Helping older patients to cope with cardiac and pulmonary disease

Family challenges, depression, and age-related developmental and psychological issues must be considered when structuring interventions for elder cardiopulmonary patients. Elderly patients tend to have difficulty coping when they face novel, unpredictable circumstances and are left to flounder in suspenseful anticipation. Furthermore, if support is not forthcoming during such times--or if they are treated in ways that strip them of control rather than in ways that bolster their sense of control--elderly patients are at great risk of quickly developing a passive, learned helplessness that can significantly complicate their rehabilitation. The overall well-being of elderly cardiopulmonary patients is affected by more than the actions of health-care providers. Poverty, pension and health-care plans, institutionalization, concomitant diseases, family issues, and other factors have a profound and, frequently, an overriding effect on the functional status of the elderly population. However, it is also true that the provision of spirit-enhancing care can make a tremendous difference in quality of life for elderly patients, independent of factors such as residential circumstance or health status. The most valued and valuable sources of social support for elderly patients come from family, church, and health-care providers. Our interventions either enhance or diminish an elderly patient's sense of autonomy and control. Our task-driven health-care system, replete with its growing emphasis on brevity of treatments and cost-effectiveness, can create a style and pace of delivering care that demoralizes an elderly patient. The results can be devastating: "When the spirit is broken, one has no will to marshall coping skills". But health-care providers who are attuned to the psychosocial issues relevant to the later life stages can make a profound difference in enhancing both rehabilitation and quality of life for elderly cardiopulmonary patients and their loved ones.