Nurturing Independent Function after Open Heart Surgery: Next Steps for Medical Social Workers

Background and Purpose: Open-heart surgery (OHS) is a common operation for older adults and can have implications for both physical and mental autonomy. Specifically, the recovery period following OHS is critical as it is often characterized by a number of risk factors (i.e. infections, physical stress, limited mobility) which may affect activities of daily living (ADL) and instrumental activities of daily living (IADL). ADL refers to basic self-care related activities (i.e. eating) and IADL are complex tasks related to independent living (i.e. grocery shopping). Any sudden changes to ADL and IADL abilities can result in numerous adverse mental health outcomes, and impact quality of life (QoL). Some of these changes may be related to health-factors, while others can be due to pre-OHS personality traits and coping skills. However, research has seldom addressed the joint impact of pre-OHS traits, coping skills, and medical indices on post-OHS ADL, IADL, and QoL outcomes of older adults. Reviewing the aforementioned joint impact is of special importance to medical social work as focused efforts may potentially result in increased QoL and post-operation functioning for patients. In an effort to address this gap in the literature, the current study reviewed said joint impact, controlling for self-reported pre-OHS depression and non-cardiac medical comorbidities. We hypothesized that, 1) medical indices derived from the Society of Thoracic Surgeon (STS) national database would contribute to post-OHS functional impairment, and 2) assessed character strengths (i.e. hope and spirituality) would be inversely related to adverse outcomes, controlling for health indicators. Methods: Data was collected from 481 patients who were scheduled for non-emergency and non-transplant OHS at the University of Michigan Health System (UMHS). Pre-OHS data was collected at two time points; approximately 16 days prior, and 2 days prior. Post-OHS data was collected approximately 36 days after the operation. Linear regression analyses were conducted on ADLY and IADL respectively. As the current study included a number of independent variables, predictors with a p-value of more than .10 were removed for the following block(s). Results: Both the final trimmed model for ADL [F (5, N = 310) = 15.768, p < 0.001, R² = 0.205] and IADL [F (7, N = 311) =11.971, p<0.001, R² = 0.216] were significant and accounted for 20% of variance respectively. In both models, patients who reported poor pre-OHS functioning, medical comorbidities, and post-OHS prayer coping had higher scores of ADL and IADL respectively, which denotes poorer functioning. Conversely, those who practiced pre-OHS prayer coping reported lower scores on both ADL and IADL. Conclusions and Implications: As hypothesized, pre-OHS prayer coping was related to better post-OHS functioning. However, character strengths had no significant effect on post-OHS functioning. Not consistent with previous literature, pre-OHS social support and post-OHS prayer coping were linked to poorer functioning. Medical social workers might benefit from encouraging religiously pre-dispositioned patients to continue their practices of prayer coping prior to OHS. Further, encouraging long-term social support, both pre- and post- OHS might result in better functioning compared to solely pre-OHS social support