Anna Chudiak

Effects of depression and anxiety on asthma-related quality of life.

INTRODUCTION Asthma is the most prevalent chronic disease in adults. It affects their quality of life. Studies confirm that depression and anxiety occurs in asthma patients. MATERIAL AND METHODS The study involved 96 patients with asthma divided into two groups: patients with controlled (n = 33) and uncontrolled asthma (n = 63). The analysis of asthma control was performed on the basis of the ACT (Asthma Control Test) results. The study used SF-36 (Short Form 36) questionnaire and HADS (Hospital and Depression Scale) Scale. RESULTS An analysis of the correlations between QoL (Quality of Life) and the level of depression revealed a decrease in QoL scores in MCS (Mental Component Score) domain in the group with controlled asthma (71.8 - patients without depression, 53.4 - patients with probable depression, and 51.4 - patients with depression; p = 0.032). A similar analysis of the correlations between QoL and the level of anxiety in this group of patients proved no correlations in PCS (Physical Component Score) and MCS domains. In the group of patients with uncontrolled asthma, anxiety and depression correlated negatively with the QoL in PCS and MCS domains. Anxiety and depression are found in asthma patients, with higher severity observed in patients with uncontrolled asthma. Female gender, the level of asthma control, asthma severity, smoking, as well as diagnoses of anxiety and depression are predictors of a significantly lower QoL in asthma. CONCLUSIONS Anxiety and depression are found in asthma patients, with higher severity observed in patients with uncontrolled asthma. Female gender, the level of asthma control, asthma severity, smoking, as well as diagnoses of anxiety and depression are predictors of a significantly lower quality of life in asthma.

Intensity of Anxiety and Depression in Patients with Lung Cancer in Relation to Quality of Life

Psychological factors, such as the anxiety and depression, which often occur in patients with lung cancer might negatively influence their quality of life. The aim of the study was to evaluate the effect of anxiety and depression in lung cancer patients on quality of life. The study included 180 lung patients of the mean age of 62.7 ± 9.7 years. The following scales were employed in the study: Quality of Life Questionnaire QLQ-C30 and LC13 scale, and Hospital Anxiety and Depression scale (HADS). The overall score of quality of life measured by QLQ-C30 was 47.1 ± 23.4 points on a hundred-point scale. Anxiety was diagnosed in 67 patients (37.2%) and depression in 75 patients (41.7%) by HADS. Quality of life was significantly worse in case of anxiety and depression (p < 0.05), which negatively influenced both functional and symptom intensity scales measured with QLQ-C30 and QLQ-LC13. We conclude that early identification of anxiety and depression may help in therapeutic decision-making and may be a useful predictive factor in lung cancer patients.

Effect of frailty syndrome on treatment compliance in older hypertensive patients

Background Frailty syndrome (FS) is an important problem in older persons. It may develop concomitantly to many aging-related diseases, including arterial hypertension, and exerts detrimental effects on both their outcomes and treatment compliance. Objective To analyze the effect of FS on treatment compliance in older hypertensive patients. Materials and methods This study of 300 hypertensive patients (167 women and 133 men) aged between 65 and 91 years (mean 71.75±7.79 years) was based on the analysis of medical documentation and survey with the Tilburg Frailty Indicator (TFI) and Hill-Bone High Blood Pressure Compliance Scale. Results Mean systolic and diastolic blood pressure values of the study subjects were 141.97 and 85.16 mm Hg, respectively. Mean time elapsed since the diagnosis of arterial hypertension was 13.74 years. FS was diagnosed in 65.67% of the study subjects. Mean global score of the Hill-Bone High Blood Pressure Compliance Scale was 20.75 points. TFI scores correlated significantly with the global score of the Hill-Bone High Blood Pressure Compliance Scale (R=0.509, P<0.001) and the values of its 2 subscales: Appointment Keeping (R=0.34, P<0.001) and Medication Taking (R=0.537, P<0.001). Conclusion FS exerts a significant effect on treatment compliance of older hypertensive patients. Treatment compliance is modulated by patients’ sex (worse compliance in men), education (better compliance in subjects with higher education), and TFI scores (worse compliance in patients with FS).

