Psychometric properties of the Polish version of the eight-item Morisky Medication Adherence Scale in hypertensive adults.

Low adherence to pharmacological treatment is often associated with poor blood pressure control, but identification of nonadherent patients in outpatient settings is difficult. The aim of the study was to translate and evaluate the psychometric properties of the Polish version of the structured self-report eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with hypertension. The study was conducted in a family doctor practice between January and July 2015. After a standard "forward-backward" procedure to translate MMAS-8 into Polish, the questionnaire was administered to 160 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach's α) and test-retest reliability. Validity was confirmed using known group validity. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); and 8 (high). Complete questionnaires were returned by 110 respondents (mean age: 60.7 years ±12.6; 54.6% were female). The mean number of pills taken daily was 3.61±4.31. The mean adherence score was 6.42± 2.0. Moderate internal consistency was found (Cronbach's α=0.81), and test-retest reliability was satisfactory (r=0.461-0.905; P<0.001). Reproducibility expressed by Cohen's κ coefficient =0.61 was good. In high-adherent patients, the percentage of well-controlled blood pressure was higher than in low-adherent patients (33.3% vs 19.1%, χ (2)=0.87, P=0.648). Psychometric evaluation of the Polish version of the MMAS-8 indicates that it is a reliable and valid measure tool to detect nonadherent patients. The MMAS-8 may be routinely used to support communication about the medication-taking behavior in hypertensive patients

Jakość życia zależna od stanu zdrowia u chorych na astmę oskrzelową

A patient is not, or at least should not be, a passive subject, but the active participant of the process of asthma treatment. This naturally imposes covering patients with bronchial asthma with a holistic model of care. Assessment of health-related quality of life (HRQoL) is one component of this model. HRQoL of asthma patients can be determined with an array of generic instruments, e.g. Medical Outcomes Survey Short Form 36 (SF-36), EuroQoL questionnaire (EQ-5D) or World Health Organization Quality of Life Questionnaire (WHOQOL), as well as with the specific tools, among which Saint George’s Respiratory Questionnaire (SGRO) and Asthma Quality of Life Questionnaire (AQLQ) belong to the most widely used. HRQoL is significantly associated with the degree of asthma control. However, literature data suggest that a determination of HRQoL alone, with either specific or generic instrument, can be insufficient, as the level of health-related quality of life turned out to be modulated by three groups of factors: 1) demographic characteristics of patients, 2) clinical parameters, and 3) personality traits of respondents. Due to particularly strong effect of psychological characteristics on the quality of life of patients with bronchial asthma, also the level of depressiveness should be examined along with the HRQoL determination. Furthermore, complex assessment of the quality of life and its determinants should be conducted longitudinally, either in individual patients or in epidemiological studies.W procesie terapii astmy pacjent nie jest — a przynajmniej nie powinien być — biernym podmiotem, lecz aktywnym uczestnikiem. W sposób naturalny narzuca to objęcie chorych na astmę oskrzelową holistycznym modelem opieki. Jednym z jego elementów jest ocena jakości życia związanej ze stanem zdrowia (HRQoL). Do oceny HRQoL u chorych na astmę oskrzelową można wykorzystać wiele instrumentów generycznych, na przykład Medical Outcomes Survey Short Form 36 (SF-36), kwestionariusz EuroQoL (EQ-5D) czy World Health Organization Quality of Life Questionnaire (WHOQOL), a także specyficzne narzędzia, spośród których najczęściej stosuje się Kwestionariusz Szpitala Św. Jerzego (SGRO) oraz Asthma Quality of Life Questionnaire (AQLQ). HRQoL jest czynnikiem związanym istotnie ze stopniem kontroli astmy. W świetle danych literaturowych wydaje się jednak, że samo określenie HRQoL za pomocą specyficznego lub generycznego instrumentu nie jest wystarczające. Wykazano bowiem, że na poziom jakości życia związanej ze stanem zdrowia wpływają trzy grupy czynników: 1) charakterystyki demograficzne chorych, 2) parametry kliniczne, oraz 3) cechy osobowości badanych. Z uwagi na szczególnie istotny wpływ charakterystyk psychologicznych na jakość życia pacjentów z astmą oskrzelową, równolegle z oceną HRQoL należy określić także poziom depresyjności. Co więcej, kompleksowa ocena jakości życia i jej determinant psychologicznych powinna być prowadzona w sposób ciągły — zarówno u indywidualnych pacjentów, jak i w badaniach epidemiologicznych

