Congestive heart failure leads to greater disability among older adults

Medical breakthroughs in recent decades have allowed heart attack survivors and other heart-disease patients to live longer. But as their hearts decline into congestive heart failure, an increasing number will experience disability and the need for nursing-home care.

A new study from the University of Michigan Health System and the VA Ann Arbor Healthcare System sheds light on the degree of disability among people with CHF, as well as the implications for the health care system, community care facilities, families and the patients themselves.

In particular, the study found that CHF patients were much more likely to be disabled than people without the condition. They were found to be much more likely to have difficulties with activities of daily living, such as grocery shopping and walking across the room. And they were more likely to require care from nursing homes and family members.

"The prevalence of congestive heart failure imposes a substantial burden on patients, families and the long-term care system," says lead author Tanya Gure, M.D., a lecturer in the Division of Geriatric Medicine at the U-M Health System. "The degree of disability in this group is quite high, and their caregiving needs are extensive. We need to make sure, in the medical community and society in general, that we are adequately meeting their health and social needs."

The study appears in the January issue of the Journal of General Internal Medicine. It is based on data from the 2000 data of the Health and Retirement Study, a national survey conducted by U-M's Institute for Social Research and funded by the National Institute on Aging. Data in the new study are based on responses from 10,626 survey respondents ages 65 and older.

Among the findings: (Note: All of the items below cite the CHF number first, followed by the percentage of people with coronary heart disease but no CHF, then people without coronary heart disease)

• People with CHF were much more likely to receive informal (unpaid) home care from a relative or another unpaid person (42 percent) than the other groups (18 percent and 11 percent).
• Formal (paid) in-home care also was more common; it had been utilized by 13 percent of people with CHF, compared with 4 percent and 2 percent in the other groups.
• Ten percent of people with CHF were in a nursing home in the prior two years, compared with 3 percent and 2 percent.
• People with CHF were much more likely to have difficulty with activities of daily living. For example, in the category of "walking across the room," about 42 percent of people with CHF reported limitations, compared with 21 percent and more than 12 percent.
• Activities such as grocery shopping were found to be much more difficult for people with CHF than others: more than 35 percent of people with CHF reported a limitation related to grocery shopping, compared with more than 14 percent and 8 percent.
• Geriatric conditions, clinical conditions which are highly prevalent in older adults - such as urinary incontinence, dementia and injury due to falling - were more common in people with CHF. In the CHF group, 36 percent had experienced urinary incontinence, compared with 23 percent and 19 percent in the other groups.

An estimated 5.3 million Americans currently have heart failure, according to the American Heart Association. Within six years of having a heart attack, about 22 percent of men and 46 percent of women will be disabled with CHF.

In addition to her appointment in the Division of Geriatric Medicine, Gure also was a member of the RWJ Clinical Scholars Program at U-M while working on this study. Along with senior author Kenneth M. Langa, M.D., Ph.D., Gure is affiliated with the VA Center for Practice Management & Outcomes Research at the VA Ann Arbor Healthcare System and the U-M Division of General Internal Medicine. Other authors of the paper are Mohammed U. Kabeto, M.S., of the U-M Division of General Internal Medicine; and Caroline S. Blaum, M.D., M.S., of the U-M Division of Geriatric Medicine and the VA Geriatric Research, Education and Clinical Center.

Funding came from the National Institute on Aging, a Paul Beeson Physician Faculty Scholars in Aging Research award (Langa), the VA Center for Practice Management & Outcomes Research and the RWJ Clinical Scholars Program (Gure), and the Ann Arbor VA Geriatric Research, Education and Clinical Center (Blaum).

Reference: Journal of General Internal Medicine, Jan. 2008, Volume 23, Issue 1, "Degree of Disability and Patterns of Caregiving among Older Americans with Congestive Heart Failure."

For more information about geriatric medicine at U-M, visit www.med.umich.edu/geriatrics