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Functional abilities of elderly coronary heart disease patients
M Ahto1, R Isoaho, H Puolijoki
1Department of Public Health and General Practice, University of Turku, Turku
Insights
Elderly patients with coronary heart disease (CHD) experience greater functional limitations than healthy individuals. While not independently associated, physical disability in CHD patients is linked to cardiovascular drug use, suggesting a connection.
Area of Science:
- Gerontology
- Cardiology
- Public Health
Background:
- Increasing survival rates for coronary heart disease (CHD) in the elderly population necessitate understanding its impact on functional abilities.
- Previous research has not fully elucidated the relationship between CHD, physical disability, and quality of life in older adults.
Purpose of the Study:
- To describe functional abilities in elderly patients diagnosed with coronary heart disease (CHD).
- To analyze the relationship between physical disability and the severity of chest pain or dyspnea in elderly CHD patients.
- To assess the independent association between physical disability and CHD in the elderly population.
Main Methods:
- A case-control study was conducted in Lieto, Finland, involving 162 elderly CHD patients and 324 age- and sex-matched controls.
- Physical functioning, including mobility, activities of daily living (ADL), and instrumental activities of daily living (IADL), was assessed using interviewer-based questionnaires.
- Logistic regression analyses were employed to examine associations between physical disability and various factors, including CHD, comorbidities, and drug therapy.
Main Results:
- Elderly CHD patients reported significantly more difficulties or dependence in mobility and IADL compared to controls.
- Among female patients, increased chest pain correlated with poorer IADL and mobility; severe dyspnea was linked to poorer mobility in both genders and IADL in males.
- CHD was not independently associated with physical disability, but disability was linked to cardiovascular drug use, suggesting an indirect relationship.
Conclusions:
- Elderly individuals with CHD exhibit greater functional limitations than their non-CHD counterparts, potentially related to disease severity.
- Factors such as depression, cancer, and psychotropic drug use confound the relationship between CHD and functional decline.
- The association between physical disability and cardiovascular drug use suggests a probable causal link between CHD and reduced physical function in the elderly.
Abstract:
The impact of coronary heart disease (CHD) on elderly patients' functional abilities is of growing interest because of the increasing number of people that survive the disease. The aim of our study was, firstly, to describe functional abilities among elderly CHD patients and, secondly, to analyze the relationships between physical disability and the severity of chest pain or dyspnea. The third aim was to assess whether there is an independent association between physical disability and CHD. The study was carried out at the health center of the municipality of Lieto, southwestern Finland. From a population of 1196 community-dwelling persons aged > or = 64 years, 89 men and 73 women with CHD (angina pectoris and/or a past myocardial infarction) were selected along with 178 male and 146 female sex- and age-matched controls without CHD. Physical functioning was assessed by means of interviewer-based questionnaires, compared between patients and controls and described in relation to the severity of chest pain and dyspnea among patients. The associations between dependence or difficulties in mobility, ADL (activities of daily living) and IADL (instrumental activities of daily living) and CHD, age, smoking, comorbidities, drug therapy and clinical characteristics were assessed by logistic regression analyses. On items representing mobility and managing in IADL, patients reported more difficulties or dependence than controls. Among female patients, more severe chest pain was associated with poor managing in IADL and tended to be associated with poor mobility. More severe dyspnea was associated with poor mobility among both male and female patients, and with poor managing in IADL among male patients. Logistic regression analyses failed to show that CHD was associated independently with physical disability among the elderly. However, physical disability was associated with the use of cardiovascular drugs in the models among both genders, which probably indirectly indicated an association between physical disability and CHD. Several confounding factors, such as higher age, depression, cancer and the use of psychotropic drugs, contributed to the decline in functional abilities even among persons with CHD. In conclusion, elderly CHD patients have greater limitations in their functional ability than matched controls, which may depend on the severity of the disease. Especially male patients' limitations in physical abilities may be influenced by the fact that men with CHD are more likely to be depressed. Although an independent association between physical disability and CHD was not found, the associations found between physical disability and the use of cardiovascular drugs probably indicate a causal relationship between CHD and physical disability.