Ethical issues concerning cardiac surgery in elderly patients — the nurse’s role as a patient advocate: A case report

Introduction: Frailty syndrome (FS) is one of the well-known risk factors for cardiac surgical treatment. Moreover, older patients are more likely to suffer from various comorbidities. Ethical issues that arise in patient care should be considered, including their identification, analysis, and appropriate resolution. The study aimed to present the nurse’s role in the therapeutic team, which should take the floor as a patientadvocate representing her/his interest.Case presentation: An 82-year-old patient was admitted to the Cardiac Surgery Clinic and was discussed in the context of emerging ethical dilemmas in clinical practice. The peri-operative risk was assessed as high; the nurse identified both frailty phenotype and FS. Currently, at postoperative day 40, the patient remains sedated, haemodynamically unstable, and has a poor long-term prognosis.Summary: If the patient is not presented with a risk assessment that includes FS assessment during the qualification process, it can be concluded that this omission violates the information component of informed consent. Nurses must speak out in those patients’ interests in order to preclude actions that may increase their vulnerability during cardiac surgery

Zastosowanie modelu adaptacyjnego Callisty Roy w opiece nad chorym ze stwardnieniem rozsianym – opis przypadku

Introduction. Multiple sclerosis (Sclerosis Multiplex — MS) is a chronic disease of the central nervous system characterized by inflammation and the loss of myelin sheath surrounding the axon. A result of disseminated demyelination process in patients suffering from MS, is a wide variety of symptoms that lead to changes in terms of functioning both in biological and psychosocial aspects. The skilful preparation of a patient to find the optimal way of dealing with the disease, as well as maintaining independence and joy of life is an essential part of the therapeutic process in patients with MS.Aim. The aim of this study was to use the Callista Roy adaptation model in the care of a patient suffering from multiple sclerosis, namely:— demonstrate the usefulness of the holistic Callista Roy adaptation model in the care of chronically ill patients,— prepare a patient to cope with the problems induced by the disease, based on the nursing process developed in line ith the guidlines of C. Roy model.Case Report. A case study of a 69 year old patient with multiple sclerosis (SM) was prepared on the basis of medical documentation (personal information forms from hospitals), an interview with the patient and direct observations.Discussion. The nursing care model based on the theory by Callista Roy proved to be very useful in the process of taking care of a patient chronically ill with SM, as it guaranteed satisfying the needs of a patient in terms of bio-psychosocial aspect, but it also gave the opportunity to acquire skills to cope with problems resulting from the disease.Conclusions. The nursing process based on the theory by Callista Roy requires from a nurse an individual and holistic approach to a patient and patient’s problems. The model structure provides a comprehensive delivery of nursing care and ensures continuous contact with a patient. This is particularly important in the era of technology development in modern medicine.(JNNN 2015;4(3):121–129)Wstęp. Stwardnienie rozsiane (Sclerosis Multiplex — SM) jest przewlekłą chorobą centralnego układu nerwowego, która charakteryzuje się stanem zapalnym i utratą osłonki mielinowej wokół aksonu. W wyniku rozsianego procesu demielinizacyjnego u pacjentów chorujących na SM obserwuje się wiele różnorodnych objawów prowadzących do zmian w funkcjonowaniu zarówno w aspekcie biologicznym, jak i psychospołecznym. Umiejętne przygotowaniepacjenta do znalezienia optymalnego sposobu radzenia sobie z chorobą, a także zachowania samodzielności i radości życia jest niezbędnym elementem procesu terapeutycznego chorych na SM.Cel. Próba zastosowania modelu adaptacyjnego Callisty Roy w opiece nad pacjentką chorującą na stwardnienie rozsiane, czyli:— wykazanie przydatności holistycznego modelu adaptacyjnego Callisty Roy w opiece nad przewlekle chorym,— przygotowanie pacjenta do radzenia sobie z problemami wynikającymi z choroby w oparciu o proces pielęgnowania opracowany zgodnie z założeniami modelu C. Roy.Opis przypadku. Studium przypadku 69-letniej pacjentki ze stwardnieniem rozsianym zostało opracowane na podstawie analizy dokumentacji medycznej (kart informacyjnych ze szpitali), przeprowadzonego wywiadu z pacjentką oraz bezpośredniej obserwacji.Dyskusja. Model pielęgnowania oparty na teorii Callisty Roy okazał się bardzo przydatny w procesie pielęgnowania przewlekle chorego z SM, ponieważ zagwarantował pacjentce zaspokojenie jej potrzeb bio-psycho-społecznych, aletakże dał możliwość nabycia umiejętności radzenia sobie z problemami wynikającymi z choroby.Wnioski. Proces pielęgnowania oparty na teorii Callisty Roy wymaga od pielęgniarki rozpatrywania pacjenta i jego problemów w sposób zindywidualizowany i całościowy. Struktura modelu zapewnia kompleksowe świadczenie usług pielęgniarskich i gwarantuje ciągły kontakt z pacjentem. Jest to szczególnie ważne w dobie technicyzacji we współczesnej medycynie.(PNN 2015;4(3):121–129

