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The Aging Process and CHF

Pepper Losely

James Madison University

Professor Andrews

November 15, 2020

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Abstract

This paper discusses the aging process and how it makes geriatric patients more prone to have

Congestive Heart Failure (CHF). There are many factors that will be discussed that cause

patients of older age to develop the key factors that lead into developing CHF. Treatment can be

pharmaceutical or non-pharmaceutical. Physical deconditioning as well as chronic pain can

contribute to the decline in quality care as well as patient outcomes. Participants in the research

articles sited in this paper were patients who were diagnosed with CHF and met the criteria to be

in the study. There are current nutrition studies that could impact malnutrition for patients with

CHF.
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The Aging Process and CHF

The process of Congestive Heart Failure (CHF) is a combination of different types heart

diseases and their effect on the body. This is a common condition in older adults age 65 and up.

CHF also causes other areas of the body to decline because of the lack of blood flow and oxygen

saturation throughout the body. If CHF can be avoided then further decline such as cognitive

impairment can also be avoided in our geriatric population.

Heart Failure and Aging

Butrous and Hummel (2016) state, “Heart Failure (HF) is a leading cause of morbidity,

hospitalization, and mortality in older adults and a growing public health problem placing a huge

financial burden on the health care system” (Butrous & Hummel, 2016, pg1). There are

pharmaceutical and non-pharmaceutical ways to help treat the symptoms of CHF. As the

geriatric population is aging they develop multi-morbid illnesses that contribute to CHF or are

contributed to by CHF. Having the comorbidities induces what is know as polypharmacy when

patients are placed on a multitude of medications to combat their evolving illnesses. Another

issue related to CHF is cognitive impairment. In lieu of decreased cardiac output, as well as

decreased oxygen saturation, the brain is no longer getting the required oxygen for proper

functioning of neurotransmitters causing symptoms such as forgetfulness, and inability to make

connections mentally. (Butrous &Hummel, 2016).

CHF Breakdown

As people age their circulation system begins to decline in function. Ventricular

hypertrophy, calcification and reduced elasticity of vessels cause the heart to be less effective in

cardiac output, perfusion, and contraction. The heart is less able to contract as well as veins and

arteries dilate. Perfusion becomes less adequate, causing physical activity to become a chore.
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These declines in circulatory function begin to cause cardiovascular diseases, hypertension,

edema, and malnutrition. Medications also have an affect on the circulatory system. (Eliopoulos,

2018).

Cacciatore et al. (2015) describes when a patient is diagnosed with CHF, they have the

following symptoms: “dyspnea, orthopnea, tachycardia, atrial fibrillation, jugular venous

distention, abdomino-jugular reflux, pulmonary rales, third sound, and edema” (Cacciatore et al.,

2015). Eliopoulos (2018) describes the classes of CHF. Class 1 having some form of disease that

affects the heart but no physical limitations. Class 2 having some symptoms with exertion but

only affects a small amount in physical limitations. Class 3 having more advanced symptoms

with little to no exertion affecting physical abilities greatly. Class 4 having symptoms almost at

any time with exertion or when resting, physical activities greatly affected. (Eliopoulos, 2018).

Treatment

Eliopoulos (2018) describes management of CHF “consisting of bed rest, ACE inhibitors,

beta-blockers, digitalis, diuretics, and a reduction in sodium intake” (Eliopoulos, 2018, pg278).

Patients are expected to minimize exertion by only getting out of bed to get in the bedside chair

or use the bedside commode for the bathroom. Patients with CHF will need to have a lot of

support due to the anxiety and fear that this disease causes. Skin care is also important due to

lack of perfusion the skin is easily broken down. Repositioning, as well as protection for boney

prominences are necessary. (Eliopoulos, 2018).

Butrous and Hummel (2016) describe non-pharmacological treatment of CHF. Exercise

training to help improve exertional capacity can improve quality of life for CHF patients.

Malnutrition also plays a large role in hospitalization as well as mortality in patients with CHF.

