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Healthcare

The link between heart disease and depression is well-established. Less clear, however, is how the two conditions can be treated simultaneously once the patient has returned home.

For many heart patients, challenges intensify after discharge from an acute care or outpatient care environment. The transition to home-based treatment should ideally involve an RN to monitor the patient and oversee medications, and a social worker/home aide to enable activity, provide human contact, and facilitate activities that bring joy.

In other words, qualified home care services may be positioned to contribute substantially to the effectiveness of the cardiologist’s treatment plan, reduce readmissions, and improve the well-being of the heart patient at home.

Depression and Cardiovascular disease: Problematic co-morbidity

The interplay between heart disease and major depressive disorder can produce a dangerous dynamic for the patient. Depressed patients are less likely to adhere to medications and rehabilitation programs, and less likely to change their lifestyle in the aftermath of a cardiac event. Smoking in particular is more prevalent among depressed heart patients. Stress plays a significant role in both conditions.

Even more troubling is the stubborn nature of depression as a chronic mental health condition. The Frontiers in Psychiatry study (linked above) reported, “Once major depression is present in those who have had a major cardiac event, we can expect them to still be suffering from depressive symptoms 4 months post discharge from the hospital.”

The extended duration of this condition can be managed with qualified home care services, which can address the mental and physical well-being of patients simultaneously.

Cardiovascular Disease & Depression

1 in 5
CVD patients suffers from depression

A 2013 report from the National Library of Medicine/Progress in Cardiovascular Diseases stated, “Approximately one out of every five patients with cardiovascular disease (CVD) suffers from major depressive disorder (MDD).” Because integrated home care (directed by an RN and supported by a social worker) can support the medical, pharmaceutical, and psychosocial aspects of care, this may indicate an expanded role for home care for patients with CVD.

3 ways home care can help

1. Measurement of depression to assess the patient’s condition.
Clinical care providers use several tools to understand the nature of a patient’s depression. There is evidence to suggest that the Beck Depression Inventory and the Patient Health Questionnaire are the fastest and most versatile; other research recommends the Cardiac Depression Scale.

Regardless of the method of data collection, an RN-led home care team can conduct ongoing assessment at predetermined intervals to help develop and document a more precise understanding of the patient’s mental condition.

2. Psychosocial remedies to offset risk of death.
A BMC/Springer Nature study reported that “low social support has also been found to seriously impact prognosis with a 3 to 5 fold increase risk of death found in those with [Coronary Heart Disease].”

The care management team, familiar with the family dynamics and personal history of the patient, is well positioned to facilitate life-affirming experiences. Examples include encouraging physical activity, social engagement, and mental stimulation such as reading and listening to music.

3. Understanding an elderly state of mind.
“Chronic heart failure and depressive disorders have a high prevalence…in the elderly,” according to a 2018 Journal of Geriatric Cardiology study. Among the problems this presents to ongoing treatment are: 1. The elderly can be highly resistant to change. 2. Multiple co-morbidities can complicate care. 3. The effects of dementia can exacerbate existing behavioral problems. 4. Cognitive impairment can impede understanding.

Home care professionals who regularly work with elderly clients understand how to navigate these issues, as well as the use of medications (such as selective serotonin reuptake inhibitors and other antidepressants), family caregiver dynamics, and the individual personality of the patient.

Cognition and the Elderly

30% - 80%
Elderly heart patients suffer cognitive impairment

A 2018 study authored by the Journal of Geriatric Cardiology stated that cognitive impairment, dementia, and depression – which have overlapping symptoms such as inertia, apathy, self-neglect, and withdrawal – sometimes lead to an incorrect diagnosis in elderly patients. Home care professionals who focus on serving the elderly may be able to provide insights to inform accurate clinical diagnoses.

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide. 

SeniorBridge offers an integrated care management practice model that involves two components:
1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on home care support services for heart disease, contact SeniorBridge.

Sources consulted:
US National Library of Medicine/NIH (2016, 2013)
BMC/Springer Nature (2012)
Hindawi Depression Research and Treatment (2014)
Journal of Geriatric Cardiology (2018)

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