Cognitive Impairment and Self-management in Adults with Heart Failure

心力衰竭成人的认知障碍和自我管理

基本信息

批准号：
8232098
负责人：
MARY DOLANSKY
金额：
$ 66.63万
依托单位：
KENT STATE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-04-05 至 2014-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8232098
关键词：
Accident and Emergency department Accounting Address Adherence Admission activity Adult Affect Age Alzheimer&apos s Disease American Anxiety Attention Blood Vessels Body Weight Changes Cardiopulmonary Caregivers Comorbidity Complex Data Decision Making Dementia Diagnosis Diet Monitoring Education Effectiveness Elderly Ethnic Origin Exhibits Failure Gender Health Health Services Health Status Heart failure Hospitalization Hospitals Impaired cognition Impairment Intervention Interview Knowledge Life Liquid substance Literature Maintenance Medical Medical center Memory Memory impairment Mental Depression Meta-Analysis Modeling Monitor Nature Neuropsychological Tests Observational Study Ohio Outcome Patient Education Patients Persons Pharmaceutical Preparations Physicians Population Prospective Studies Psychosocial Factor Public Health Quality of life Relative (related person)Reporting Research Sampling Screening procedure Self Management Sensory Severities Severity of illness Sleep Social support Sodium Stroke Structure Symptoms System Techniques Testing Treatment Protocols Vascular Dementia Visit Woman age related biopsychosocial care seeking cognitive function cost demographics design environmental change executive function follow-up health literacy high risk improved innovation medication compliance meetings men nervous system disorder peer prospective public health relevance skills success

项目摘要

DESCRIPTION (provided by applicant): Self-management and Cognitive Impairment in Adults with Heart Failure Successful self-management of heart failure (HF) depends on self-management that includes adherence to the treatment regimen and effective decision making and corrective action when HF symptoms are exacerbated. Recent reports indicate that 25-50% of HF patients have unrecognized cognitive impairment, yet little is known about the effects of this unrecognized cognitive impairment on patient self-management and the resulting impact on health and health service use. Using the Biopsychosocial Model of HF Self-management, our aim is to assess the relationship between cognitive impairment, patient self-management, health, and health service use in a sample of 400 men and women with NYHA Class 2 and 3 HF. Research questions are: 1) How is cognitive impairment (memory, attention, global and executive function) related to various aspects of impaired self-management (knowledge of adherence, adherence to sodium restriction and medications, symptom monitoring of weight changes, and decision and action to seek care)? 2) How are these relationships altered when adjusting for medical, demographics, and psychosocial factors (illness severity, comorbidity, physical, sensory and sleep impairments, previous HF hospitalization; age, gender, ethnicity, SES, education, health literacy; social support/caregiver assistance, depression, and anxiety)? 3) What are the relationships among degree of cognitive impairment, quality self-management, health status (severity of HF symptoms, cardiopulmonary health status, HF-related quality of life), and health service use (physician visit/call, emergency room use and hospitalization)? Data will be collected at baseline, during 21 days of adherence monitoring, and at 3, 6, 9, and 12-month follow-up. Although previous studies have examined failures of patient self-management by interviewing patients after hospital admission for a HF exacerbation, this study is innovative in that it will examine relationships among cognitive function, self-management effectiveness and health outcomes in a prospective study. The prospective nature will allow for the study of patients that effectively self-manage their treatment as well as patients whose self-management is less effective. In addition, the effect of cognitive impairment on both the maintenance of the complex HF treatment regimen and the management of worsening symptoms will be evaluated. Conclusions from this study will have important implications for screening HF patients for cognitive impairment, identifying high risk patients, and designing and implementing patient self-management interventions targeted to cognitively impaired HF patients to improve health outcomes. PUBLIC HEALTH RELEVANCE: Self-management and Cognitive Impairment in Adults with Heart Failure Successful self-management of heart failure (HF) depends on self-management that includes adherence to the treatment regimen and effective decision making and corrective action when HF symptoms are exacerbated. Recent reports indicate that 25-50% of HF patients have unrecognized cognitive impairment, yet little is known about the effects of this unrecognized cognitive impairment on patient self-management and the resulting impact on health and health service use. Using the Biopsychosocial Model of HF Self-management, our aim is to assess the relationship between cognitive impairment, patient self-management, health, and health service use in a sample of 400 men and women with NYHA Class 2 and 3 HF. Conclusions from this study will have important implications for screening HF patients for cognitive impairment, identifying high risk patients, and designing and implementing patient self-management interventions targeted to cognitively impaired HF patients to improve health outcomes.

描述（由申请人提供）：心力衰竭成人的自我管理和认知障碍心力衰竭 (HF) 的成功自我管理取决于自我管理，包括坚持治疗方案以及在 HF 症状时做出有效决策和纠正行动加剧。最近的报告表明，25-50% 的心力衰竭患者存在未被识别的认知障碍，但人们对这种未被识别的认知障碍对患者自我管理的影响以及由此对健康和卫生服务使用产生的影响知之甚少。我们的目的是使用心力衰竭自我管理的生物心理社会模型，以 400 名患有 NYHA 2 级和 3 级心力衰竭的男性和女性为样本，评估认知障碍、患者自我管理、健康和卫生服务使用之间的关系。研究问题是：1）认知障碍（记忆、注意力、整体和执行功能）与自我管理受损的各个方面（遵守知识、坚持限钠和药物、体重变化的症状监测以及决策和执行功能）如何相关？采取行动寻求护理）？ 2) 在调整医疗、人口统计和心理社会因素（疾病严重程度、合并症、身体、感觉和睡眠障碍、既往心衰住院史；年龄、性别、种族、SES、教育、健康素养；社会支持/看护者的帮助、抑郁和焦虑）？ 3) 认知障碍程度、自我管理质量、健康状况（心力衰竭症状的严重程度、心肺健康状况、心力衰竭相关的生活质量）和健康服务使用（医生就诊/呼叫、急诊室使用）之间有何关系和住院）？将在基线、21 天的依从性监测以及 3、6、9 和 12 个月的随访期间收集数据。尽管之前的研究通过采访因心力衰竭恶化入院后的患者来检查患者自我管理的失败，但本研究的创新之处在于它将在前瞻性研究中检查认知功能、自我管理有效性和健康结果之间的关系。前瞻性性质将允许对能够有效自我管理治疗的患者以及自我管理效果较差的患者进行研究。此外，还将评估认知障碍对维持复杂心力衰竭治疗方案和治疗恶化症状的影响。这项研究的结论对于筛查心力衰竭患者的认知障碍、识别高危患者以及设计和实施针对认知障碍心力衰竭患者的自我管理干预措施以改善健康结果具有重要意义。公共卫生相关性：心力衰竭成人的自我管理和认知障碍心力衰竭 (HF) 成功的自我管理取决于自我管理，包括坚持治疗方案以及在心力衰竭症状恶化时采取有效的决策和纠正措施。最近的报告表明，25-50% 的心力衰竭患者存在未被识别的认知障碍，但人们对这种未被识别的认知障碍对患者自我管理的影响以及由此对健康和卫生服务使用产生的影响知之甚少。我们的目的是使用心力衰竭自我管理的生物心理社会模型，以 400 名患有 NYHA 2 级和 3 级心力衰竭的男性和女性为样本，评估认知障碍、患者自我管理、健康和卫生服务使用之间的关系。这项研究的结论对于筛查心力衰竭患者的认知障碍、识别高危患者以及设计和实施针对认知障碍心力衰竭患者的自我管理干预措施以改善健康结果具有重要意义。