Table 3 Study Outcomes, Impact of Cognitive Impairment, Relevant Risk Factors and Suggested Strategies
From: Self-management of heart failure in dementia and cognitive impairment: a systematic review
Author | Study Outcome (n and/or %) | Impact of Cognitive Impairment on Self- care | Other Risk Factors for Self-Care Impairment | Suggested Strategies/Intervention |
|---|---|---|---|---|
Alosco, 2012 | Adherence Score: 84.0/100 SD = 11.6. 16% were Non-Adherenta | ↓Attention:↓Doctor’s Appointment Adherence (r(138) = 0.29, p < 0.001) & ↓Medication Management (r(138) = 0.25, p < 0.01). ↓Executive Function: ↓Doctor’s Appointment Adherence (r(138) = 0.29, p < 0.001). ↓Language:↓Medication Management (r(138) = 0.28, p < 0.01) &↓Diet Adherence (r(138) = 0.17, p = 0.04) | Myocardial infarction is associated with↑ treatment adherence (ß = 0.23, p = 0.01) | Cognitive function assessment can influence the course of heart failure management |
Alosco, 2012 | Activities of daily living score: 25.2/28 (SD = 3.4) | ↓TMTA performance (Attention, Visuospatial): ↓Medication Management (ß = − 0.24, p < 0.05) ↓MMSE:↓Driving scores (ß = − 0.25, p < 0.001) | – | Regular screening of cognitive impairment can provide information about self-care behaviors |
Alosco, 2014 | Instrumental activities of daily living score: 13.5/16 (SD = 2.9). ↓Executive function: ↑Cigarette smoking (r(167) = − 0.20, p = 0.01) | ↓Executive function: ↓Instrumental activities of daily living performance (ß = 0.24, p = 0.01) – Especially food preparation (r(167) = 0.16, p < 0.03) & medication management (r(167) = 0.15, p = 0.05). ↓Executive function associated with ↑cigarette use (r(167) = − 0.20, p = 0.01). | Male (ß = − 0.29, p < 0.001), Diabetes (ß= − 0.19, p = 0.01) Depression (ß = − 0.15, p = 0.04) associated with↓instrumental activities of daily living performance | Technological devices which promote executive function could improve self-care outcomes. |
Cameron, 2009 | Self-care maintenance: 67.8/100, SD = 17.3 Self-care management: 50.1/100, SD = 16.6 Self-care confidence: 62.0/100, SD = 20.0 The 7 variable modelb = 39% of variance in Self-care maintenance & 38% of variance in Self-care management | Cognitive function non-significant factor in 7 variable model however when omitted from the model, 6 variables explain ↓4% of the variance in self-care maintenance (39% - > 35%). This was also seen in self-care management (38 - > 34%) | Self-care maintenance: ↑Age: ↑Self-care maintenance (ß = 0.51, p < 0.01); Significant comorbidity (CCSI≥4): ↑Self-care maintenance (ß = 0.34, p = 0.02). Self-care management: Male: ↓Self-care management (ß = − 0.33, p = 0.02); No significant comorbidity (CCSI< 4) (ß = 0.33, p = 0.03): ↑Self-care management; Depression: ↑Self-care management (ß = 0.32, p = 0.04); ↓Self-care confidence: ↓Self-care management (ß = 0.39, p < 0.01) | Screening for modifiable and non-modifiable factors can ↑ health outcomes and follow up strategies |
Dickson, 2008 | Self-care management: (71.3/100, SD = 18.6) 44% had adequate scores (>70). Self-care maintenance: (71.6/99.99, SD = 14.3) 61% had adequate scores (>70). Significant difference in self-care maintenance and self-care management between expertc, noviced and inconsistent groupse (p = 0.001). | ‘Inconsistent’ group: Cognitive impairment (DSS < 26) had ↑self-care management and ↑self-care maintenance scores vs. ‘↓ vigilant’ and ‘discordant’ (p = 0.02 to 0.03). | – | Developing self-efficacy in difficult situations will lead to (+) self-care decisions and help overcome temptations which leads to ↑self-care confidence |
Habota, 2015 | Trend: Congestive heart failure (mean = 0.5, SD = 0.4) performing ↓ than controls (mean = 0.6, SD = 0.3). For the proportion of tasks missed, there was a main effect of group (F(1,57) = 4.52, p = 0.038, ηp2 = 0.07). The congestive heart failure group (mean = 0.26, SD = 0.31) missed ↑ tasks than the control group (mean = 0.16, SD = 0.21). | – | – | ↑Self-care adherence may need to include prospective memory training |
Harkness, 2014 | Self-care management: MoCA score < 26 (mild cognitive impairment) scored significantly ↓ vs. scores ≥26 (48.1/100 (SD = 24) vs. 59.3/100 (SD = 22), p = 0.035). Also observed with the MoCA cutoff at < 24 and ≥ 24, (45.6/100 (SD = 23) vs. 58.1/100 (SD = 23), p = 0.008) | MoCA was a significant factor (B = 1.784, p = 0.001) in model for self-care management (F(3,96) = 7.04, p < 0.001). Mild cognitively impaired participants (both < 26 and < 24) were ↓ likely to call a doctor or nurse for guidance (52% vs. 89%, p = 0.001, 46% vs. 82%, p < 0.001 respectively) | – | Formal screening for mild cognitive impairment can help to identify individuals who are risk of self-care management difficulty and of delaying assistance from a health care provider. Experiential learning and problem solving skills are important for the elderly. |
