QOL-associated factors in elderly patients who underwent cardiovascular surgery
Environ Health Prev Med
QOL-associated factors in elderly patients who underwent cardiovascular surgery
Kiyoko Terashima 0 1
Yoko Yoshimura 0 1
Kazuyoshi Hirai 0 1
Yukinori Kusaka 0 1
0 K. Hirai Y. Kusaka Department of Environmental Health, School of Medicine, University of Fukui , 23-3 Shomoaitsuki, Matsuoka, Eiheizi-cho, Fukui 910-1193 , Japan
1 K. Terashima (&) Y. Yoshimura Faculty of Nursing and Social Welfare Sciences, Fukui Prefecture University , 4-1-1 Kenzyozima, Matsuoka, Eiheizi-cho, Fukui 910-1195 , Japan
Objectives Quality of life (QOL) was compared between elderly patients treated with cardiac surgery (cardiac surgery group) and general elderly nonoperated individuals (control group) to clarify differences in QOL-associated factors between the two groups. Methods The cardiac surgery group consisted of 82 patients aged 72.5 years at approximately 2 years after discharge, and the control group consisted of 95 elderly individuals aged 77 years living at home. QOL was measured based on interviews using two scales: disease-specific QOL and Short Form (36) Health Survey (SF-36) in the cardiac surgery group, and SF-36 in the control group. Associated factors included the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence, living with one's spouse, exercise habit, and the number of past medical history items. Results There was no cardiac surgery procedure-associated significant difference in disease-specific QOL. When comparing SF-36 between groups, the physical health level was significantly lower in the cardiac surgery group, but no significant difference was noted in the mental health level. Regarding physical health level of SF-36-associated factors, mental health level was a negative factor in both groups. In the cardiac surgery group, age was a negative factor. In the control group, the TMIG index and number of past medical history items were positive and negative factors, respectively. Conclusions As elderly people with high physical health levels after cardiac surgeries may have low mental health levels, physicians and nurses need to be aware and address this situation.
Cardiovascular surgery; Disease-specific; QOL; SF-36; TMIG index of competence; Comparison study
Introduction
The mortality rate from chronic diseases has increased with
the aging of society, and the number of deaths from heart
diseases in 2006 in Japan was 173,125, accounting for
16.0% of all deaths. Mortality rates (per 100,000 persons)
from ischemic heart disease in men and women were
68.1% and 53.5%, respectively, accounting for 44.3% of all
deaths from heart diseases [
1
]. The number of surgeries
performed in the cardiac surgery field has been increasing
over the years, from 20,000 in the late 1980s to 54,000 in
2006, and surgeries for ischemic heart disease accounted
for about one third of all cardiac surgeries. According to a
survey performed by the Japanese Association for
Coronary Artery Surgery, coronary artery bypass grafting
(CABG) was performed in 14,583 cases at 319 facilities
nationwide in 2007, and an off-pump procedure using a
nopump oxygenator, established as the standard CABG
procedure, was employed in more than 60%, [
2
], indicating
that low-invasive cardiovascular surgery has been rapidly
spreading and the number of aging patients undergoing
surgery will further increase.
However, surgery of ‘‘the heart,’’ an organ that strongly
symbolizes life, may have a marked psychological
influence on elderly patients. Moreover, elderly people’s
conditions become complicated by the impairment of motor
organs with aging, which makes it difficult to maintain
activity during the postoperative process of discontinuing
bed rest and after discharge. Therefore, the quality of life
(QOL) of elderly patients following cardiac surgery may be
influenced by many factors in a complex way in addition to
the physical stress of surgery. The purpose of
cardiovascular surgeries has changed to improved QOL from simply
treatment and prolongation of life; for this purpose, QOL
has been actively investigated [
3–10
]. However, most
studies evaluate surgical indications based on the New
York Heart Association (NYHA) and Canadian
Cardiovascular Society (CCS) survival rate before and after
surgery, the effect and treatment, and intervention employing
a QOL scale only from viewpoints of health care workers.
Cardiac surgery improves survival rate and symptoms and
improves QOL in many reports [11], but there have been
fewer reports on QOL evaluation from viewpoints of the
elderly patients themselves, such as whether they found
pleasure in and realized the significance of their own social
roles.
In this study, participants were elderly patients at
approximately 2 years after CABG, valve replacement, or
aortic/thoracic aortic bypass grafting at the same medical
institution who were relatively healthy and could continue
outpatient visits. The time required after cardiac surgery to
recover their preoperative QOL leve (...truncated)