Polypharmacy in elderly women after myocardial infarction.

The aims of the study were to: (a) examine the number, absolute volume, and type of daily medications older women were taking 6 to 12 months post-myocardial infarction (MI); (b) describe the financial burden of cardiac medications; and (c) examine the relationship of age, education, and income to the number of medications. An analysis of a cross-sectional descriptive study of women >65 years of age who were post-MI was used. Most (89%; N = 83) were taking at least one cardiac medication, costs per day varied ($0.13–$6.75), and total number of pills taken per day was 1 to 19. Age, education, and income did not explain the number of medications. Consideration of the financial burden of medications is important to increase compliance and foster secondary prevention in older women

The effects of hyperglycemia on length of stay with myocardial infarction

The influence of patients' co-morbidities and admission blood glucose on critical care and hospital length of stay was examined. The model significantly explained variance in hospital length of stay

Development of the McSweeney acute and prodromal myocardial infarction symptom survey.

Background/Objectives: Coronary heart disease (CHD) is the number one cause of death in women, yet, little is known about women's symptoms. Early symptom recognition of CHD in women is essential but most instruments do not assess both prodromal and acute CHD symptoms. Our aims were to develop an instrument validly describing women's prodromal and acute symptoms of myocardial infarction and to establish reliability of the instrument, the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS). Methods: Four studies contributed to the content validity and reliability of this instrument. Two qualitative studies provided the list of symptoms that were confirmed in study 3. The resulting instrument assesses 37 acute and 33 prodromal symptoms. In study 4, 90 women were retested 7 to 14 days after their initial survey. We used the kappa statistic to assess agreement across administrations. Results: The women added no new symptoms to the MAPMISS. The average kappa of acute symptoms was 0.52 and 0.49 for prodromal. Next we calculated a weighted score. The mean acute score for time 1 was 19.4 (SD = 14.43); time 2 was 12.4 (SD = 8.79) with Pearson correlation indicating stability (r = .84; P < .01). The mean prodromal score at time 1 was 23.80 (SD = 24.24); time 2 was 26.79 (SD = 30.52) with a Pearson correlation of r = .72; P < .01. Conclusions: The tool is comprehensive, has high content validity, and acceptable test-retest reliability. Low kappas were related to few women having those symptoms. The symptom scores remained stable across administrations

Fatigue and physical activity in older women after myocardial infarction.

Background Within 6 years of a myocardial infarction (MI) more women (35%) than men (18%) will have another MI. Participation in physical activity is one of the most effective methods to reduce cardiac risks; however, few older women participate. One of the most frequently reported barriers to physical activity is fatigue. Objectives The specific aims of this study were to (1) describe factors related to fatigue in older women after MI and (2) examine the relationship of fatigue to physical activity in older women after MI. Methods This descriptive correlational study examined the effects of age, body mass index, comorbidities, sleep, beta-blocker medication, depression, and social support on fatigue and physical activity in women (N = 84), ages 65 to 88 years old, 6 to 12 months post-MI. All women had their height and weight measured and completed (1) a health form on comorbidities, physical activity, and medication history; (2) the Geriatric Depression Scale; (3) the Epworth Sleepiness Scale; (4) the Revised Piper Fatigue Scale; and (5) the Social Provisions Scale. Results The majority (67%) of the women reported fatigue that they perceived as different from fatigue before their MI. Moderately strong correlations were noted among depression, sleep, and fatigue, and multivariate analysis indicated that depression and sleep significantly accounted for 32.7% of the variance in fatigue. Although only 61% of the women reported participating in physical activity for exercise, most were meeting minimal kilocalories per week for secondary prevention. Fatigue was not significantly associated with participation in physical activity. Conclusion Describing correlates to fatigue and older women’s participation in physical activity after MI are important to develop interventions targeted at increasing women’s participation in physical activity, thus decreasing their risk for recurrent MIs

Predictors of the end of life in chronic kidney disease: A pilot study.

