van der Wal Martje H L, Jaarsma Tiny
Department of Cardiology, University Medical Center Groningen, University of Groningen, The Netherlands.
Int J Cardiol. 2008 Apr 10;125(2):203-8. doi: 10.1016/j.ijcard.2007.10.011. Epub 2007 Nov 26.
As a result of the improvement of pharmacological and non-pharmacological treatment of heart failure patients, the heart failure regimen is becoming more complicated, especially for elderly patients with co-morbid diseases. Non-adherence to this regimen is a problem in many heart failure patients, leading to worsening symptoms, rehospitalization and decreased quality of life.
This paper gives an overview of literature on adherence to pharmacological and non-pharmacological treatment in elderly heart failure patients. The paper addresses the definition of adherence and the extent and significance of the problem of non-adherence in elderly heart failure patients. Factors contributing to non-adherence, focused on the elderly are outlined and finally interventions to improve adherence in this elderly heart failure patient group are described.
Non-adherence to medication and lifestyle recommendations is a major problem in elderly heart failure patients. Five dimensions that affect adherence are described consisting of social and economic factors, factors related to the health care system, to the condition of the patient, the therapy and factors related to the patient. Since non-adherences is a multidimensional problem, interventions need to be directed to all factors that are related to adherence in elderly heart failure patients. A multidisciplinary approach in a heart failure team is crucial to improve adherence in this vulnerable patient group. Effectiveness of interventions to improve adherence in elderly heart failure patients needs to be further tested.
由于心力衰竭患者药物和非药物治疗的改善，心力衰竭治疗方案变得更加复杂，尤其是对于患有合并症的老年患者。许多心力衰竭患者存在不依从该治疗方案的问题，导致症状恶化、再次住院和生活质量下降。
本文综述了老年心力衰竭患者药物和非药物治疗依从性的相关文献。本文阐述了依从性的定义以及老年心力衰竭患者不依从问题的程度和意义。概述了导致不依从的因素，重点关注老年人，并最终描述了改善该老年心力衰竭患者群体依从性的干预措施。
不依从药物治疗和生活方式建议是老年心力衰竭患者的一个主要问题。描述了影响依从性的五个维度，包括社会和经济因素、与医疗保健系统相关的因素、患者状况、治疗以及与患者相关的因素。由于不依从是一个多维度问题，干预措施需要针对与老年心力衰竭患者依从性相关的所有因素。心力衰竭团队采用多学科方法对于提高该脆弱患者群体的依从性至关重要。改善老年心力衰竭患者依从性的干预措施的有效性需要进一步检验。
