A Study Of Social Adaptability In Older Patients With Acute Myocardial Infarction

ObjectivesThis study was to investigate the social adaptability in older people with acute myocardial infarction (AMI) andto understand their health-related disabilities or difficulties so todevelop specific health education interventions for the improvement of quality of nursing care and patient outcomes post-AMI.MethodsThis study was constituted of two phases.During the first phase the qualitative approach was taken to interview 18 AMI patients who metthe criteria using an interview guide including the measure of their health-related difficulties using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS II) on the 7th day post-admission and the 30th day post-discharge respectively. Interview transcripts were analyzed using content analysis from which the health education booklet was formulated after its contents being reviewed and revised by medical and nursing experts.During the second phase, the quantitative approach was used to evaluated the quality of life in79 older patients with AMI on the second day of their admission and two weeks after their discharge. These inpatientswere randomly allocated to Observation Group (n=41) and Control Group (n=38). The Control Group received the conventional health education, while the Observation Group received additionalhealth education deliveredby thepre-developedhealth education booklet in the first phasefollowing the standard health education pathway.Result18 patients attended in the first interview, male to female ratio was 2:1(12:6),the average age was 67.6 years(s=5.282).Total of 79 patients had a clinical trial to try health education booklet and health education pathway, including Control Group(n=38) and Observation Group(n=41).The average age in Control Group was 67.05 years(s=5.475).Observation Group, the average age was 66.8 years(s=5.085).With a total of four experts to participate in the validity evaluation and modifications, of which 2 doctors and 2 nurses,1 men and 3 women,the average age was 42.25 years(s=6.397).First, the content analysis shows that the social adaptation occurred in the following six thematic aspects in older patients with AMI.Theme One.ImprovedDisease AwarenessThe majority of older patients with AMIwere found lack of AMI-related knowledge (e.g.etiology, clinical manifestations, prognosis, treatment and rehabilitation) especially the attack of myocardial infarction.In this study 72.2%(13/18) of patients paid no attention to itwhen symptoms appeared, and some of them even questioned about the diagnosiseven when they were admitted for it.Theme Two.Social AdaptationThis was mainly related to that patients were required to have the strict bedrest, the adjustment of family and social responsibilities as well as economic regulation during the first three days post-AMI. Patients had to change the scope of interpersonal interactions to accommodate with the changed needs, physically, mentally, socially and economically.Theme Three.Psychological AdaptationThe major psychological responses in older patients with AMI were nervousness, sensitivity towards diseased conditions,worries about prognosis and changes to self-identity. Overall patients appeared to have negative cognitions, adverse emotions, withdrawal behaviors and passive attitudes.Theme Four.Life style ModificationThis was mainly related to smoking (i.e.quit smoking), drink and food (i.e. the initial loss of appetite evolving to the compositional dietary change), resting (i.e. controlling of physical activities) and attitude (for many trivia no longer preoccupied).Theme Five.Active Learning ofAdaptationOlder patients with AMI started to pay more attention to the learning from nurses and other AMI patients in addition to the learning through different media modalities.Theme Six.Compliance BehaviorsPatients’ compliance to treatments (e.g. medication,follow-up reviews) was affected by their memory and the ability to reach a understanding. It was also related to doctors’inclination to communicate with patients’family instead of patients themselves. The limitation in communication and cognition were the main causes to the comprised medical compliance.Second,overall the WHODAS II score (79.8 ± 9.26) on the seventh day post-admission were significantly different (t=6.731, p<0.00\) from the score (57.5 ± 15.12) one-month post-discharge. At these two time points four domains scores were found significantly different from each other, i.e. Walking Around (t=5.944,p<0.001), Self-Care (t=4.140,p<0.001), Living Activities (t=6.624,p<0.05) and Social Participation (t=6.133,p<0.001).Third, the quality of life scores, i.e. SF-8 scores, in the Observation Group and the Control Group were not significantly different (p>0.05) from each other on the second day of admission in contrast with the significant group difference (p<0.05) in each of eight areas of quality of life on the second week post-discharge.ConclusionsOlder patients with AMI confronted complicate challenges to their social adaptation in the acute phase, which requires specific support to adjust to the diseased conditions. The AMI Health Education Booklet for Older People as well as the accompanied standard health education pathway was found to be effective at improving educational and patient outcomes resulting in the better rehabilitation and quality of life in older AMI patients.