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Dagliga aktiviteter bland äldre personer med kronisk hjärtsvikt: begränsningar och möjligheter
Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Occupational Therapy.
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Chronic Heart Failure (CHF) is known to have a substantial impact on activities of daily living (ADL) and symptoms such as breathlessness and fatigue are characteristic. Despite this, research in occupational therapy concerning people with CHF is rare. The overall aim of this thesis was to increase the knowledge of ADL ability and fatigue among those with CHF, to describe experiences of limitations in occupational performance and the strategies that these elderly people use to manage their daily activities and also to describe a programme including energy conservation for clients with CHF in primary healthcare.

Method Three groups of older people with a verified diagnosis of CHF and one group of occupational therapists (OTs), all recruited from primary healthcare, were analyzed. The ADL ability of 40 participants was described, with reference to dependence on others, perceived strain and quality of occupational performance. The association between ADL ability and the New York Heart Association Classification (NYHA), a functional classification for people with CHF, was analyzed. Fatigue and its association to ADL ability, use of assistive devices and community support were also analyzed. Ten respondents were then interviewed and asked to describe the strategies they used to manage ADL. The interview results were combined with the current body of research and CHF guidelines to form a base for the development of an intervention programme, including energy conservation, for people with CHF. The programme, based on the Occupational Therapy Intervention Process Model (OTIPM), was used by OTs in primary healthcare, and the clients’ ADL, goal achievements and use of energy conservation strategies were described, as well as the five clients’ and two OTs’ experiences of the program.

Results Most participants were independent in personal ADL activities (PADL). A majority was dependent in one or more instrumental ADL activities (IADL) and perceived strain when performing the activities independently. The Assessment of Motor and Process Skills (AMPS) showed a reduced quality of occupational performance compared with healthy people of the same age. Age had a significant impact on ADL performance. Despite this, participants in NYHA III/IV showed significantly increased effort (under motor cutoff) when performing ADL tasks compared with those in NYHA I/II. Fatigue was common and greater fatigue was associated significant with increased dependence and decreased quality of occupational performance, with the exception of shopping. Participants who used assistive devices and home care estimated higher physical fatigue, but no correlation was found with community mobility services. Comorbidities, which can affect occupational performance, were common in all the studies.

The participants experiences of limitations in occupational performance and the strategies that they used to manage their daily activities were described as redefining an active life, aware of one’s impaired body and planning activities and balancing the degree of effort.

During the interventions according to the programme the clients’ increased their participation and independence in daily activities, consciously gave up what were less meaningful activities for them and deteriorated because of the progression of the CHF. Most goals were achieved and many energy conservation strategies were used by the clients. The clients’ experiences were described as working in collaboration to manage daily activities and using professional support from OTs to enhance their activities. The OTs’ experiences of the programme were described as being supported with specific knowledge and a structured way of working and finding clinical benefits from working according to the program, but doubt the possibilitiy of using it, due to constraints in clinical practice.

Discussion The participants' physical fatigue and breathlessness had a negative impact on their ADL-ability. Age affected ADL performance, but the impact of a more severe CHF remained adjusted for age. An ongoing process of occupational adaptation due to periodical physical decline and fluctuating day-to-day ability was described. Many of the strategies used by the participants to handle daily activities could be described as energy conservation strategies, an indication that occupational therapy interventions including energy conservation management would be beneficial for clients with CHF. Both the OTs and the clients described that the specialized programme provided structure for the OTs’ work, knowledge about CHF and about valuable energy conservation strategies. The programme seemed to support the OTs to work in a more comprehensive client-centered way.

Conclusion The work with this thesis has increased the limited existing knowledge about elderly people with CHF and their ADL ability, fatigue and the adaptation of occupational performance that they use to manage their daily activities. The experiences indicated that a specialized programme including energy conservation for occupational therapy in primary healthcare seemed to support the OTs work in a more comprehensive client-centered way. The programme needs to be further evaluated.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2014. , 82 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1636
Keyword [sv]
Aktiviteter i dagligt liv, Fatigue, Kronisk hjärtsvikt, Äldre, Program, OTIPM, Energibesparande arbetssätt, Intervju, Observation, Arbetsterapi, Intervention, Primärvård.
National Category
Occupational Therapy
Identifiers
URN: urn:nbn:se:umu:diva-87081ISBN: 978-91-7601-016-7 (print)OAI: oai:DiVA.org:umu-87081DiVA: diva2:706095
Public defence
2014-04-11, Aulan, Vårdvetarhuset, Umeå universitet, Umeå, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-03-21 Created: 2014-03-18 Last updated: 2014-03-21Bibliographically approved
List of papers
1. Activities of daily living for old persons in primary health care with chronic heart failure
Open this publication in new window or tab >>Activities of daily living for old persons in primary health care with chronic heart failure
2008 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 22, no 2, 203-210 p.Article in journal (Refereed) Published
Abstract [en]

