The Application Of Continuous Care Among Older Adults With Implanted Pacemaker

ObjectiveThe aim of this research is to study how to innovatively provide continuous health care service for elderly patients with implanted pacemaker, and to explore an effective, scientific, and standardized healthcare service model. This model prompts patients to establish good compliance behaviors; delays the occurrence of complications through individualized rehabilitation training, improves patients’ quality of life and provides a reference for the construction and application of a standardized, comprehensive and individualized healthcare service model.MethodsThis study investigated elderly patients with pacemaker implantation who had admitted in a provincial hospital (3A) located in Zhengzhou city during the time period from December2012to December2013. Eighty patients who meet the inclusion criteria were randomly divided into two groups—one is the control group with38cases, the other is the intervention group with42cases by convenience sampling method. These patients were underwent baseline survey and received continuous health care service intervention. A variety of measurement instruments including the Self-rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), Aquarel Scale, and SF-36summary tables were used to analyze the intrinsic link between patients’ depression level, anxiety level and their quality of life. In-depth discussion was conducted in relate to the intrinsic link between the depression level, anxiety level and quality of life for elderly patients before and after pacemaker implantation, and at one year after discharge. Both control group and intervention group received routine health care service during hospitalization. The intervention group received extra individualized guidance based on their discharge evaluation. They also received telephone interviews in the first and second week. The monthly phone or text follow-up interviews were conducted for twelve months. The data were recorded and summarized for analysis. Questionnaires and telephone follow-up data obtained after passing the evaluation, two researches record the data into EpiData3.0database, the data were double checked and analyzed by SPSS17.0software and X2/t tests, p<0.05was considered statistically significant. ResultsThrough the comparison of the disease-related quality of life, anxiety and depression levels between these two groups of patients before pacemaker implantation, there is no statistically significant difference (P>0.05) with regard to their disease-related quality of life, and the SAS and SDS anxiety and depression levels. In comparing the two groups of patients in terms of health-related quality of life, anxiety and depression levels before and after pacemaker implantation, the patient’s health-related quality of life scores increased, whereas the depression and anxiety scores decreased, the difference is statistically significant (P<0.01). After12months implementation of continuous care for the intervention group, health-related quality of life was evaluated by SF-36summary tables, the scores of six dimensions increased including physiological function (PF), role physical (RP),and total scores etc., the differences were statistically significant(P <0.05). Patients’ anxiety and depression were evaluated by SAS and SDS, the scores were reduced, the differences were statistically significant (P<0.05). Through the comparison of the two group of patients’ disease-related cognition knowledge, the differences in disease-related knowledge, medication knowledge and rehabilitation knowledge among control group and intervention group are statistically significant (P<0.01), The cases in the intervention group who have acquired disease-related knowledge, medication knowledge and rehabilitation knowledge were increased dramatically, from2,3,2cases respectively before intervention to23,35and28cases respectively, accounting for54.76%,83.34%and66.67%of the total cases respectively.Conclusions1. The results of this study suggests:elderly patients have relatively severe depression and anxiety before and after pacemaker implantation. After provide continuous health care service for these patients, their depression and anxiety level decreased significantly.2The application of continuous health care can accelerate the recovery of older patients’ with implanted pacemakers and promote the restore of their social functions, thereby improving patients’ quality of life.3Continuous health care service can improve patients’ knowledge in related to cardiovascular disease, medication and rehabilitation. Moreover, it can raise patients’ self-care awareness, prompts patients to firmly grasp skills of taking care of pacemakers, and help them to modify unhealthy lifestyle.