Evangelista Lorraine, Doering Lynn V, Dracup Kathleen, Westlake Cheryl, Hamilton Michele, Fonarow Gregg C
School of Nursing, University of California, Los Angeles Calif 90095-6918, USA.
J Cardiovasc Nurs. 2003 Jul-Aug;18(3):197-206; quiz 207-8. doi: 10.1097/00005082-200307000-00005.
Although compliance behaviors of heart failure (HF) patients have become the focus of increasing scrutiny in the last decade, the prevalence of noncompliance among elderly patients with HF is poorly understood. We conducted this study to describe and compare the compliance behaviors of elderly patients (> or = 65 years) and younger patients (< 65 years) with HF on 6 prescribed activities: medical appointments, medications, diet, exercise, smoking cessation, and alcohol abstinence. Data from a sample of 140 older (50%) and younger (50%) HF patients matched for genderand disease severity were collected with the HF Compliance Questionnaire and analyzed via descriptive statistics, chi-square, paired t-tests, and Pearson correlations. We found that elderly patients were more compliant with diet (77% vs 65%, p = .001) and exercise (67% vs 55%, p = .021) than were their younger counterparts. There was no difference in the other health care behaviors. Of the 70 elderly patients, 51% reported some degree of difficulty complying with exercise while 37%, 24%, and 23% had difficulty following diet, keeping follow-up appointments, and taking medications, respectively. A smaller percentage of elders continued to smoke (9%) and drink alcohol (18%). Patients were asked why they had difficulty following their health care regimens; responses varied by prescribed activity. Lastly, we found inverse relationships between perceived difficulty following and compliance with all of the 6 behaviors measured (p < .001); as difficulty increased, compliance decreased. Strategies to help older patients minimize perceived difficulties associated with health care regimens may improve compliance and long-term morbidity and mortality from HF. Assumptions about older age being related to noncompliance appear invalid in patients with HF.
尽管在过去十年中，心力衰竭（HF）患者的依从行为已成为越来越多审查的焦点，但老年HF患者中不依从的患病率仍知之甚少。我们开展这项研究，以描述和比较老年患者（≥65岁）和年轻患者（<65岁）HF患者在6项规定活动中的依从行为：医疗预约、药物治疗、饮食、运动、戒烟和戒酒。使用HF依从性问卷收集了140名年龄较大（50%）和较年轻（50%）、性别和疾病严重程度相匹配的HF患者的数据，并通过描述性统计、卡方检验、配对t检验和Pearson相关性分析。我们发现，老年患者在饮食（77%对65%，p = 0.001）和运动（67%对55%，p = 0.021）方面比年轻患者更依从。在其他医疗行为方面没有差异。在70名老年患者中，51%报告在运动依从方面有一定程度的困难，而分别有37%、24%和23%的患者在饮食、遵守随访预约和服药方面有困难。继续吸烟（9%）和饮酒（18%）的老年人比例较小。患者被问及为何在遵循医疗方案方面有困难；回答因规定活动而异。最后，我们发现所感知的遵循困难与所测量的所有6种行为的依从性之间存在负相关关系（p < 0.001）；随着困难增加，依从性降低。帮助老年患者将与医疗方案相关的感知困难降至最低的策略可能会提高依从性以及HF的长期发病率和死亡率。关于老年与不依从相关的假设在HF患者中似乎是无效的。