Digital health and modern technologies applied in patients with heart failure: Can we support patients' psychosocial well-being?

Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients' health outcomes. Technology now offers promising ways to integrate personalized support from health care professionals via a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care

Self-Reported Medication Adherence Measured With Morisky Medication Adherence Scales and Its Determinants in Hypertensive Patients Aged ≥60 Years: A Systematic Review and Meta-Analysis

Background: The aim of this systematic review and meta-analysis was to estimate medication adherence in hypertensive patients aged ≥60 years and to explore potential determinants of adherence with antihypertensive treatment in this age group.Methods: A systematic search of the PubMed, Scopus, and Google Scholar using the Cochrane guidelines was performed. The analysis included articles published between 1 January 2000 and 30 June 2018. The patients were considered adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale (MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL). If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for determinants of medication adherence were recorded.Results: Thirteen studies including a total of 5,247 patients were available for the meta-analysis. The pooled percentage of adherence was 68.86% (95% CI: 57.80–79.92%). Subgroup analysis did not demonstrate a significant difference in the adherence measured with the MMAS-8 and the MGL (68.31 vs. 70.39%, P = 0.773). The adherence of patients from Western countries (Europe, United States) turned out to be significantly higher than in other patients (83.87 vs. 54.30%, P = 0.004). The significant determinants of better adherence identified in more than one study were older age, retirement/unemployment, duration of hypertension >10 years, and a lower number of prescribed drugs.Conclusion: Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons. Adherence in older persons was associated with age, socioeconomic status, and therapy-related factors

Job satisfaction among school nurses

Introduction Job satisfaction among Polish nurses is a significant predictor of the quality of health care provided. A school nurse is a specialist who improves student well-being, promotes health behaviours, advances academic and life success, thus, high levels of motivation and job satisfaction are indispensable to manage this role. Aim The aim of the research was to assess the factors affecting job satisfaction among school nurses. Material and methods The study was conducted among 125 nurses working in Polish schools. Sociodemographic data were obtained using an original questionnaire developed by the authors. The level of job satisfaction was assessed on the basis of the Satisfaction with Work Questionnaire (SPP). Results The mean age of the group studied was 52.7±7.2 years. 93.6% of the respondents had a work experience exceeding 15 years, 42.3% were medical vocational college graduates. Analysis of the SPP questionnaire showed that the group surveyed obtained an average of 5.0±1.0 points (min.2.8, max.7.0). Higher SPP scores were observed in the group of nurses with shorter job seniority (

Quality of life and health behaviours of patients with tuberculosis — sex differences