Chronic heart failure (CHF) is a common condition among Europe's aging population. Findings indicate that CHF patients must make significant changes in many aspects of daily life. Previous studies of older primary health-care participants and their activities of daily living (ADL)-ability are rare. The aim of this study was to describe ADL-ability in older people with CHF syndrome. The factors considered were dependence on others, perceived strain, quality of performance, and the association between The New York Heart Association classification (NYHA) and ADL-ability. The participants, recruited from a primary health-care centre, had symptoms indicating CHF and were diagnosed by a cardiologist. Forty persons over 65 years (mean age 81), participated in the study and self-reported co-morbidity was frequent. The Assessment of Motor and Process Skills (AMPS) and the Staircase of ADL were used to describe ADL-ability. Most participants were independent with respect to personal activities of daily living (PADL), and 75% were dependent in one or more instrumental activities of daily living (IADL), usually shopping. Most participants perceived strain, and only three could perform all ADL without strain. Age had a significant impact on ADL performance (motor measures: OR 7.11, CI 1.19-42.32, p = 0.031 and process measures: OR 8.49, CI 1.86-38.79, p = 0.006). However, participants showed lower ADL motor and process ability in AMPS compared with well persons of the same age. Participants in NYHA III/IV (adjusted for age), had significantly increased effort (under motor cut-off) when performing ADL-tasks (OR: 15.5, CI 2.40-100.1, p = 0.004) compared to those in NYHA I/II. Older persons in primary health care with CHF exhibit a high amount of dependence, perceived strain and increased effort during performance of ADL. There is an association between NYHA class III/IV and a decreased ADL-ability (AMPS motor ability) even when adjusted for age.

Keyword
quantitative approaches, statistics, occupational therapy, rehabilitation, elder care, coronary heart disease
National Category
Nursing Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-19410 (URN)10.1111/j.1471-6712.2007.00514.x (DOI)18489690 (PubMedID)
Note

Funding from EC Structural Funds North Sweden, Objective One, HeartNet Centre and

Foundation of Medical Research, Skellefteå

Available from: 2009-03-05 Created: 2009-03-05 Last updated: 2017-12-13Bibliographically approved
2. Impact of fatigue on everyday life among older people with chronic heart failure
Open this publication in new window or tab >>Impact of fatigue on everyday life among older people with chronic heart failure
2010 (English)In: Australian Occupational Therapy Journal, ISSN 0045-0766, E-ISSN 1440-1630, Vol. 57, no 1, 34-41 p.Article in journal (Refereed) Published
Abstract [en]

Fatigue had a negative impact on ADL mainly from physical rather than from mental causes. Improved energy conservation strategies to reduce the consequences of fatigue are needed.

Keyword
activities of daily living; ageing; fatigue; occupational performance; primary health care
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-41436 (URN)10.1111/j.1440-1630.2009.00847.x (DOI)000274621400006 ()20854563 (PubMedID)
Available from: 2011-03-24 Created: 2011-03-24 Last updated: 2017-12-11Bibliographically approved
3. Occupational performance and strategies for manageing daily life among elderly with heart failure
Open this publication in new window or tab >>Occupational performance and strategies for manageing daily life among elderly with heart failure
(English)Manuscript (preprint) (Other academic)
Keyword
Qualitative design, activities of daily living, ageing, occupational adaptation, occupational balance, occupational therapy
National Category
Occupational Therapy
Research subject
Occupational therapy
Identifiers
urn:nbn:se:umu:diva-87078 (URN)
Available from: 2014-03-18 Created: 2014-03-18 Last updated: 2015-07-03Bibliographically approved
4. Experiences of a programme for occupational therapy for people with chronic heart failure: a case study
Open this publication in new window or tab >>Experiences of a programme for occupational therapy for people with chronic heart failure: a case study
Show others...
(English)Manuscript (preprint) (Other academic)
Keyword
Intervention, activities of daily living, energy conservation, goal achievement, case study.
National Category
Occupational Therapy
Identifiers
urn:nbn:se:umu:diva-87080 (URN)
Available from: 2014-03-18 Created: 2014-03-18 Last updated: 2015-07-03Bibliographically approved

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