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Why Do Elders Delay Responding to Heart Failure Symptoms?

Jurgens, Corrine Y.; Hoke, Linda; Byrnes, Janet; Riegel, Barbara

doi: 10.1097/NNR.0b013e3181ac1581

Background: Elders with heart failure (HF) are at risk for frequent hospitalizations for symptom management. Repeated admissions are partly related to delay in responding to HF symptoms. Contextual factors such as prior illness experiences and social/emotional factors may affect symptom interpretation and response. The Self-Regulation Model of Illness guided this study as it acknowledges the dynamic nature of illness and influence of contextual factors and social environment on the interpretation and response to symptoms.

Objective: The purpose of this study was to describe contextual factors related to symptom recognition and response among elders hospitalized with decompensated HF.

Methods: A mixed-methods design was used. The HF Symptom Perception Scale (physical factors), Specific Activity Scale (functional performance), and Response to Symptoms Questionnaire (cognitive/emotional factors) were administered to participants aged ≥65 years. Symptom duration and clinical details were collected by interview and chart review. Open-ended questions addressing the symptom experience, including the context in which symptoms occurred, were audiotaped, transcribed, analyzed, and compared across cases to inform the quantitative data.

Results: The convenience sample (n = 77) was 48% female, 85.7% were non-Hispanic White, and mean age was 75.9 years (SD = 7.7 years). Functional performance was low (81% class III/IV). The most frequently reported symptoms were dyspnea, dyspnea on exertion, and fatigue. Median duration of early symptoms of HF decompensation was 5 to 7 days, but dyspnea duration ranged from 30 minutes to 90 days before action was taken. Longer dyspnea duration was associated with higher physical symptom distress (r = .30) and lower anxiety (r = -.31). Sensing and attributing meaning to early symptoms of HF decompensation were problematic.

Discussion: The physical symptom experience and the cognitive and emotional response to HF symptoms were inadequate for timely care seeking for most of this older aged sample.

Corrine Y. Jurgens, PhD, RN, ANP-BC, FAHA, is Clinical Associate Professor, Stony Brook University, New York, and John A. Hartford Postdoctoral Fellow, University of Pennsylvania, Philadelphia.

Linda Hoke, PhD, RN, APN-BC, CCNS, CRRN, is Clinical Nurse Specialist, Hospital of the University of Pennsylvania, Philadelphia.

Janet Byrnes, MS, RN, ANP, is Assistant Director of Nursing, Stony Brook University Medical Center, New York.

Barbara Riegel, DNSc, RN, FAAN, FAHA, is Professor, University of Pennsylvania, Philadelphia.

Accepted for publication January 30, 2009.

Funding for this study was provided by the John A. Hartford Foundation Building Academic Geriatric Nursing Capacity Scholarship Program.

The authors gratefully acknowledge the scholarly support of Dr. Neville Strumpf and the faculty of the University of Pennsylvania's Hartford Center of Geriatric Nursing Excellence.

Corresponding author: Corrine Y. Jurgens, PhD, RN, ANP-BC, FAHA, School of Nursing, Stony Brook University, HSC L2-223, Stony Brook, NY 11794-8240 (e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.