Because low sodium diets are difficult to maintain in the atmosphere of packaged foods, CHF
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patients usually are deprived of adequate nutrition. There are thought and studies of having

delivered meals that are nutrient dense to patients with CHF. (Butrous & Hummel, 2018).

In a study done by Bakitas et al. (2020) it was found that treatment of patients newly

diagnosed with CHF with palliative care seemed to help with pain control and how pain was

affecting their lives. The study was done mostly to improve quality of life but that was found to

be inconclusive, but pain control does in fact improve quality of life. (Bakitas et al., 2020).

Alemzadeh-Ansari et al. (2017) describe pain in CHF patients as “total pain”. Pain is not usually

the symptom that most medical professionals are concerned with treating because dyspnea and

other symptoms that can be objective are more important than the subjective symptom of pain.

This causes pain to be under treated and causes the patient with CHF more issues with chronic

pain. (Alemzadeh-Ansari et al., 2017).

The study by Kessel et al. (2017) measures the Care-Related Quality of Life (CaReQoL

CHF) for patients with CHF using patient-reported outcome measures (PROM). In their study

they found that patients with CHF do not feel like they are safe because their condition can

worsen at any time. This causes them great discomfort and anxiety. Patients want to know that

they are being watched over by healthcare professionals by using Telehealth options to monitor

heart function. In pursuit of patient care outcomes, the Kessel et al. team (2017) created a

CaReQoL CHF questionnaire to ensure that patients are receiving the care that they desire.

(Kessel et al., 2017).

Conclusion

As the aging populations circulatory system declines CHF is more prevalent. The aging

body causes decline in function and is the main cause of CHF. Treatment of CHF symptoms is

how quality of life is improved. With pharmaceutical and non-pharmaceutical treatment patients
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are able to maintain activities for a longer period of time than if there were no interventions

present. These interventions outlined in this paper can help nurses to better care for their patients

and anticipate their needs as their CHF worsens. With studies and research there is hope that

CHF can be combated to extend quality of life and patient outcomes.

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References

Alemzadeh-Ansari, M., Ansari-Ramandi, M. & Naderi, N. (2017). Chronic pain in chronic heart

failure. J Tehran Heart Center. 12(2). 49-56.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5558055/#__ffn_sectitle

Bakitas M., Dionne-Odom J., Ejem D., Wells, R., Azuero, A., Stockdill, M., Keebler, K.,

Sockwell, E., Tims, S., Engler, S., Steinhauser, K., Kvale, E., Durant, R., Tucker, R.,

Burgio, K., Tallaj, J., Swetz, K., Pamboukian, S. (2020). Effect of an early palliative care

telehealth intervention vs usual care on patients with heart failure: The ENABLE CHF-

PC randomized clinical trial. JAMA Intern Medicine. 180 (9):1203–1213.

doi:10.1001/jamainternmed.2020.2861

Butrous, H., & Hummel, S. (2016). Heart failure in older adults. The Canadian journal of

cardiology. 32(9). 1140-1147. https://doi.org/10.1186/s12913-017-2452-4

Cacciatore, F., Abete, P., Ferrara, N., Calabrese, C., Napoli, C., Maggi, S., Varricchio, M.,

Rengo, F. (2015). Congestive heart failure and cognitive impairment in an older

population. Journal of the American Geriatrics Society, 46: 1343-1348.

doi:10.1111/j.1532-5415.1998.tb05999.x

Eliopoulos, C. (2018). Gerontological Nursing Ninth Edition. Philadelphia. Wolters Kluwer.

https://doi.org/10.1037/0000165-000

Van Kessel, P., de Boer, D., Hendriks, M., & Plass, A. (2017). Measuring patient outcomes in

chronic heart failure: psychometric properties of the Care-Related Quality of Life survey

for Chronic Heart Failure (CaReQoL CHF). BMC Health Service Res. 17.536.

https://doi.org/10.1186/s12913-017-2452-4