Congestive heart failure (CHF) is one of the common health challenges in aging persons. The health condition is one of the major causes of deaths and health complications for individuals that above sixty-five years. Congestive heart failure is not only a major cause of health complication and death in aging individuals but also contribute high number of re-admission among aging person. Moreover, treating congestive heart failure cost a fortune and is a major challenge to families with a CHF patient.
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Considering its significance to the health of aging persons, Health care provision for aging persons should therefore consider CHF management. Because of increased cases of CHF and its health and cost implications, various recent research studies have focused towards coming up with better chf management Congestive heart failure occurs when the heart is not able to meet the body’s demand for oxygen.
The heart of congestive heart failure patient is weak and is not able to supply sufficient blood in key body organs. The condition id further accelerated by secondary factors such a as high blood pressure and coronary artery disease which weaken the heart.
Similarly, faulty heart valves, a condition that occurs when the valves between heart chambers do not open properly forcing the heart to work harder to keep the blood flowing correctly also weakens the heart leading to heart failure. Other tertiary factors such as diabetes, severe anemia as well as kidney or liver filature could precipitate to heart failure.
The symptoms of the disease are easily recognizable such as shortness of breath coughing, swelling feet and ankles, swelling abdomen as well as weight gain. The treatment and recovery require keen supervision and medication that should be regularly maintained failure to which the condition accelerates depending on the seriousness of the disease or factor involved (Stewart et al 2002, pp361)..
Heart failure is common among the elderly and financially dependent population. These are often considered a burden to society and therefore given little attention and follow up.
The smaller financially stable population spends a considerable amount on medication and end up under cost and doctor supervision. In a community with limited or few resources there is little or no follow-up for the elderly after heir discharge from hospital.
This is because most of them often live lone and only receive one visit per week by a nurse. The nurse assesses their needs and ensures that they have taken their medicine. The regulatory and effectiveness of the medication depends on the patients discipline and punctuality in taking it (Ewald et al 2008, pp101).
The rates of discipline vary and depend on how the patient perceived the instruction on medications. This therefore poses a problem of taking medications on time. Since most of the patient lives alone, no one will remind them that a puff of cigarette or a sip of wine is a risk factor.
Medical conditions identified as risk factors to congestive heart failure include coronary artery disease, diabetes, hypertension, valvular heart disease, hyperthyroidism and earlier history of heart disease. Apart from medical conditions and age, lifestyle factors such as smoking, excessive consumption of alcohol and continuing use of anabolic steroids are noted as among risk factors of congestive heart failure.
Statement of the problem
Congestive heart failure contributes to a high number of readmission cases in elderly patients and accounts to up to a quarter of all hospitalization expenditure.
Medical scientists have noted that congestive heart failure is not only a common indication of hospitalization in elderly patients but is also linked to early deaths and a high immortality rate among these patients (Rosamond Wet al. 2008, pp146).
This study will interrogate the rates of readmission as compared to admission in a local hospital with a bed capacity of 300 patients. The study will only focus on elderly 65 and above regardless of sex, race, ethnicity, socio eco, status in life etc. admitted only with CHF and reasons ranges from non-compliance of med, no diet modification, smoking, and alcohol.
No younger population or any less than 65 y/o. The research will narrow down to the readmission and admission rates for the period between January 2010 and March 2011 as well as the relevant data that will facilitate the development of a case management strategy (Krumholz et al 2000, pp 476).
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Appropriateness of Approach
The research will use quantitative descriptive design by doing retrospective chart review of cases diagnosed with congestive heart failure admitted in the local hospital. The data will be gathered between dates of January 2010 up to March 2011 period. The quantitative design is appropriate for this study because of the numbers needed for the research. This is a chart review of the chf cases from dates mentioned. This will study the data of chf readmission and the reason for consult.
Purpose of the research
Role and bias of the researcher
The research will embrace both qualitative and quantitative methods in collecting data relevant to the research. The mixed approach will allow the researcher to interrogate the individual patients based on their experiences as well as their reasons and factors surrounding their conditions.
