Archives of gerontology and geriatrics
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Several aspects of congestive heart failure are discussed in the light of international literature and of recent findings of our group. The annual incidence of heart failure in elderly subjects, aged >or=75y, is 13 to 50/1000, while it is 1.6/1000 in people aged 45-54 y. The prevalence of heart failure is about 3% in subjects aged 45-64% in subjects aged more than 65 y and 10% in subjects aged more than 75 y. ⋯ No specific drugs exist for the pharmacologic treatment of heart failure in the elderly, so that the geriatric specificity in the treatment of heart failure can be recognized in the art of drug choice and dosage, to obtain the best results with the least side effects. The multiple etiology of congestive heart failure, the comorbidity, the loss of autonomy and the deterioration of cognitive functions suggest the need for multidimensional approach and continuative intervention in elderly patients with heart disease, and in particular with congestive heart failure. Further studies on disease- and age-related changes are necessary to develop new and more potent strategies to secure 'successful ageing'.
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In the present paper we discuss two issues about relationships between congestive heart failure and the brain. First, major acute cerebrovascular events are very frequent among elderly people, but stroke does not appear to be frequently associated with congestive heart failure. Second, some cardiovascular conditions may determine progressive damage of cerebral tissue, with consequent impairment of cognitive functions. ⋯ A novel multicentric study (CHF Italian Study II) has been performed to identify cognitive functions more specifically impaired during congestive heart failure in the elderly. Preliminary data relative to 385 patients, confirmed that congestive heart failure may induce a generalized impairment of cognitive functions. These data have relevant clinical implications because they demonstrate that a multidisciplinary approach is necessary in these patients, both for prevention and rehabilitation therapy.
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Arch Gerontol Geriatr · Nov 1995
Quality of life cards - a novel way to measure quality of life in the elderly.
Taking into account the multiple factors/dimensions that contribute to the concept of quality of life (QoL), a pack of cards (80 cards) was developed and validated in 30 elderly patients, fifteen from the continuing care setting and fifteen from the day hospital. Twenty of the 80 cards contained words or statements indicating positive or negative affect, 20 cards were based on positive or negative life experience and 40 cards dealt with satisfaction or happiness or dissatisfaction or unhappiness relating to areas of personal or family life. ⋯ Test to retest reliability in 11 patients revealed an 'r' value of 0.99 (P < 0.0001). In addition, high correlations were noted between the total score obtained using the 80 QoL cards and the subscale scores for 'affect', 'life experience' and 'satisfaction/happiness' in the 30 patients studied initially and in the 20 patients studied subsequently.
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Arch Gerontol Geriatr · Mar 1995
The impact of a support group programme for care-givers on the institutionalisation of demented patients.
Support group programmes have been proposed to alleviate the care-givers' burden and postpone institutionalisation of demented patients. Experimental studies on these programmes failed to detect any impact on care-givers' burden, but none have examined the effect on institutionalisation. The objective of this paper is to assess the impact of a support group programme for care-givers on the institutionalisation of demented patients. ⋯ At 24 months, the probability of being institutionalised was 0.33 in the study group and 0.45 in the control group. This difference was not statistically significant (log-rank test: chi2 = 1.02; P = 0.31). These results emphasize the lack of scientific evidence about efficacy of such programmes and the need for a large multi-centre study on this topic.
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Congestive heart failure (CHF) represents the most frequent cause of death and disability in the elderly. The prevalence of impairment of cognitive abilities is very high in aging and several clinical studies have demonstrated high association between cardiovascular diseases (in particular CHF) and cognitive deterioration. However, little attention has been paid to the decline of cognitive functioning during congestive heart failure in elderly patients. ⋯ This paper confirms that a multidimensional approach is necessary to better characterize and treat elderly patients, in particular those with CHF. More attention should be paid to encourage mild physical activity, to provide emotional support to patients and also to assess their general cognitive abilities. Studies on large populations of patients with heart disease have to be designed to investigate psychosocial and cognitive status in these patients.