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：
8054934
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/8054934
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）：心力衰竭成功自我管理（HF）的成年人的自我管理和认知障碍取决于自我管理，包括遵守治疗方案和有效的决策和HF症状加剧时遵守治疗方案和有效的纠正措施。最近的报道表明，25-50％的HF患者的认知障碍未被认可，但对这种未被认可的认知障碍对患者自我管理以及对健康和健康服务使用的影响几乎一无所知。使用HF自我管理的生物心理社会模型，我们的目的是评估400名NYHA 2和3 HF的男性和女性的认知障碍，患者自我管理，健康和健康服务使用之间的关系。研究问题是：1）认知障碍（记忆，注意力，全球和执行功能）如何与自我管理受损的各个方面有关（对依从性的知识，遵守钠限制和药物，体重变化的症状以及决策和采取行动寻求护理）？ 2）在调整医学，人口统计和社会心理因素（疾病严重性，合并症，身体，感觉和睡眠障碍，以前的HF住院；年龄，性别，种族，SES，SES，教育，健康素养；社会支持/护理人员的帮助，抑郁症，抑郁和焦虑）时，这些关系将如何改变3）认知障碍，质量自我管理，健康状况（HF症状的严重程度，心肺健康状况，与HF相关的生活质量质量）和健康服务使用（医师访问/呼叫，急诊室使用和住院）之间有什么关系？数据将在基线，依从性监测的21天以及3、6、9和12个月的随访中收集。尽管以前的研究通过接受HF加剧的住院治疗后通过采访患者来检查患者自我管理的失败，但该研究具有创新性，因为它将在一项前瞻性研究中检查认知功能，自我管理效果和健康结果之间的关系。前瞻性性质将允许研究有效自我管理的患者以及自我管理效率较低的患者。此外，将评估认知障碍对维持复杂HF治疗方案的维持和恶化症状的治疗的影响。这项研究的结论将对筛查HF患者的认知障碍，确定高风险患者以及设计和实施针对认知障碍HF患者的患者自我管理干预措施具有重要意义，以改善健康结果。公共卫生相关性：心力衰竭成功的心力衰竭（HF）的成年人的自我管理和认知障碍取决于自我管理，包括遵守治疗方案和有效的决策和有效的决策和HF症状加剧时的纠正措施。最近的报道表明，25-50％的HF患者的认知障碍未被认可，但对这种未被认可的认知障碍对患者自我管理以及对健康和健康服务使用的影响几乎一无所知。使用HF自我管理的生物心理社会模型，我们的目的是评估400名NYHA 2和3 HF的男性和女性的认知障碍，患者自我管理，健康和健康服务使用之间的关系。这项研究的结论将对筛查HF患者的认知障碍，确定高风险患者以及设计和实施针对认知障碍HF患者的患者自我管理干预措施具有重要意义，以改善健康结果。