Hawkins, 2012 | Cognitive impairment present in 57.6%. Verbal learning, immediate memory, and delayed verbal memory were found to be impaired. Associations with cognitive impairment: Age (OR = 1.42, 95%CI = 1.03–1.95, p = 0.031); African American race (OR = 3.59, 95%CI = 1.90–6.81, p < 0.01); Depression (OR = 1.43, 95%CI = 1.12–1.83, p = 0.004); Former alcohol use (OR = 2.13, 95%CI = 1.06–4.31, p = 0.034); missed follow up of pill count (OR = 2.03, 95%CI = 1.20–3.45, p = 0.009). Medication adherence ↑ in participants with no CI vs. MCI (78.1% vs. 70.7%, p = 0.017) | – | – | Screen patients for cognitive impairment and depression. Interventions should look to target verbal learning, verbal memory and delayed verbal memory |
Hjelm, 2015 | Psychomotor speed associated with self-care (ß = − 0.09, t(99) = −2.92, p = 0.004). No moderating effects of depression were found. | – | – | Screening for impaired psychomotor speed to identify patients in need of individualized self-care teaching. |
Karlsson, 2005 | Intervention group did not have ↑ knowledge vs. control group after 6 months (13.2 (SD = 3.4) vs. 12.7 (SD = 3.3), NS). | MMSE< 24 had ↓ scores in self-care and heart failure knowledge vs. MMSE≥24 (10.1 (SD = 3.6) vs. 12.8 (SD = 3.4), p < 0.01) at baseline. There was no difference between the 2 groups after 6 months. | – | Education of patients should be given individually and given through different means (verbal, written, electronic) |
Kim, 2015 | NYHA I (asymptomatic) vs. NYHA≥II (symptomatic): Global function (27.8 (SD = 2.5) vs. 24.9 (SD = 4.4), p = 0.001), Memory (17.5 (SD = 5.7) vs. 13.4 (SD = 5.2), p = 0.001), executive function (23.4 (SD = 9.8) vs. 16.9 (SD = 9.6), p = 0.002) Also observed in self-care confidence (57.0 (SD = 17.4) vs. 53.2 (SD = 13.8), p = 0.009). | Delayed recall memory predicted self-care confidence adequacy (OR = 1.41, 95%CI = 1.03–1.92, p = 0.033). MACE had ↓ K-MMSE scores vs. ‘event free’ (23.9 vs. 27.1, t = 2.30, p = 0.024). | – | – |
Lee, 2013 | MoCA < 26: ↓Self-care management scores vs. MoCA ≥26 (difference = 8.2%, SD = 3.8%, p = 0.043). MoCA < 24: ↓Adjusted self-care maintenance (difference = 13.8%, SD = 5.4%, p = 0.014) and self-care management scores (difference = 21.4%, SD = 8.0%, p = 0.014) vs. participants with scores ≥24. MoCA < 24 also had significantly lower EHFScBS scores (difference = 38.3%, SD = 11.2%, p = 0.001) | MoCA < 24 had worse adjusted consulting behavior scores (difference = 50.7%, SD = 15.3%, p = 0.001) | – | Cognition should be assessed with clinically appropriate tools (e.g. employing the MoCA cutoff of < 24). Systematic screening for mild cognitive impairment |
Smeulders, 2010 | Participants with TICS< 33 had worse cardiac quality of life at first follow up (Difference = − 6.3, p = 0.027, 95%CI = − 11.9 to − 0.7). Scores were not significantly different at 6 and 12 months. | – | – | Encourage patients with ↓education levels to participate in CDSMP classes. Tailor CDSMP to cognitively impaired patients. Screen for cognitive status and education level. |
Vellone, 2015 | MMSE score influenced self-care maintenance and self-care management through the mediating effects of self-care confidence MMSE predicted self-care confidence. Self-care confidence predicted self-care management and self-care maintenance. Cognition does not have a direct effect on self-care. It only influenced self-care through its effect on self-care confidence | – | Self-care maintenance ↑Illness duration predicted ↑self-care maintenance Self-care management: ↑NYHA class predicted ↓self-care management Self-care confidence: ↓Age and female gender predicted ↑self-care confidence | Interventions that ↑ self-care confidence may ↑self-care even in patients with cognitive impairment. Reward patients for small successes in their adherence to self-care behaviors. Introduce patients to others in the same situation who are proficient at self-care. Tell patients that they are able to be proficient at self-care. Provide and encourage support for patients. |