The features of the course of heart failure in elderly and senile patients are determined by significant changes in other organ systems that directly or indirectly affect its development and treatment. With age, the glomerular filtration rate decreases, and the kidney is less able to maintain intravascular volume and electrolyte homeostasis (Von Lueder and Agewall, 2018). Aging is also associated with numerous changes in the respiratory system, which reduce the respiratory reserve. Some of these effects, such as a mismatch in the ventilation/perfusion ratio of respiratory disturbances during sleep, may directly contribute to the development of heart failure, leading to hypoxemia or pulmonary hypertension (Von Lueder and Agewall, 2018). Other changes reduce the ability of the lungs to compensate for the decrease in the minute volume of the heart, increasing the respiratory volume and minute ventilation, thereby contributing to the feeling of shortness of breath.
Age-related changes in nervous system function include impaired thirst mechanism, which can contribute to dehydration and reduction of intravascular fluid volume in patients receiving diuretics. In addition, this leads to a decrease in the ability of autoregulatory mechanisms of the central nervous system to maintain brain perfusion with changes in systemic blood pressure (Mai Ba et al., 2020). The latter effect may aggravate cognitive impairment. Aging is also associated with broad changes in reflex reactions (Von Lueder and Agewall, 2018). For example, a violation of the sensitivity of carotid baroreceptors to acute changes in blood pressure itself can lead to orthostatic hypotension or fainting. In addition, such a risk may be further aggravated by taking several medications used to treat heart failure.
Given the low-stress resistance of elderly and senile patients, it is extremely important to identify and prevent the occurrence of certain factors. These are the reasons that can destabilize their condition and contribute to the decompensation of blood circulation. Most often, this is non-compliance with the reception regime medications and diets. In hospitalized patients, iatrogenic volume overload (for example, during the perioperative period) can also trigger the exacerbation of heart failure (Mai Ba et al., 2020). Thus, ethical considerations should take into account a certain number of factors reflecting the severity of the course of this disease.
To provide medical care in the framework of the treatment of heart failure, the patient has the right to choose a hospital and a doctor, taking into account the consent of the latter. When choosing a doctor and a medical organization, they have the right to receive information in an accessible form about a medical organization and its activities and doctors, their level of education, and qualifications (Von Lueder and Agewall, 2018). It is worth noting that patients have the right to demand the replacement of the attending physician. In the case of this doctor’s requirement, the head of the department or medical organization should facilitate the patient’s choice of another doctor.
The patient should also have the right to refuse medical intervention, and such a refusal can be either complete or partial. They are entitled to refuse treatment or disagree with some specific suggestion of the doctor but continue to be treated by them, refusing the proposed manipulations or treatment methods (Son et al., 2020). In case of refusal of medical intervention, the possible consequences of such refusal should be explained to the patient in an accessible form. Refusal of medical intervention should be recorded in the medical documentation.
A mixed-method approach is the most appropriate option because both quantitative and qualitative data are employed in the proposed study. The former is composed of educational initiatives, the transitional care program, and follow-up suggestions (telephone calls and telemonitoring) organized by nurses over six months. At the same time, the latter comprises educational initiatives, the transitional care program, and follow-up suggestions (telephone calls and telemonitoring) organized by nurses. Thirty participants with a history of congestive heart failure will be recruited from Brigham and Women’s Hospital to test the research hypothesis. The facility’s selection is contingent on the fact that it offers a wide range of services and treatment alternatives to persons with this disease, allowing for a conclusion on their understanding of the associated dangers. In their work with the studied group of patients, these experts highlight the necessity of high-quality services, which is in line with the study’s goals. The incidence of congestive heart failure in the previous month, treatment at Brigham and Women’s Hospital, and the requirement for effective self-care will be the criteria for participation in this study.
Cardiology clinics provide patients with medications that nurses distribute, but their main goal is to normalize the patient’s well-being. In addition, there is evidence that general practitioners are often afraid to prescribe adequate therapy and titrate doses of medications, even in patients with already diagnosed heart failure (Son et al., 2020). Therefore, for these patients not to remain without dose correction, a system of training in the care of patients with heart failure should be organized in many hospitals. It is a system of specialized medical care in which nurses are trained to improve the quality of treatment by educating patients and modifying treatment by ensuring relationships between different levels of medical care (Son et al., 2020). Such a model of medical care can be highly effective in terms of providing care to patients who have suffered heart failure and allows taking care not only timely but also effectively.
Mai Ba, H., Son, Y. J., Lee, K., & Kim, B. H. (2020). Transitional care interventions for patients with heart failure: An integrative review. International Journal of Environmental Research and Public Health, 17(8), 2925. Web.
Son, Y. J., Choi, J., & Lee, H. J. (2020). Effectiveness of nurse-led heart failure self-care education on health outcomes of heart failure patients: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 17(18), 6559. Web.
Von Lueder, T. G., & Agewall, S. (2018). The burden of heart failure in the general population: A clearer and more concerning picture. Journal of Thoracic Disease, 10(17), 1934–1937. Web.