Introduction: Despite the introduction of effective antituberculosis drugs, tuberculosis (TB) is still a serious health problem and one of the most significant causes of death among infectious diseases. Current publications indicate an increase of tuberculosis cases among smokers, diabetics, malnurished subjects and those abusing alcohol and drugs. In the literature, there are only few studies raising the topic of the quality of life (QoL), stress management and health behaviour among patients with tuberculosis. The aim of this study was to evaluate QoL of patients with tuberculosis taking into account gender differences. In the study, the analysis of knowledge, health behaviour and stress management among TB patients depending on sex was carried out. Material and methods: The study included 80 subjects diagnosed with TB (including 38 females) who were hospitalised at the Regional Hospital Centre of Kotlina Jeleniogórska, Medical Unit Wysoka Łąka, Pulmonology and Phthisiology Department in Kowary between August 2012 and January 2013. The following questionnaires were used in the study: Mini-COPE — evaluating stress management, WHOQoL — assessing the quality of life of patients, IZZ — assessing health behaviour. Results: A difference with regards to sociodemographic profile between females and males was observed. Half of the women surveyed were working (50% vs 19% of men), whereas half of men were entitled to unemployment benefit (50% vs 18.4% of women). More than half of women lived with their family (55.3%), whereas 47.6% of men lived alone. The majority of the subjects consumed alcohol occasionally (60.2% of women vs 45.2% of men), but as many as 31% of male patients vs 7.9% of females admitted that they consumed alcohol frequently. Among the respondents, people who consumed alcohol occasionally dominated (60.2% women vs. 45.2% of men), but as many as 31% of male patients vs. 7.9% of women admitted to consume alcohol frequently. Quality of life (QoL) assessment has shown no statistically significant differences between the sexes in this field. The respondents rated lowest their QoL in the physical domain, 12.4 ± 3.1 (12.9 ± 3.0 women vs. 11.8 ± 3.1 men) and 12.6 ± 2.4 in the environmental domain (13.1 ± 2.3 women vs 12.1± 2.4 men). Women received a higher rating of health behaviour on all subscales of the IZZ questionnaire, with the highest score in the prevention behaviour subscale (3.6 ± 0.7) and the lowest in the subscale of proper eating habits (3.1 ± 0.8). In men the highest score of health behaviour was observed in the subscale of positive mental attitude (3.1 ± 1.0) and the lowest in the subscale of proper eating habits (2.5 ± 0.8). Conclusions: 1. There are differences between sociodemographic profile of TB patients: women are younger, better educated, economically active and more likely to remain in relationships; 2. There is no difference in QoL of TB patients between the sexes, whereas there are differences in the strategies of stress management and in applied health behavior; 3. Differences between genders indicate the need for matching treatment and preventive action for different patients profiles based on the cooperation of doctors, social workers, therapists, and psychologists.Introduction: Despite the introduction of effective antituberculosis drugs, tuberculosis (TB) is still a serious health problem and one of the most significant causes of death among infectious diseases. Current publications indicate an increase of tuberculosis cases among smokers, diabetics, malnurished subjects and those abusing alcohol and drugs. In the literature, there are only few studies raising the topic of the quality of life (QoL), stress management and health behaviour among patients with tuberculosis. The aim of this study was to evaluate QoL of patients with tuberculosis taking into account gender differences. In the study, the analysis of knowledge, health behaviour and stress management among TB patients depending on sex was carried out. Material and methods: The study included 80 subjects diagnosed with TB (including 38 females) who were hospitalised at the Regional Hospital Centre of Kotlina Jeleniogórska, Medical Unit Wysoka Łąka, Pulmonology and Phthisiology Department in Kowary between August 2012 and January 2013. The following questionnaires were used in the study: Mini-COPE — evaluating stress management, WHOQoL — assessing the quality of life of patients, IZZ — assessing health behaviour. Results: A difference with regards to sociodemographic profile between females and males was observed. Half of the women surveyed were working (50% vs 19% of men), whereas half of men were entitled to unemployment benefit (50% vs 18.4% of women). More than half of women lived with their family (55.3%), whereas 47.6% of men lived alone. The majority of the subjects consumed alcohol occasionally (60.2% of women vs 45.2% of men), but as many as 31% of male patients vs 7.9% of females admitted that they consumed alcohol frequently. Among the respondents, people who consumed alcohol occasionally dominated (60.2% women vs. 45.2% of men), but as many as 31% of male patients vs. 7.9% of women admitted to consume alcohol frequently. Quality of life (QoL) assessment has shown no statistically significant differences between the sexes in this field. The respondents rated lowest their QoL in the physical domain, 12.4 ± 3.1 (12.9 ± 3.0 women vs. 11.8 ± 3.1 men) and 12.6 ± 2.4 in the environmental domain (13.1 ± 2.3 women vs 12.1± 2.4 men). Women received a higher rating of health behaviour on all subscales of the IZZ questionnaire, with the highest score in the prevention behaviour subscale (3.6 ± 0.7) and the lowest in the subscale of proper eating habits (3.1 ± 0.8). In men the highest score of health behaviour was observed in the subscale of positive mental attitude (3.1 ± 1.0) and the lowest in the subscale of proper eating habits (2.5 ± 0.8). Conclusions: 1. There are differences between sociodemographic profile of TB patients: women are younger, better educated, economically active and more likely to remain in relationships; 2. There is no difference in QoL of TB patients between the sexes, whereas there are differences in the strategies of stress management and in applied health behavior; 3. Differences between genders indicate the need for matching treatment and preventive action for different patients profiles based on the cooperation of doctors, social workers, therapists, and psychologists

