| Background: Heart failure is associated with a pattern of cognitive impairment that includes deficits in memory, attention, executive function, and psychomotor speed. Mild cognitive impairment (MCI), a syndrome defined as a decline in cognition beyond what is expected in aging, is prevalent in heart failure. These cognitive impairments are associated with poor self-care, higher hospital readmission rates, and a fivefold increase in mortality. The relationship between MCI and self-care in heart failure patients has not been well studied, and research examining factors and interventions that may increase self-care behaviors in patients with MCI is limited.;Objective: The purpose of this dissertation study was to determine the effectiveness of a targeted self-care intervention designed for patients with MCI hospitalized for heart failure as evidenced by improved self-care behaviors, increased knowledge, and reduced readmission rates. The research also identified predictors of self-care in heart failure patients with MCI.;Design and Methods: A randomized controlled trial was conducted using a Pretest-Posttest Control Group design to test the intervention. Patients who screened positive for MCI were randomized to the treatment or control group. The treatment group received a targeted self-care teaching intervention using principles of cognitive training. Self-care, heart failure knowledge, social support, and depression were assessed at baseline and at 30 days post-discharge.;Sample: A sample of 125 patients was studied which included English speaking men and women age 21 years of age or older with MCI admitted to the hospital for exacerbation of heart failure.;Findings: Patients in the intervention group had higher heart failure knowledge than patients in the control group at the 30 day follow-up point. Mean heart failure knowledge scores increased significantly in the intervention group, and decreased in the control group at the 30 day follow-up period (P<0.001). When controlling for other variables, patients in the intervention group showed a greater increase in heart failure knowledge than patients in the control group. There was no significant difference in self-care scores between the groups. Variables significantly associated with heart failure knowledge were education level and race. At baseline, greater heart failure knowledge, younger age, race, greater disease severity, higher education level, and greater social support were significant predictors of self-care.;Conclusions: The results provide new information about self-care in patients with MCI. This knowledge can guide the development of interventions that could improve heart failure knowledge, self-care, and delay or avoid heart failure related readmissions. |