The aim of this pilot study was to describe indicators present at the end of life in persons with chronic kidney disease. Retrospective chart reviews of 10 randomly selected patients were conducted to describe demographic, physiological, and functional variables. Using a repeated measures ANOVA, The Palliative Performance Scale and the Braden Scale both showed significant differences during the death admission from previous admissions. These functional measures may provide useful insight in identifying the end of life in persons with chronic kidney disease

Exploring older women’s lifestyle changes after myocardial infarction.

The researchers explored the failure of older women to attend cardiac rehabilitation after myocardial infarction, and examined facilitating and inhibiting factors in making lifestyle changes. Three global categories emerged: physiological changes, health decisions and actions, and life outcomes of the change process

An act of courage: Women’s decision-making processes regarding outpatient cardiac rehabilitation attendance.

The purpose of this qualitative study was to describe the factors that affect women's attendance and adherence to a cardiac rehabilitation (CR) program after a myocardial infarction (MI). We used in-depth interviews and a health survey form to collect data. The purposive sample consisted of 40 women who had experienced a first MI within the previous 6 weeks to 12 months. Of those 40, 18 women were not offered the program, 8 declined it, and 14 attended. Using content analysis and constant comparison, we identified three distinct phases: “initial decision,” “CR attendance,” and “reevaluation.” Four data clusters positively influenced the continuation of CR attendance: “Psychological Appraisal,” “Program Components,” “Staff Behaviors,” and “Outcomes.” When women encountered a fifth cluster—“Barriers”—they entered the reevaluation phase. Results of this study support specific interventions for each phase

Commentary on “nursing home residents’ sense of coherence and functional status

Functional status is an important measure in older adults. Functional decline has been associated with emergency room visits in elders (Wilber, Blanda, & Gerson, 2006), and elders are at a high risk of functional decline after hospitalization (Cornett, Swine, Malhomme, Gillet, & D’Hoore, 2006). Furthermore, those with functional decline consume larger resources. Therefore, identifying those elders at risk for functional decline is important. This descriptive study examined functional status over time in older adults living in nursing homes

Do you know them when you see them? Women’s prodromal and acute symptoms of MI.

This study described women's prodromal and acute symptoms associated with myocardial infarction (MI) based on interviews with 76 women who had experienced an MI in the previous year. Sixty-eight women experienced prodromal symptoms including unusual fatigue (70%), shortness of breath (53%), and pain in the shoulder blade/upper back (47%). All women experienced acute symptoms including chest pain/discomfort (90%), unusual fatigue (59%), shortness of breath (59%), and shoulder blade/upper back discomfort (42%). Although women in this study reported numerous prodromal symptoms, none had received a new diagnosis of coronary heart disease (CHD) prior to MI. Practitioners must develop an awareness of and a more comprehensive approach to treating women at risk for CHD. Further research to elucidate prodromal and acute symptom clusters is needed to assist practitioners in early diagnosis of CHD in women

Cardiovascular risks and physical activity in middle-aged and elderly African-American women.

Cardiovascular disease rates are higher in African American women and they have more cardiovascular risk factors than other groups. Although one of the most important cardiovascular risk reduction behaviors is physical activity, few studies have focused on African American women's cardiovascular risk and physical activity. Therefore, the aims of this descriptive pilot study were to describe modifiable cardiovascular risks and to explore physical activity, as measured by pedometer steps, in younger (n = 22; aged 21-45 years) and older (n = 22; aged 46-75 years) community-dwelling African American women. The total number of pedometer steps recorded in 3 days ranged from 1,153 to 52,742. Day 1 steps were significantly different than day 2 and day 3 steps across the sample (F = 5.30, df = 1, P < .05). Risk factors were similar across the age groups. There was no relationship between the 3-day total or average number of daily steps and cardiovascular risks. Thus, interventions may be used in both age groups, with modifications for cohort effects of approach and health status. Given the disparities in cardiovascular disease and the Healthy People 2010 national health objectives, it is important to continue a variety of efforts to assist adult women of all ages to increase their physical activity and to decrease other CVD risks