Importance of education in bronchial asthma treatment — gender differences

Introduction: Despite significant progress in understanding mechanisms and effective treatment there are still therapeutic failures in patients treated for bronchial asthma. Education is vital in the therapeutic process. It improves the control of the disease at the individual level by influencing the adherence and compliance. Material and methods: The study included 100 patients suffering from bronchial asthma and treated according to GINA 2002 guidelines in Allergy Clinic. Asthma control test (ACT), analysis of patients’ medical documentation and a self-constructed questionnaire concerning health promotion and education were used in the study. Aim of this work was to assess differences in the influence of education on results of bronchial asthma control between sexes. Results: Average duration of asthma was similar in women and men (13.0 ± 11.16 vs.12.7 ± 9.74 years). Weaker asthma control was found in women (ACT 17.7 vs. 20.4), as well as lower FEV1 values (80−50% of predicted value in 60.3% of women vs. 43.25 of men). In women an analysis of correlation concerning patients’ knowledge and conducted health education with asthma control revealed a statistically significant positive correlation of knowledge acquired from the allergologist with asthma control, information about proceeding in acute attack, whereas negative correlation with asthma control with knowledge passed on by family doctor was found. Among the male respondents positive correlations of knowledge with asthma control within the scope of knowledge from allergologist and information concerning proceeding in asthmatic attack were found, while negative correlation with information coming from family doctor was revealed. Conclusions: Health education in patients with asthma should be conducted by a specialist in allergic diseases and well-prepared healthcare professionals

