Double jeopardy: the influence of excessive daytime sleepiness and impaired cognition on health‐related quality of life in adults with heart failure

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/106066/1/ejhfhfs054.pd

Predictors of Objectively Measured Medication Nonadherence in Adults With Heart Failure

Background—Medication nonadherence rates are high. The factors predicting nonadherence in heart failure remain unclear. Methods and Results—A sample of 202 adults with heart failure was enrolled from the northeastern United States and followed for 6 months. Specific aims were to describe the types of objectively measured medication adherence (eg, taking, timing, dosing, drug holidays) and to identify contributors to nonadherence 6 months after enrollment. Latent growth mixture modeling was used to identify distinct trajectories of adherence. Indicators of the 5 World Health Organization dimensions of adherence (socioeconomic, condition, therapy, patient, and healthcare system) were tested to identify contributors to nonadherence. Two distinct trajectories were identified and labeled persistent adherence (77.8%) and steep decline (22.3%). Three contributors to the steep decline in adherence were identified. Participants with lapses in attention (adjusted OR, 2.65; P=0.023), those with excessive daytime sleepiness (OR, 2.51; P=0.037), and those with ≥2 medication dosings per day (OR, 2.59; P=0.016) were more likely to have a steep decline in adherence over time than to have persistent adherence. Conclusions—Two distinct patterns of adherence were identified. Three potentially modifiable contributors to nonadherence have been identified

Spouse caregiving: The impact of stressors and perceptions on well-being.

Chronic, irreversible dementia causes a great deal of stress to family care providers. Limited attention has been devoted to the psychological factors which intervene in the relationship betwen stressors and health outcomes experienced by spouse caregivers. However, based on a cognitive-phenomenological model of stress, perceptions of upset are examined as they intervene between aberrant behavioral stressors and the health outcomes of spouse caregivers. A secondary data analysis was conducted on 315 caregivers who provided home-care to a spouse with chronic dementia. Major variables included three types of aberrant behaviors (Forgetful, Socially Disruptive, and Disoriented), indices of how upset the caregiver was, corresponding to each type of aberrant behavior, and health of the caregiver (depression, anxiety, and somatic symptoms). Bivariate analyses revealed that Socially Disruptive behavior was most strongly correlated with caregiver upset, although this form of upset was less strongly correlated to health of the caregiver than upsets related to Forgetful and Disoriented behaviors. Compared to patient behaviors, caregiver upset had a stronger relationship to caregiver health. Caregivers who were most upset about patient behaviors suffered from greater depression, anxiety, and somatic symptoms. Caregivers who experienced higher levels of Disoriented and Socially Disruptive behaviors suffered from higher degrees of anxiety and somatic symptoms, respectively. Gender had little impact upon the explanation of health outcomes although female caregivers who experienced Forgetful and Disoriented behaviors and who were upset about them, were significantly more likely to be anxious and exhibit somatic symptoms. Age of the caregiver, however, had no effect on explaining any health outcome. Findings support the cognitive-phenomenological model of stress which proposed that subjective perceptions, not environmental stressors alone, is the major determining factor in the adaptational outcome of the individual. Thus, the importance of psychological mediators, such as the feeling of upset, in the care of the community demented is useful in underst and ing and suggesting policies for how some caregivers may avoid negative health effects.Ph.D.GerontologyUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/161963/1/8821638.pd

Predictors of objectively measured medication nonadherence in adults with heart failure

Medication nonadherence rates are high. The factors predicting nonadherence in heart failure remain unclear.status: publishe

Determinants of Excessive Daytime Sleepiness and Fatigue in Adults With Heart Failure

Little is known about excessive daytime sleepiness (EDS) in heart failure (HF). The aim of this cross-sectional descriptive study was to describe the prevalence of EDS and factors associated with it in HF. A secondary purpose was to explore the correlates of fatigue. We enrolled a consecutive sample of 280 adults with a confirmed diagnosis of chronic HF from three outpatient settings in the northeastern United States. Patients with major depressive illness were excluded. Clinical, sociodemographic, behavioral, and perceptual factors were explored as possible correlates of EDS. Using an Epworth Sleepiness Scale score \u3e 10, the prevalence of EDS was 23.6%. Significant determinants of EDS were worse sleep quality (p = .048), worse functional class (p = .004), not taking a diuretic (p = .005), and lack of physical activity (p = .04). Only sleep quality was associated with fatigue (p \u3c .001). Sleep-disordered breathing was not significantly associated with EDS or with fatigue. These factors may be amenable to intervention

Excessive daytime sleepiness is associated with poor medication adherence in adults with heart failure

A relationship between excessive daytime sleepiness (EDS) and poor treatment adherence has been suspected but not confirmed. We hypothesized that medication adherence would be poorer in adults with heart failure (HF) and EDS and that cognitive status would be the mechanism of effect