The research will be conducted for a whole year to capture an all round analysis of the situation in the local hospital (Hobbs et al 2002, pp214). Due to the lack of medical expertise, the researcher will employ the assistance of the doctors and nurses who have experience and have worked with the patients for a long time.
The research will employ non-probability purposive sampling techniques in collecting data for the research. The patients admitted in the hospital come from different societal divides hence they cannot be easily identified not categorized. Further, the rate of admission and re- admission depends on a variety off factors that are beyond the control of this research and therefore crating a random environment.
Appropriateness of Sampling Technique
Non-probability purposive sampling allows the researcher to defeat the bias that may exist in the collection of data. The selection of a sample from a divergent population within a short time and also increases the accuracy of the research and ensures that the researcher maintains an objective perspective.
Non-probability purposive sampling allows the researcher to cover a large sample size within a short period of time ensuring that the research is completed on time. Non-probability purposive sampling also reduces the costs involved in the research since it narrows down the population size (Able, et al 2007).
Congestive heart failure affects people of all ages since it is caused by a variety of factors. Among children, it is not very prevalent since children have a high chance of recovery correction and treatment (Raphael et al. 2007, pp 476). The condition is however more prevalent among the elderly and adult population.
The research will therefore target the elderly population 65 y/o and above regardless of co morbidities as long as admitted or readmitted with chf. This represents a majority of the elderly dependent population with a few exceptions.
The research will among other things satisfy the following hypothesis.
- Should answer the question as to why readmission or admission is high among elderly in the local hospital given the period of study.
- Provide the major reason for readmission
- Avail a possible solution, which will be the involvement of the case management, using multi disciplinary team approach.
The research will engage both primary and secondary methods of data collection and analysis. Primary methods are more interactive and involve manual gathering of data from the subject phenomenon (Creswell 1994, p345). They involve collecting data for the first time. There are two commonly accepted primary approaches to research; the qualitative and the quantitative.
The study will employ the use of chart review as its only primary method. This method allows the researcher to interrogate various aspects of the admission and re-admission rates(Aronow, W et al 1999).
The research will present the data in the form of a table that will indicate the number of admission/readmissions per month on the given dates in the local hospital in question. The table will also provide information on the reason for these results and an account of the trend and future prospect of re admission for the same month of admission.
Data collection will begin by getting all charts for admission from January 2010 to March 2011 specifically for patients admitted with chf ages 65 and above. The procedure to be followed will be : chart review, collect data, tabulate the months, then a tabular presentation of the reasons for admission/ re-admission. This provides a diverse opinion that is diverse and constructive. (Wilkinson 199, p21).
Aronow, W et al (1999). “Comparison of incidence of congestive heart failure in older African-Americans, Hispanics, and Caucasians.” Am J of Cardiol 84 (5): 611–2
Auble TE, et al (2007). “Comparison of four clinical prediction rules for estimating risk in heart failure”. Annals of emergency medicine 50 (2): 127–35, 135.e1–2
Creswell, J. W. (1994). Research design: Qualitative & quantitative approaches. Thousand Oaks, CA: Sage p345.
Ewald , et al (2008). “Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction”. Intern Med J 38 (2): 13–101
Hobbs et al ( 2002). “Impact of heart failure and left ventricular systolic dysfunction on quality of life: a cross-sectional study comparing common chronic cardiac and medical disorders and a representative adult population”. Eur. Heart J. 23 pp 214
Krumholz et al. (2000). “Predictors of readmission among elderly survivors of admission with heart failure”. Am. Heart J. 139 (1 Pt 1): 72–7.
Raphael et al. (2007). “Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure”. Heart 93 (4): 82–476
Rosamond et al. (2008). “Heart disease and stroke statistics–2008 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee”. Circulation 117 (4): e25–146
Stewart et al (2002). “The current cost of heart failure to the National Health Service in the UK”. Eur. J. Heart Fail. 4 (3): 71–361.
Wilkinson, A. M. (1991). The scientist’s handbook for writing papers and dissertations. Englewood Cliffs, NJ: Prentice Hall p 21.