Impact of cognitive function on compliance with treatment in heart failure

Jankowska-Polańska Beata, Kuśnierz Maria, Dudek Krzysztof, Jaroch Joanna, Uchmanowicz Izabella. Impact of cognitive function on compliance with treatment in heart failure. Journal of Education, Health and Sport. 2017;7(2):392-420. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.400294 http://ojs.ukw.edu.pl/index.php/johs/article/view/4337 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 754 (09.12.2016). 754 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2017; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.02.2017. Revised 15.02.2017. Accepted: 28.02.2017. Impact of cognitive function on compliance with treatment in heart failure Wpływ funkcji poznawczych na przestrzeganie zaleceń terapeutycznych w niewydolności serca Beata Jankowska-Polańska*a, Maria Kuśnierza, Krzysztof Dudekb, Joanna Jarochc, Izabella Uchmanowicza aDepartment of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 5 Bartla Street, 51-618 Wroclaw, Poland. bDepartment of Logistic and Transport Systems, Faculty of Mechanical Engineering, Wroclaw University of Technology, 27 Wyspianski street, 50-370 Wroclaw, Poland. c Marciniak Lower-Silesian Specialist Hospital ‒ Emergency Medicine Centre, Cardiology Unit Corresponding author: Beata Jankowska-Polańska, Department of Clinical Nursing, Wroclaw Medical University, K. Bartla 5, 51-616 Wroclaw, Poland. Tel.: +48 71 784 1824; Fax: +48 71 345 9324. E-mail addresses: (B. Jankowska-Polańska) [email protected] (Marysia Kuśnierz) [email protected] (I. Uchmanowicz) [email protected] (Krzysztof Dudek) [email protected] (Joanna Jaroch) [email protected] Abstract: In heart failure (HF) patients frailty syndrome and cognitive impairment (CI) affect outcome by decreasing the capability for performing self-care, adhering to the prescribed treatment regimen, monitoring symptoms. The aim was to investigate whether CI affects the compliance to therapeutic regimens. Methods: 170 with HF were included. We employed the Mini Mental State Examination (MMSE), for dementia and the Revised Heart Failure Compliance Scale to assess compliance. Results: CI patients showed lower compliance in all domains: 2.8±1.0 vs 3.3±1.0 (keeping appointments), 2.8±0.9 vs. 3.4±0.9 (pharmaceutical compliance), 0.4±0.8 vs. 1.4±1.2 (regular body weight monitoring), 2.0±1.3 vs. 2.7±1.0 (reduced salt intake), 1.9±1.2vs. 2.9±1.0 (fluid intake restriction), and 0.5±0.8 vs. 1.7±1.1 (regular exercise). Multiple regression analysis showed cognitive function to be an independent predictor for regular body weight monitoring (β=1.223;p<0.001), fluid intake restriction (β=1.081;p<0.001), and regular exercise (β=1.237;p<0.001). In multivariate analysis, the stimulant variables for compliance with HF treatment were: education (β=1.124), being in a relationship (β=2.231), and lack of cognitive impairment (β=0.320); the number of hospitalizations due to HF was identified as a destimulant (β=-0.495). Conclusion: Non-compliance is a major problem in elderly with HF. The cognitive function is an independent contributor to total compliance and to compliance with non-pharmaceutical recommendations. Being in a relationship and education are independent predictors of better compliance, while the number of rehospitalizations due to HF exacerbations is an independent predictor of worse compliance. Early detection of CI may offer an opportunity for intervention and a key strategy for improving clinical outcomes in older adults with HF. Streszczenie: U pacjentów z niewydolnością serca występowanie zespołu kruchości i zaburzeń funkcji poznawczych może wpływać na efekty leczenia, poprzez zmniejszenie możliwości samoopieki, przestrzegania ustalonych schematów terapeutycznych oraz upośledzenie monitorowania objawów. Celem badania była ocena związku funkcji poznawczych z przestrzeganiem zaleceń terapeutycznych w leczeniu niewydolności serca. Metody: Do badania włączono 170 pacjentów z rozpoznaną niewydolnością serca. W badaniu wykorzystano Mini Mental State Examination (MMSE) do oceny funkcji poznawczych oraz Revised Heart Failure Compliance Scale (RHFCS) do oceny przestrzegania zaleceń terapeutycznych ograniczania podaży sodu w diecie, ograniczenia płynów, codziennego ważenia i aktywności fizycznej. Wyniki Pacjenci z zaburzeniami funkcji poznawczych mają niższy poziom przestrzegania zaleceń w zakresie wszystkich domen kwestionariusza RHFCS, stosownie: przestrzeganie wizyt kontrolnych (2.8 ± 1.0 vs 3.3 ± 1.0), przestrzeganie zaleceń farmakologicznych (2.8 ± 0.9 vs. 3.4 ± 0.9), regularna kontrola masy ciała (0.4 ± 0.8 vs. 1.4 ± 1.2), ograniczenia spożycia soli (2.0 ± 1.3 vs. 2.7 ± 1.0), ograniczenia spożycia płynów (1.9 ±1.2 vs. 2.9 ±1.0), regularna aktywność fizyczna (0.5 ±0.8 vs. 1.7 ±1.1). Analiza regresji wielorakiej pokazała, że funkcje poznawcze są niezależnym predyktorem związanym z regularną kontrolą masy ciała (β=1.223; p<0.001), ograniczeniem płynów (β=1.081; p<0.001) i regularną aktywnością fizyczną (β=1.237; p<0.001). W analizie wieloczynnikowej niezależnymi predyktorami dostosowania do terapii niewydolności serca (stymulantami) okazały się: wykształcenie (β-1.124), życie w związku (β=2.231) i brak zaburzeń funkcji poznawczych (suma punktów kwestionariusza MMSE) (β=0.320) natomiast destymulantem - liczba hospitalizacji z powodu niewydolności serca. (β=-0.495) Wnioski Nieprzestrzeganie zaleceń terapeutycznych jest istotnym problemem wśród pacjentów z niewydolnością serca w wieku podeszłym. Funkcje poznawcze są niezależnym predyktorem mającym związek z przestrzeganiem zaleceń terapeutycznych. Życie w związku i wykształcenie są niezależnymi predyktorami zwiększającymi przestrzeganie zaleceń terapeutycznych, natomiast liczba rehospitalizacji z powodu zaostrzenia niewydolności serca jest niezależnym predyktorem obniżającym przestrzeganie zaleceń terapeutycznych. Wczesne rozpoznawanie zaburzeń funkcji poznawczych może przyczyniać się do lepszego planowania interwencji i strategii zmierzającej do poprawy przestrzegania zaleceń i zwiększenia skuteczności leczenia. Key words: heart failure, compliance, cognitive function Słowa kluczowe: niewydolność serca, przestrzeganie zaleceń, funkcje poznawcz