Progress in CardiologyCognitive influences on self-care decision making in persons with heart failure
Section snippets
Self-care in heart failure as a decision making process
Self-care is an active process intended to maintain health through treatment adherence, symptom monitoring, recognition, and treatment and an evaluative process whereby learning occurs in response to prior self-care. Managing an illness such as heart failure requires that symptoms are recognized early and treated quickly.6 Yet, numerous studies have demonstrated that dietary indiscretion, medication nonadherence, and failure to detect and act upon early symptoms of fluid retention are primary
Overview of patient decision making
Most of patient decision making research has focused on studies of patient choices about specific treatment options, informed consent, advanced directives, or general treatment preferences. When choosing between limited options, the problem-solving task is discrete, and the decision is made based on static choices. That is, patients weigh the specific options and make one decision, for example, choosing surgery over radiation therapy as cancer treatment. Although researchers have attempted to
Cognitive impairment in heart failure
Cognitive function refers to the information-processing abilities of attention, learning and memory, executive function (eg, cognitive flexibility and abstract reasoning), visual-spatial and visual-construction skills, psychomotor abilities, perceptual skills and language—functions critical to self-care. Cognitive deficits have been demonstrated in persons with heart failure using general cognitive measures such as the Mini-Mental Status Examination8 and neuropsychological testing. Two leading
Cognition and decision making in heart failure self-care
Cognitive impairment may contribute to failed self-care in 2 ways. Deficits in memory and attention may impair treatment adherence, one aspect of self-care, because of forgetfulness and poor learning ability. In a study testing the effect of standardized one-on-one instruction and written information about the treatment regimen on medication adherence, more than 50% of patients with clinically stable heart failure were unable to name their medications or dosages, and 75% failed to remember to
Neural processing and the effect on self-care decision making
Self-care decision making requires that symptoms are perceived and interpreted. A timely response to symptoms requires the ability to reason, make associations, and foresee consequences of actions. The ability to learn, thereby improving self-care decision making in the future, assumes memory.
Treatment seeking delay in response to early symptoms could reflect neural processing problems manifested in increased deliberation time. Impaired symptom perception has been identified as a mechanism
Conclusion
True self-care is a decision-making process requiring the cognitive ability to learn, perceive, interpret, reason, and respond. Cerebral ischemia, infarction, and hypoxemia impair concentration, memory, and processing abilities. These deficits, which have been shown to occur in persons with heart failure, may affect naturalistic decision-making ability through their influence on knowledge acquisition, interpretation of physical sensations, use of prior experience, and skill development. We
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Cognitive impairment as a barrier to utilizing preventive health services among older adults
2022, Archives of Gerontology and GeriatricsHeart failure impairs mood and memory in male rats and down-regulates the expression of numerous genes important for synaptic plasticity in related brain regions
2021, Behavioural Brain ResearchCitation Excerpt :It is now becoming well-accepted that, in addition to neurohumoral activation and the associated systemic cardiac, renal and vascular complications, HF is comorbid with depression, anxiety and memory deficits, both in human patients [6–10] and experimental animal models [11,12]. These mood and cognitive disturbances have serious implications for quality of life and self-care in patients who have HF because hospital readmission and mortality rates are significantly higher in HF patients that have depression and/or cognitive impairments compared to HF patients without these comorbidities [9,13–15]. It is critical to identify the neurobiological mechanisms and substrates that underlie HF-induced mood and cognitive disturbances HF in order to identify treatments that may improve quality of life and decrease mortality in this prevalent disease.
“When you're homeless, they look down on you”: A qualitative, community-based study of homeless individuals with heart failure
2021, Heart and LungCitation Excerpt :Outpatient HF care involves intensive self-management (SM): individuals with HF are expected to monitor weight gain, modulate dietary intake, adhere to complex medication regimens, and actively engage with nurses and physicians regarding their care.5 Improved HF SM is associated with improved HF outcomes,6 but for many patients, the complexity of SM behaviors makes it difficult to avoid exacerbations and readmission.7,8 A growing body of literature documents the challenges faced by homeless individuals in SM of chronic conditions such as diabetes mellitus, including difficulties with health prioritization and expenses.9
Cognitive impairment measured by Mini-Cog provides additive prognostic information in elderly patients with heart failure
2020, Journal of CardiologyCitation Excerpt :Given that our results suggest that performing both tests does not contribute to better prognostication, Mini-Cog may be one of recommendable CI screening tools which is clinically feasible and prognostically relevant. Some previous studies reported that CI is related to poor self-management skills, such as medication adherence [24], self-confidence [25], and decision-making [26]. Hawkins et al. reported that CI was independently associated with reduced heart failure knowledge and health literacy in patients with heart failure [27], which were suggested to be associated with poor prognosis [28].
Comprehensive Geriatric Assessment in the Management of Older Patients With Cardiovascular Disease
2020, Mayo Clinic Proceedings