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Man måste vila emellanåt: patienters självskattade och berättade erfarenheter av att leva med kronisk hjärtsvikt
Umeå University, Faculty of Medicine, Omvårdnad.
2007 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall purpose was to explore the experience of living with chronic heart failure among patients in primary healthcare. Comparisons were made between patients with confirmed heart failure (HF, n=49), patients with symptoms indicating HF but with no HF (NHF, n=59), and a reference group (n=40). The mean age was 77 years. Patients in the HF and NHF groups had more general and physical fatigue, more reduced activity, worse physical quality of life and higher degree of depression compared with the reference group. The HF group had also higher degree of physical fatigue and worse physical quality of life than the NHF group. When comparing degrees of depression between the three groups and adjusting for fatigue, the physical dimension of fatigue was of greater importance in explaining group differences. In the HF group general fatigue was more closely related to limitations in role functioning for physical reasons than to reduced physical function per se. Women experienced more fatigue than men. Narrative interviews were conducted with ten women with confirmed heart failure, aged 73-89 years, with special reference to fatigue. The findings were presented in two themes, ‘living with the loss of physical energy’, and ‘striving for independence while being aware of deteriorating health’. The conclusion in study IV was in accordance with the results in the quantitative studies, indicating that the experience of HF or symptoms similar to HF had the greatest impact on the physical dimensions of fatigue and health-related quality of life. From a clinical perspective the findings in this thesis emphasize the importance of careful investigation of each patients experienced problems. In particular symptoms of depression and different dimensions of fatigue need to be analysed. Interventions aimed at reducing fatigue needs to be developed, and its further impact on health-related quality of life should be investigated.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2007. , p. 60
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1113
Keywords [en]
Nursing
Keywords [sv]
Omvårdnad, kronisk hjärtsvikt, livskvalitet, fatigue, depression, äldre
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-1322ISBN: 978-91-7264-366-6 (print)OAI: oai:DiVA.org:umu-1322DiVA, id: diva2:140650
Public defence
2007-09-19, Aulan, Vårdvetarhuset, Umeå Universitet, 901 87 Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2007-08-31 Created: 2007-08-31 Last updated: 2009-05-19Bibliographically approved
List of papers
1. Fatigue and health-related quality of life in elderly patients with and without heart failure in primary healthcare.
Open this publication in new window or tab >>Fatigue and health-related quality of life in elderly patients with and without heart failure in primary healthcare.
2007 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 6, no 3, p. 208-215Article in journal (Refereed) Published
Keywords
Age Distribution, Aged, Aged; 80 and over, Analysis of Variance, Attitude to Health, Case-Control Studies, Comorbidity, Fatigue/epidemiology/etiology/psychology, Female, Health Status, Heart Failure; Congestive/*complications, Humans, Logistic Models, Male, Nursing Methodology Research, Primary Health Care, Quality of Life/*psychology, Questionnaires, Risk Factors, Severity of Illness Index, Sex Distribution, Sickness Impact Profile, Sweden/epidemiology
Identifiers
urn:nbn:se:umu:diva-18144 (URN)doi:10.1016/j.ejcnurse.2006.09.004 (DOI)17092775 (PubMedID)
Available from: 2008-01-08 Created: 2008-01-08 Last updated: 2018-06-09Bibliographically approved
2. Depression among elderly people with and without heart failure, managed in a primary healthcare setting.
Open this publication in new window or tab >>Depression among elderly people with and without heart failure, managed in a primary healthcare setting.
2008 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 3, p. 376-382Article in journal (Refereed) Published
Abstract [en]

BACKGROUND AND RESEARCH OBJECTIVES: Depression is common among patients with heart failure (HF) and among elderly in general. Problems in diagnosing and care planning can arise as symptoms of HF, dyspnoea and especially fatigue, are nonspecific and also overlap with symptoms of depression. The objective of this study was to describe the prevalence and compare degrees of depression among patients with confirmed HF, patients with symptoms similar to HF (no heart failure, NHF) and a reference group in one primary healthcare centre (PHC), after adjusting for background characteristics and fatigue. SUBJECTS AND METHODS: A descriptive case-reference study was conducted in one PHC in a middle-sized city. Participants were 49 patients with confirmed HF, 59 patients with symptoms similar to HF (NHF) and 40 people in a reference group. After informed consent data were collected by structured interviews using the Geriatric Depression Scale and the Multidimensional Fatigue Inventory-20. Odds ratios for the outcomes HF vs. NHF, HF vs. reference group, and NHF vs. reference group were calculated. RESULTS: The HF and NHF groups had similar degrees of depression which were significantly higher than for the reference group. This difference between the groups did not remain significant when adjusting for physical fatigue. More patients in the NHF than in the HF group were living alone and there were more women in the NHF than in the reference group. CONCLUSIONS: Prevalence of depression and degrees of fatigue were higher among elderly from a PHC who experienced HF symptoms, independent of objectively measured heart function, compared with elderly without such symptoms. When comparing degrees of depression between the three groups and adjusting for fatigue, the physical dimension of fatigue was of greater importance in explaining group differences.

Identifiers
urn:nbn:se:umu:diva-19057 (URN)10.1111/j.1471-6712.2007.00540.x (DOI)18840221 (PubMedID)
Available from: 2009-03-03 Created: 2009-03-03 Last updated: 2017-12-13
3. Factors related to fatigue among older patients with heart failure in primary health care
Open this publication in new window or tab >>Factors related to fatigue among older patients with heart failure in primary health care
Show others...
2008 (English)In: International Journal of Older People Nursing, ISSN 1748-3735, E-ISSN 1748-3743, Vol. 3, no 2, p. 96-103Article in journal (Refereed) Published
Keywords
fatigue, heart failure, older people, primary health care
Identifiers
urn:nbn:se:umu:diva-22230 (URN)10.1111/j.1748-3743.2007.00091.x (DOI)
Available from: 2009-04-29 Created: 2009-04-29 Last updated: 2017-12-13
4. The experience of fatigue among elderly women with chronic heart failure.
Open this publication in new window or tab >>The experience of fatigue among elderly women with chronic heart failure.
2008 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 7, no 4, p. 290-295Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Fatigue is a common and distressing symptom in chronic heart failure (CHF). Most of the current methods for evaluating patients' symptoms fail to consider the meaning or importance that these symptoms have for the patient. AIM: To illuminate the lived experience of fatigue among elderly women with CHF. METHOD: Narrative interviews were conducted with 10 women with CHF, aged 73-89 years. Interviews were analysed with qualitative content analysis. RESULTS: The findings are presented in two themes and five subthemes. The first theme, 'living with the loss of physical energy', was based on three subthemes describing the experience of fatigue: 'experiencing a substantial presence of feebleness and unfamiliar bodily sensations', 'experiencing unpredictable variations in physical ability', and 'needing help from others in daily life'. The second theme, 'striving for independence while being aware of deteriorating health', describes how the women managed their life situation; it was based on two subthemes: 'acknowledging one's remaining abilities', and 'being forced to adjust and struggle for independence'. CONCLUSIONS: Fatigue was experienced as loss of physical energy, leading to discrepancies between intention and capacity. The will to reduce dependency on others involved a daily struggle against fatigue.

Identifiers
urn:nbn:se:umu:diva-19037 (URN)10.1016/j.ejcnurse.2007.12.004 (DOI)18262844 (PubMedID)
Available from: 2009-03-03 Created: 2009-03-03 Last updated: 2017-12-13

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CiteExportLink to record
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Citation style
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