Psychosocial Aspects of Coronary Heart Disease in the Elderly - Essay Example

? Psychosocial Aspects of Coronary Heart Disease in the Elderly al affiliation Psychosocial Aspects of Coronary Heart Disease in the Elderly Coronary arteries in the heart may become narrow or blocked due to deposits of cholesterol and other fats on the inner side. This narrowing or blockage is known as coronary heart disease (CHD). The arteries function abnormally due to restricted blood flow caused by the obstruction. The heart is deprived of oxygen and nutrients, and the patient may suffer from chest pains. Total obstruction may deprive the heart muscles of energy completely resulting in a heart attack. According to Marmot and Elliot (2005), more than 80% of deaths from CHD occur in people over 65 years old. A combination of blood pressure level, obesity, smoking, cholesterol and sedentary lifestyles increases the risk of the disease and death in affected patients. Inability to manage stress and other psychological disturbances is also considered a cause of CHD. Psychologists can help old people manage the disease and reduce secondary risks brought by CHD complications. Psychosocial factors such as anger, stress, depression, hostility and social isolation contribute to the disease development. Psychosocial factors are factors that relate psychological conditions to the social environment. These factors also worsen the condition in affected patients. The heart is linked to emotional conditions of a person. For example, people with high anger levels suffer from the disease more than those with low anger disposition. Elderly patients are more prone to depression and social isolation. These people have lower social-economic status than younger patients, which has a negative effect on rehabilitation programs and medical therapy compliance. These factors cause the disease by affecting behaviours such as smoking, alcohol consumption or physical activities (Glassman & Sartorius, 2011). These factors may also cause direct chronic patho-physiological changes in patients. Access to medical care may also be influenced by social support and psychological conditions of the patient. Addressing psychosocial factors may play as a mediating pathway as stated by Illic and Apostolovic (2002). Type A Behaviour and Hostility This is a personality behaviour characterized by hard living and competitive behaviour as explained by Hemingway and Marmont (2000). Patients have pronounced impatience, vigorous speech, and hostility. This is an action-emotion complex exhibited by individuals engaged in chronic struggle to obtain several poorly defined things from the environment. They expect these results in the shortest time possible and, where necessary, against other people in the same environment. This type of behaviour is equivalent to smoking and hypertension. Patients develop time urgency, aggressiveness, competitiveness, and easily aroused hostility. Psychological autonomic responses to interpersonal stress are altered in hostile individuals. This associates hostility and CHD as explained by Kuper, Mrmont and Hemingway (2002). These individuals have cynical thoughts, angry feelings and aggressive behaviour. Hostile people will have little confidence in others and consider them unsocial, dishonest, and mean. This hostility leads to reduction in tonic vagal cardiac modulation of the heart. Hostility is linked to clinical depression and physiological disorder through an abnormality in the central nervous system. Depression Clay (2001) says that depression, anxiety, and pathological anger affect cardiac events in CHD patients. It produces risk through increased sympathetic tone, decreased heart rate and increased blood coagulation. According to Perk (2007), stress is one of the most important CHD risk factors. These events produce a distressed personality type and predict cardiac events as a medical risk. The heart rate variability may also decrease and the ventricular rhythm may increase. Patients suffering from CHD experience anxiety, fear, and posttraumatic stress reactions. Elderly people have anxiety and fear of death due to the disease. Anxiety originates from the body of the patient and represents a response to a biological threat. Low to moderate anxiety affects cardiac physiology and cardiac end points. High anxiety levels may result in panic attacks and sudden death due to reduced vagal modulation of cardiac rate. Patients with CHD suffer from depression. They fear for their lives and have reduced quality of life and ability to work normally. Depression in old people may cause sudden attacks and is brought about by reduced social support and environmental stressors. It is also a result of CHD attack. Patients diagnosed with CHD develop psychological distress as a reaction to the life threatening condition. Due to their old age, they have to confront issues of dependence on others and loss of control. The patients may develop defence mechanisms such as denying the disease, hostility to family members, and regression. Denial is brought about by lack of acceptance by the conscious part of the psyche. This mechanism tries to resolve emotional conflict and anxiety by disallowing feelings, thoughts, wishes and external reality. Healthy denial may reduce the physiological effects of anxiety. The patient develops aggression due to the unjust feeling of the condition. This feeling causes anger and the patients can only deal with it through aggression to family members and medical staff. Depression also causes hypertension, rise in blood pressure, which is a risk factor for CHD as stated by Miller (2009). Social support and social isolation According to Heather (2006), social integration refers to the presence or absence of relationships and social ties. The structure of one’s relationships forms the social network. Social support is the provision of emotional concern, assistance and information by people in one’s social network. Lack of social support increases cardiovascular risk by 5.6. Older people often have dense, strong and larger social networks and require their social support. Social isolation of old CHD patients causes loneliness and lack of companionship. Lack