Selected factors affecting adherence in the pharmacological treatment of arterial hypertension

Background Low adherence to hypertension (HT) management is one of the major contributors to poor blood pressure (BP) control. Approximately 40%–60% of patients with HT do not follow the prescribed treatment. The aim of the study was to analyze the relationship between selected variables and adherence to hypotensive pharmacological treatment. Besides socioclinical variables, the study focused on the role of illness acceptance. Participants and methods The study included 602 patients with HT. Adherence and acceptance of illness were assessed using the following validated instruments: the Acceptance of Illness Scale (AIS) and the Morisky Medication Adherence Scale (MMAS). Results The high-adherence group comprised a significantly higher percentage of patients with high illness acceptance scale scores than that of patients with low-to-moderate scores (42.4 vs 31.8%; P=0.008<0.01). The odds ratio (OR) showed that high adherence to pharmacological treatment was >1.5 times as likely to occur in the high acceptance group as in the low-to-moderate acceptance group (OR =1.58, 95% CI 1.14–2.19). Spearman’s rank correlation coefficients showed statistically significant correlations between adherence and sex (men ρ=−0.101; P=0.012), age >45–66 years (ρ=0.098; P=0.015), higher education level (ρ=0.132; P=0.001), grade ESC of HT (ρ=−0.037; P=0.057), receiving one-tablet polytherapy (ρ=0.131; P=0.015), and illness acceptance (ρ=0.090; P=0.024). Conclusion Acceptance of illness is correlated with adherence to pharmacological treatment, and consideration should be given to more widespread assessment of illness acceptance in daily practice. Male sex, age >45–66 years, duration of illness grade ESC of HT, and receiving one-tablet polytherapy are significant determinants of adherence to pharmacological treatment in HT.

Hypertension and Frailty Syndrome in Old Age: Current Perspectives

Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.

Psychometric properties of the Polish version of the eight-item Morisky Medication Adherence Scale in hypertensive adults.

Low adherence to pharmacological treatment is often associated with poor blood pressure control, but identification of nonadherent patients in outpatient settings is difficult. The aim of the study was to translate and evaluate the psychometric properties of the Polish version of the structured self-report eight-item Morisky Medication Adherence Scale (MMAS-8) among patients with hypertension. The study was conducted in a family doctor practice between January and July 2015. After a standard “forward–backward” procedure to translate MMAS-8 into Polish, the questionnaire was administered to 160 patients with hypertension. Reliability was tested using a measure of internal consistency (Cronbach’s α) and test–retest reliability. Validity was confirmed using known group validity. Three levels of adherence were considered based on the following scores: 0 to <6 (low); 6 to <8 (medium); and 8 (high). Complete questionnaires were returned by 110 respondents (mean age: 60.7 years ±12.6; 54.6% were female). The mean number of pills taken daily was 3.61±4.31. The mean adherence score was 6.42± 2.0. Moderate internal consistency was found (Cronbach’s α=0.81), and test–retest reliability was satisfactory (r=0.461–0.905; P<0.001). Reproducibility expressed by Cohen’s κ coefficient =0.61 was good. In high-adherent patients, the percentage of well-controlled blood pressure was higher than in low-adherent patients (33.3% vs 19.1%, χ2=0.87, P=0.648). Psychometric evaluation of the Polish version of the MMAS-8 indicates that it is a reliable and valid measure tool to detect nonadherent patients. The MMAS-8 may be routinely used to support communication about the medication-taking behavior in hypertensive patients.

