Abstract 2085: Changed Expectations: Why Health-Related Quality of Life is Better in Elderly Patients with Heart Failure than in Younger Patients
Older heart failure (HF) patients (pts) often report better quality of life (QOL) than do younger pts. Reasons for this are unclear, but identification of mechanisms underlying this phenomenon may provide insights for interventions to improve QOL for all with HF. To determine reasons for differences in QOL seen in older compared to younger HF pts. A mixed methods approach was used in which:
QOL was compared among HF pts in 4 age groups;
sociodemographic (gender, ethnicity, marital status), clinical (NYHA class, ejection fraction), and psychosocial (depression, anxiety, social support) factors related to QOL were determined using multiple regression; and
pts described their views of QOL during semi-structured qualitative interviews. A total of 2121 HF pts (39% women; 62% NYHA class III/IV) participated in the quantitative component.
Of these, 18 participated in qualitative interviews lasting ~45 minutes. QOL was assessed using Minnesota Living with HF Questionnaire (MLHFQ), psychosocial variables using Brief Symptom Inventory (anxiety), Beck Depression Inventory-II (depression), and Perceived Social Support Scale (social support). The 4 age groups were based on quartiles: ≤54 (n=551); 55– 64 (n=525), 65–74 (n=568), and ≤75 (n=477). QOL was worse in the youngest age group, and best in the two oldest groups (p <.001). Pts ≥ 65 yrs had worse functional status (p<0.001) and more comorbidities (p<0.002), but less anxiety (p<0.001), depression (p<0.001) and more social support (p<0.001) than younger pts. Functional status, anxiety and depression predicted QOL in all age groups except the oldest where depression was the sole predictor. Qualitatively, all pts acknowledged the negative impact of HF on their QOL. Nonetheless older pts said that their QOL exceeded expectations for their age or the alternative of death. Younger pts bemoaned loss of activities and roles, and said their QOL was very poor. The apparent paradox of better QOL among ≥ 65 despite worse functional status and more comorbidities appears to be the result, in part, of better psychosocial status. The major factor driving this phenomenon, however, is a change with advancing age in expectations about what constitutes good QOL.
This research has received full or partial funding support from the American Heart Association, AHA National Center.