Cohen 1995), congestive heart failure (Clabby and Howarth 2007), diabetes (Munshower 2004), munchausen (Kannai 2009), fibromyalgia (Navon 2005), neurologic impairment (Gellerstedt and Mauksch 1993), parenting children with health challenges (Rosenberg et al 2008;Thomasgard et al 2004) and HIV/AIDS (Lowe 2007). MedFT Casebook authors also addressed navigating cultural differences in establishing care (Schirmer and Le 2002), supporting the doctor-patient relationship (Knishkowy and Herman 1998;Radomsky 1996), and facilitating the act of collaboration (Leahy et al 1994;Prest et al 1996;Ruddy et al 1994).…”

Medical Family Therapists in Action: Embracing Multiple Roles

“…The unique and demanding nature of practicing MedFT is well demonstrated by authors describing its application to particular healthcare contexts and specific presenting problems (Clabby & Howarth, ; Edwards & Turnage, ; Hughes, Hertlein, & Hagey, ; Phelps et al., ). However, arriving at a common professional identity and nomenclature proves complex and evolving (Linville, Hertlein, & Prouty Lyness, ; Tyndall et al., ).…”