A Study On The Characteristics And Factors Influencing The Basic Activities Of Daily Living Ability Of Hospitalized Elderly Patients With Heart Failure

ObjectiveExploring the characteristics and influencing factors of basic activities of daily living in hospitalized elderly patients with heart failure.MethodsFrom December 2021 to December 2022,237 elderly heart failure patients who fulfilled the inclusion and exclusion criteria in the Department of Cardiology,The First Hospital of Soochow University,were chosen using a convenience sampling method.The general information questionnaire,Barthel Index(BI),Symptom Status Questionnaire-Heart Failure(SSQ-HF),The Short Physical Performance Battery(SPPB),Geriatric Depression Scale-15(GDS-15),Geriatric nutrition risk index(GNRI)and Mini-mental State Examination(MMSE)were distributed to the patients 1～2 days before discharge.SPSS 25.0 and Winsteps 3.72.3 software were used for statistical analysis,and statistical methods included descriptive statistics,one-way ANOVA,t-test,nonparametric test,Spearson correlation analysis,multiple linear regression,and Rasch analysis with test level a=0.05.Results1.In this study,237 baseline questionnaires were valid,and 237 elderly patients with heart failure ranged in age from 60 to 95(74.13±7.71)years.There were 162 males(68.4%)and 75 females(31.6%);67(28.3%)NYHA Class Ⅱ,83(35.0%)NYHA class Ⅲ and 87(36.7%)NYHA class Ⅳ were enrolled.2.Descriptive analysis of BADL ability in hospitalized elderly patients with heart failure:the highest proportion was 57.38%for mild dependence,followed by 30.40%for non-dependence,8.44%for moderate dependence and 3.80%for severe dependence.BI score of 237 patients was 83.97±19.14 points.62.9%,45.6%and 41.8%were dependent on going up and down stairs,walking on flat ground and taking a bath,respectively.98.3%and 97.0%were independent on controlling bowel and bladder.3.Descriptive analysis of factors influencing BADL capacity in hospitalized elderly patients with heart failure:the top three heart failure symptoms in hospitalized elderly patients with heart failure were:daytime dyspnea(89.0%),fatigue or lack of energy(66.7%),and dyspnea when lying down(54.9%),with 49.4%of patients experiencing four or more symptoms;67.9%of elderly patients had physical dysfunction;39.2%of elderly patients with cognitive decline;71.3%of elderly patients had nutritional risk;and 23.6%of elderly patients had a depressive state.4.Rasch model analysis showed that the Barthel index was unidimensional,the subject ability estimates were higher than the test difficulty estimates,the MNSQ values for both the weighted fit(Infit)and unweighted fit(Outfit)were between 0.7 and 1.3,and the ZSTD values were between-2 and+2.The data fit the model well.The discrimination of subjects and items were relatively large,2.47 and 20.03,respectively,and the measurement instruments discriminated well between subjects of different ability levels.The reliability of subjects and items were 0.86 and 1,respectively,with good scale consistency and stability.The order of difficulty of each item in the Barthel index was:bathing>grooming>up and down stairs>using the toilet>eating,dressing>control bowel,control bladder>walking>bed-chair transfer.Except for bath and grooming,there were no corresponding patients,and there were corresponding subjects for other items.The ability level of the subjects failed to reach the most difficult items.About 2.1 percent of patients with the least difficul "bed-chair transfer" lacked a matching program.5.Spearman correlation analysis showed that all BADL abilities were correlated with physical symptoms(all P<0.05),and there was a higher correlation between walking up and down stairs(r=-0.605,P<0.01),bed-chair transfer(r=-0.593,P<0.01)and walking(r=-0.588,P<0.01).The correlation between BADL ability and cognitive function,depressive state and nutritional risk was low.All P<0.05 except that control bowel and bladder.had no statistical significance in the correlation with nutritional risk.6.Univariate analysis of BADL ability in hospitalized elderly patients with heart failure showed that there were statistically significant differences in 11 factors including age,regular exercise habit,number of hospitalizations in the past 6 months,influence of visual and hearing impairment on daily life,length of stay,BMI,number of heart failure symptoms,nutritional risk,cognitive function,depressive state and physical function(all P<0.05).7.Multiple linear regression results showed that the influencing factors of BADL ability in hospitalized elderly patients with heart failure were:Regular exercise habits(β=-0.143,P=0.005),length of hospital stay(β=-0.140,P=0.007),symptoms of heart failure(β=-0.185,P=0.001),nutritional risk(β=-0.137,P=0.008),depressive status(β=-0.342,P<0.001)and physical function(β=-0.168,P=0.003).Conclusion1.There is a high rate of impaired BADL ability in hospitalized elderly patients with heart failure,and the patients with completely independent BADL ability still account for a minority.Therefore,the relevant evaluation and attention of BADL ability in this group should not be ignored.2.For hospitalized elderly patients with heart failure,bathing and grooming are the most difficult BADL abilities,while bed chair transfer and walking are the easiest BADL abilities.The matching degree between the difficulty of Barthel index and the BADL ability of patients was acceptable.However,a small number of patients were still unable to complete the basic daily living activities covered by Barthel index,and a small number of patients had no corresponding BADL project to match them.This suggests that we should carefully interpret the Barthel index score in practical clinical work,identify patients with low BADL ability as early as possible,and timely meet the nursing needs of such people.At the same time,an easier program could be set up under the "bed-chair transfer" to more fully assess the patient’s BADL ability.3.The BADL ability of hospitalized elderly patients with heart failure was affected by regular exercise habits,length of hospital stay,symptoms of heart failure,depressive state,physical function and nutritional risk.Patients without regular exercise habits,longer hospital stay,more severe symptoms of heart failure,depressed state,decreased physical function and higher nutritional risk had poor BADL ability.For patients undergoing hospitalization,early comprehensive and effective evaluation of various functions and timely intervention measures are conducive to the recovery of patient autonomy and independence,which can relieve the long-term care pressure of family and society after discharge.