Self-Management of Heart Disease in Older Adults

The Centers for Disease Control and Prevention cite heart disease as the leading cause of death for Americans, with 610,000 dying from heart disease each year. The American Heart Association estimates that 81% of people who die of coronary heart disease are over the age of 65. Heart failure is also the most common cause of hospitalization for adults over the age of 65 and costs the nation an estimated 32 billion a year. Older adults are at an increased level of risk for heart disease incidence and mortality. Further, ethnic minority older adults with heart disease, who have low socioeconomic status, live below the federal poverty level and have inadequate health insurance have been shown to have worse outcomes. At the same time the older adult population is growing at an unprecedented rate in the United States.

Fortunately, heart disease is highly sensitive to self-management interventions. Treatment plans for heart disease patients often include increasing physical activity, restricting the intake of fatty foods, and limiting smoking and binge drinking. However the presence of such a plan is only the first step in the patient’s ability to manage their disease. Another important aspect of self-management is a patient’s level of self-efficacy, or confidence. The presence of both a self-management plan and increased confidence to control their disease has shown to increase engagement in healthy behaviors. While self-management has been identified as a factor in increasing healthy behaviors in older adults, confidence to manage heart disease has not been studied extensively with older adults.

This study hypothesized that the presence of a heart disease self-management plan (and confidence to manage) would decrease negative health behaviors in older adults. Using the 2011-12 California Health Interview Survey (CHIS), older adults (65+) with heart disease were identified (n=3,026). Multivariate linear regressions were performed on physical activity and dietary behaviors; self-management was significant for both. However, multiple logistic regression revealed that self-management was not significant when looking at the other negative health behaviors such as smoking and binge drinking.

The findings of this study have implications for both clinical practice and future research. For those with heart disease, maintaining health means adhering to a self-management plan which includes physical activity, positive dietary behaviors, and reduction of smoking and binge drinking. Further, this study highlights the importance of self-efficacy on patient health management. Practitioners should consider patients’ level of confidence in managing their disease and interventions for individuals with chronic diseases may include increasing confidence levels. Self-management education may include traditional patient education regarding the chronic disease as well as increase the patient’s confidence in following the plan. Interventions should also underscore the importance of the collaborative relationship between the healthcare provider and the patient as that may influence adherence to self-management plan. And given that some racial groups were more prone to negative behaviors, even after controlling for self-management, future research should focus on exploring how race and culture influence health behaviors and how self-management plans should take those factors into consideration.