Assessment of frailty syndrome using Edmonton frailty scale in Polish elderly sample

Abstract The aim of the study was to assess the incidence and severity of the frailty syndrome assessed with the Edmonton Frailty Scale. This is a cross-sectional study conducted among 382 patients (236 men and 146 women, mean age 71.9 years). The Edmonton Frailty Scale was administered during the patient’s admission to the hospital. The Polish adaptation was performed using the standard methodology. The Cronbach’s alpha coefficient for the whole Edmonton Frailty Scale was 0.709. The mean correlation between positions and the overall result was r = 0.180. There were no statistically significant differences between women and men in the area of Edmonton Frailty Scale mean score (p < 0.05). The socio-clinical analysis, showed statistically significant differences in the age of respondents, educational attainment, occupational activity, number of drugs taken and co-occurrence of chronic diseases. A higher values of the Edmonton Frailty Scale were indicated for individuals >70 years than for those <70 years (p < 0.001). The Edmonton Frailty Scale proved to be a reliable tool which may be used in the Polish population. The use of this questionnaire for frailty syndrome may be helpful in everyday clinical practice.

Relation between cognitive impairment and treatment adherence in elderly hypertensive patients

Background Nonadherence to medical treatment and lack of cooperation in hypertensive patients >65 years of age are believed to be caused by a number of age-related problems, such as cognitive impairment. Numerous epidemiological and prospective studies have demonstrated that hypertension that remains untreated for many years or is unsuccessfully treated for reasons such as poor compliance and adherence of the patient may lead to cognitive impairment. Objective The objective of this study was to investigate the occurrence of cognitive impairment and its effect on treatment compliance and adherence in elderly hypertensive patients. Design This study was an analytical cross-sectional study. Patients and methods The study was conducted on 300 patients aged 65–91 years (mean age=71.8 years, SD=7.8 years) diagnosed with hypertension. The following research tools were used: 1) Hill-Bone High Blood Pressure Compliance Scale (HBCS) and 2) Mini–Mental State Examination (MMSE). We also analyzed medical documentation to obtain basic sociodemographic and clinical data. The study was approved by the Bioethics Committee of the Medical University of Wrocław (no KB-144/2016). Results Cognitive impairment occurred in 60% of the patients. A group of 63% patients complied with antihypertensive therapy, with the mean score of 20.8 points. Cognitive impairment was strongly correlated with the total score of the HBCS questionnaire (p<0.001) and two of its subscales: “appointment keeping” (p<0.001) and “medication taking” (p<0.001). Conclusion Compliance and adherence levels are higher in patients with a higher educational level, whereas male sex adversely affects treatment adherence in elderly hypertensive patients.

Wpływ edukacji diabetologicznej na ocenę jakości życia chorych z cukrzycą typu 2

Wstep. Cukrzyca typu 2 jest chorobą przewleklą rozwijającą sie podstepnie przez dlugie lata bez objawow klinicznych. Powoduje wiele zmian w dotychczasowym funkcjonowaniu, przez co obniza ocene jakości zycia. Obok farmakoterapii waznym elementem leczenia pacjenta z cukrzycą jest edukacja diabetologiczna, ktora ma za zadanie odpowiednio przygotowac pacjenta do wspoluczestniczenia i wspolpracy w procesie leczenia. Cel pracy. Celem pracy bylo zbadanie wplywu edukacji diabetologicznej na ocene jakości zycia chorych z cukrzycą typu 2. Material i metody. Grupa respondentow liczyla 100 osob (56 kobiet i 44 mezczyzn). Wszystkich chorych podczas pobytu poddano zorganizowanej edukacji diabetologicznej. Grupe kontrolną stanowilo 100 pacjentow (57 kobiet i 43 mezczyzn). Do pomiaru oceny jakości zycia oraz satysfakcji z leczenia chorych z cukrzycą typu 2 wykorzystano kwestionariusz ogolny SF-36 (Short Form 36) oraz specyficzny ADDQoL (Audit of Diabetes-Dependent Quality of Life). Wyniki. Choroba wplynela na ocene jakości zycia w grupie chorych edukowanych oraz nieedukowanych. Chorzy edukowani lepiej oceniali swoją jakośc zycia we wszystkich domenach kwestionariusza SF-36 oraz ADDQoL. Wnioski. Edukacja diabetologiczna pozytywie wplywa na ocene jakości zycia we wszystkich domenach kwestionariusza SF-36 i ADDQoL. Problemy Pielegniarstwa 2015; 23 (1): 1–6