of intimacy and lack of a sense of belonging by isolated people are linked to CHD. Some of the elderly people live alone, divorced or widowed. Loneliness is the major cause of CHD in old people. The elderly people have little to contribute to the society, which increases the risk factors.Women are more affected by social isolation than men, therefore they have a higher risk of CHD. They have more hormones than men, thus having more psychological disorders according to Bankier and Littman (2002). Psychotherapy The main aim of psychotherapy is minimizing the psychological stress in patients by making them more psychologically comfortable. The psychologist aims at creating a relationship that will make the patient feel safe to express their feelings and therefore feel accepted. Successful adaptation causes a realistic insight into the limitations and helps them adjust to the actual condition. Rehabilitation suppresses anxiety, regression, and denial. Psychologists try to determine the psychological needs of the patient and implement stress management and relaxation techniques. Psychotherapy is considered as a logical treatment for depression caused by CHD. Interventions such as stress management, education, attention to isolated patients, and referral to professionals of high levels of anxiety can help CHD patients. Patients who attend peer support groups report more health problems and receive more support from psychologists and therapists. According to Austin, Boyd and Austin (2010), 75% of CHD patients who undergo therapy for depression respond positively to medication. Therapists help old people cope with CHD through their expertise in communication, ability to understand and integrate bio-psychosocial issues, and their skills in exploring sensitive emotional topics. Therapists can prescribe antianxiety agents such as benzodiazepines. These drugs help in anxiety relief and reduce cardiovascular toxicity (Alpert & Ewy, 2002). Exercise training is recommended to enhance psychological functioning. Elderly CHD patients have exercise trainability comparable to young people. Both men and women show comparable improvement after exercise and there are no adverse effects of exercise in elderly people. Standard exercise improves functional capacity and reduces complications related to physical activity. Exercise reduces CHD risk factors such as obesity, hypertension and insulin resistance. According to Hanna and Wenger (2005), glucose control and insulin resistance are improved by exercise which reduces the chances of diabetes. Diabetes is common in elderly people and modifications in their lifestyles that increase metabolism and loss of body fat are encouraged. Statistics show that 2 out of 3 elderly people with diabetes die from heart complications such as CHD according to Wendland (2002). A psychologist should encourage patients to engage in several exercise activities as part of rehabilitation. Cognitive therapy and psychosocial interventions play an important role in the treatment of depressed and socially isolated CHD patients. Separation, isolation and rejection trigger fear and anxiety in old people, which increases the risk of CHD. Patients may block depression and anxiety and the therapist is required to adopt supportive counselling aiming at individual needs. Exercise is required for old people as a way of treating CHD and preventing secondary attacks. Women are more affected by the condition and require more attention during the rehabilitation process. Patients may become hostile due to anger feeling inside them and psychiatrists are required to use their skills to develop relationship with patients that will enable them to deal with the situation. Smoking and unhealthy diet should be highly discouraged in patients to reduce the chances of attack. The government, through NSF, has set guidelines and health requirements that psychologists can follow to rehabilitate the elderly (Pathy, 2006). References Alpert, J. S., & Ewy, G. A. (2002).Manual of cardiovascular diagnosis and therapy. Philadelphia: Lippincott Williams & Wilkins. Austin, W., Boyd, M., & Austin, W. (2010).Psychiatric & mental health nursing for Canadian practice. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins. Bankier B., & Littman, A. (2002). Psychiatric disorders and coronary heart disease in women – a still neglected topic: Review of the literature from 1971 to 2000. Psychotherapy Disorders and Coronary Heart Disease in Women, 71, 133-140. Clay, R. A. (2001, January). Research to the heart of the matter. American Psychological Association, 32, 42. Glassman, A., Mario, M., & Sartorius, N. (2011). Depression and heart disease. Chichester: John Wiley & Sons. Hanna, I. R., & Wenger, N. K. (2005, June 15). Secondary prevention of coronary heart disease in elderly patients. American Family Physician, 71, 2289-2296. Hemingway, H., & Marmont, M. (2000, May 29). Psychosocial factors in the aetiology and prognosis of coronary heart disease: Systematic review of prospective cohort studies. BMJ, 318, 1460-1467. Heather, M. A. (2006, September/October). Depression, isolation, social support, and cardiovascular disease in older adults. Journal of Cardiovascular Nursing, 21, S2-S7. Ilic, S., & Apostolovic, S. (2002). Psychological aspects of cardiovascular diseases. Medicine and Biology, 9, 138-141. Kuper, H., Marmot, M., & Hemingway, H. (2002, February 2). Systematic review of prospective cohort studies of psychosocial factors in the etiology and prognosis of coronary heart disease. Seminars in Vascular Medicine, 2, 267-314. Marmot, M. G., & Elliott, P. (2005).Coronary heart disease epidemiology: From aetiology to public health. Oxford: Oxford University Press. Miller, C. A. (2009). Nursing for wellness in older adults. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. Pathy, M. S. J. (2006). Principles and practice of geriatric medicine. Chichester: John Wiley & Sons. Perk, J. (2007). Cardiovascular prevention and rehabilitation. London: Springer. Wendland, L., & Association for the Prevention of Torture. (2002). A handbook on state obligations under the UN Convention Against Torture. Geneva: Association for the Prevention of Torture. Read More