Go to the hospital or stay at home? A qualitative study of expected hospital decision making among older African Americans with advanced heart failure.

To address the need for more information concerning hospital decision making, we conducted in-depth interviews among African Americans with heart failure and their family caregivers (n = 11 dyads). Using a case scenario, we asked participants about their anticipated hospitalization decisions. Most patients indicated that they would seek care to avoid further deterioration or death from their worsening condition. Many family caregivers anticipated having an active influence on hospitalization decisions. Findings suggest that social workers should encourage the development of adequate home-based services, recognize diverse communication styles, and use this information to facilitate medical decision making by these patients and their caregivers.

Life disruption, life continuation: contrasting themes in the lives of African-American elders with advanced heart failure.

This study addresses the need for more information about how urban African-American elders experience advanced heart failure. Participants included 35 African Americans aged 60 and over with advanced heart failure, identified through records from a community hospital in Detroit, Michigan. Four focus groups (n = 13) and 22 individual interviews were conducted. We used thematic analysis to examine qualitative focus groups and interviews. Themes identified included life disruption, which encompassed the sub-themes of living scared, making sense of heart failure, and limiting activities. Resuming life was a contrasting theme involving culturally relevant coping strategies, and included the sub-themes of resiliency, spirituality, and self-care that helped patients regain and maintain a sense of self amid serious illness. Participants faced numerous challenges and invoked a variety of strategies to cope with their illness, and their stories of struggles, hardship, and resilience can serve as a model for others struggling with advanced illness.

Self-Care Among Older Adults With Heart Failure.

Background: It is estimated that 5.7 million Americans are living with heart failure (HF) today. Despite the fact that HF is one of the most common reasons people aged 65 years and older are admitted into the hospital, few studies describe the self-care in this older adult population. Purpose: The purpose of the study was to review the current literature on self-care in this population to better understand the influence of selected factors on self-care and health outcomes. Methods: A literature search was completed and resulted in including 28 studies. Results: Multiple factors have been reported as barriers to self-care including depression and presence of peripheral arterial disease. Factors having a positive effect on self-care are male gender, number of cardiologist referrals, and self-efficacy. There were few studies that described the association between cognitive functioning and self-care. There is a lack of strong evidence to support the association between self-care and health outcomes such as readmission rate, but recent studies suggest that a 30-day readmission is not a valid predictor of health outcomes. Implications: The assessment of the psychological factors and health care resource utilization patterns that may influence self-care is recommended. More research that addresses the role of cognitive factors in influencing self-care is needed.

Addressing Heart Failure Challenges through Illness-Informed Social Work.

This article describes the role of social workers in addressing the needs of people with heart failure. Although previous studies have explored the role of social workers in health care settings, few studies have addressed the challenges of specific chronic diseases such as heart failure. To address this gap in the literature, this study used qualitative interviews with health care social workers (n = 8) to obtain in-depth information about activities and challenges related to heart failure care. Findings suggest that health care social workers perceive heart failure as characterized by an uncertain illness trajectory, frequent hospitalizations, and difficulties accessing formal and informal care. These findings suggest the importance of what we term illness-informed social work, a practice that combines heart failure knowledge with social work competencies to address the complex psychosocial issues in heart failure care.

Enhancing aging services through evidence-based health promotion: a training for service providers.

During the next several decades, increasing numbers of older Americans will suffer chronic illnesses and many will face challenges due to growing racial and economic health disparities. Agencies serving older adults need to respond by creating and promoting evidence-based health promotion (EBHP) practices to address the growing diversity among older adults in urban areas. One such agency, the Detroit Area Agency on Aging recently partnered with the Wayne State University School of Social Work to conduct an EBHP educational program for service providers. The educational program used information from the National Council on Aging Center for Healthy Aging, the reach, effectiveness/efficacy, adoption, implementation, and maintenance (RE-AIM) model, and the National Wellness Institute. Survey respondents found that the interaction with other participants was beneficial and helped them to conceptualize EBHP as a new way of thinking about service delivery. Participants learned practical lessons about implementing a training program on evidence-based practice and additional steps are offered to increase the uptake of EBHP practices by older adult service providers.

The lived experience of heart failure at the end of life: a systematic literature review.

The growing number of older adults with heart failure (HF) suggests the need for more information about how people with this condition experience their illness and strategies for coping with this condition. To address this need, the authors conducted a systematic review of the literature and an in-depth, thematic analysis of qualitative first-person accounts on the lived experience of HF. Results suggest that people with HF face many challenges, including those associated with the formal health care system, life disruption, social isolation, symptoms, and uncertainty about prognosis and symptoms. Coping strategies include HF management, dealing with the dying process, and social support. Social workers, who encounter people with HF in a variety of practice settings, can play a key role by focusing on the needs of people with HF, addressing and strengthening their ability to manage their condition, facilitating social support, and helping them to cope with the dying process. Greater attention to these issues in the social work literature is needed, with a particular focus on the role of racial and ethnic diversity as they pertain to people with HF facing end-of-life issues.