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The journey of the frail older adult with heart failure: implications for management and health care systems

Published online by Cambridge University Press:  03 October 2014

George A Heckman ,
Cara Tannenbaum ,
Andrew P Costa ,
Karen Harkness  and
Robert S McKelvie
George A Heckman*
Affiliation:
Research Institute for Ageing, School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
Cara Tannenbaum
Affiliation:
Faculté de Medicine, Centre de Recherche de l’InstitutUniversitaire de Gériatrie de Montréal, Québec, Canada
Andrew P Costa
Affiliation:
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Karen Harkness
Affiliation:
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
Robert S McKelvie
Affiliation:
Department of Medicine, McMaster University, Hamilton, Ontario, Canada
*
Address for correspondence: George A Heckman, Schlegel Research Chair in Geriatric Medicine, Research Institute for Ageing, Associate Professor, School of Public Health and Health Systems, University of Waterloo, LHN 3734, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1. Email: ggheckma@uwaterloo.ca
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Summary

The heart failure epidemic predominantly affects older people, particularly those with concurrent co-morbid conditions and geriatric syndromes. Mortality and heath service utilization associated with heart failure are significant, and extend beyond the costs associated with acute care utilization. Over time, older people with heart failure experience a journey characterized by gradual functional decline, accelerated by unpredictable disease exacerbations, requiring greater support to remain in the community, and often ultimately leading to institutionalization. In this narrative review, we posit that the rate of functional decline and associated health care resource utilization can be attenuated by optimizing the management of heart failure and associated co-morbidities. However, to realize this objective, the manner in which care is delivered to frail older people with heart failure must be restructured, from the bedside to the level of the health care system, in order to optimally anticipate, diagnose and manage co-morbidities.

Keywords

heart failurefrailtydisease managementmultimorbidityclinical skills
Type
Review Article
Information
Reviews in Clinical Gerontology , Volume 24 , Issue 4 , November 2014 , pp. 269 - 289
Copyright
Copyright © Cambridge University Press 2014 

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