Outpatient cardiac rehabilitation in elderly patients.

Exercise as part of cardiac rehabilitation plays a role in minimizing disability associated with myocardial infarction and coronary artery bypass surgery. The beneficial effects have been documented primarily among middle-aged participants. The study of those aged 65 years or greater has received less attention. The purpose of this review article is to summarize available data regarding exercise training in elderly patients with heart disease and review issues and considerations for their participation, together providing a basis for inclusion of more elderly in cardiac rehabilitation. Both male and female elderly patients with heart disease can benefit from exercise through significant improvements in functional capacity and reduced myocardial work. Changes are similar in magnitude to those observed among younger participants. Because elders are the fastest growing U.S. population segment and have a twofold to threefold higher incidence of acute myocardial infarction than younger individuals, decreasing disability by including more elderly in cardiac rehabilitation has important public health implications.

Social support and the elderly client.

The elderly have a higher risk of experiencing less social support because of role losses and changes associated with aging and chronic disease processes, and there is pressure from third-party payors to reduce the length of home healthcare services. Few studies have examined patients' instrumental social support after discharge from home healthcare. Therefore, this descriptive study examined instrumental social support of discharged home healthcare clients (N = 57) who were older than 65 years old, using a telephone interview and retrospective record review. The purposes were to investigate (1) source and number of sources of received support based on age, gender, marital status, race, and functional ability; (2) whether source of support was associated with physical and mental health outcomes; (3) whether clients' perception of need for more support was associated with physical and mental health outcomes. The results indicated that the number of sources of social support was associated with clients' gender, marital status; and functional status; trends toward improvements in mental and physical health outcomes were associated with support provided by friends and neighbors.

Use of the stages of change in exercise adherence model among older adults with a cardiac diagnosis.

PURPOSE: Researchers have recommended use of the Stages of Change in Exercise Adherence (STAGES), a process-oriented model, to better understand exercise adherence behavior. This study aimed to further understand the process by evaluating the predictors of exercise adherence and the validity of the STAGES model among older adults (N = 349) with a cardiac diagnosis after discharge from a cardiac rehabilitation inpatient program. METHODS: Recently discharged inpatient participants, aged 65 years or older and ambulatory, responded to a computer-assisted telephone interview regarding their exercise behaviors and attitudes toward exercise (mean response time = 32.3 minutes). Between 55 and 80 participants in each of five stages of exercise adherence were interviewed. Demographic profiles and other information were obtained from a chart review of cardiac rehabilitation inpatient records. RESULTS: Perceived self-efficacy, perceived benefits of exercise, interpersonal support for exercise, and perceived barriers to exercise were significant predictors of exercise adherence using direct entry discriminant analysis. These predictors accounted for 50% of the variance in stage of exercise adherence. The theoretical ordering of the STAGES model was supported (P < .0001). Exercise time significantly increased with each subsequent stage of exercise adherence from the precontemplation stage to the maintenance stage. CONCLUSIONS: This study evaluated the validity of the STAGES model in a sample of older cardiac rehabilitation participants. The STAGES model can be applied to the study of exercise behavior among this group of older adults.

Analysis of a home health agency's productivity system.

Productivity is an important issue in home care. Employee perceptions of an equitable system are crucial and have been linked to job satisfaction, motivation, and production. Ten staff nurses, and all supervisors and program directors were interviewed to elicit perceptions of the productivity system. Staff nurses' time sheets for seven months were evaluated retrospectively for visit length, number of visits per day, payer source, mileage per day, and travel time per day. Mean time in minutes spent in the patient's home on intravenous visits (n = 58 visits) was approximately twice as long as that of home care visit (n = 11,573 visits). Mean length of hospice visits (n = 368 visits) was 25 to 29 minutes longer than that of mean home care visits. The proportion of Medicare reimbursement was negatively correlated with productivity bonus point achievement (when two high and two low bonus point outliers were removed). Recommended changes were based on both qualitative analysis of employee perceptions of the productivity system and quantitative analysis of time sheets.