Background & Aims: Chronic heart failure (CHF) is one of the most common physical problems in the elderly that causes numerous disabilities. In addition, it is the main reason for elderlies’ referral to medical centers. Overall, experiencing CHF and its complications, as well as entering the medical environment can exacerbate psychological pressure on patients, including depression and anxiety, thereby increasing heart rate and decreasing patients’ desire to continue the treatment. In fact, this is one of the unfavorable consequences of hospitalization. Moreover, depression and anxiety are the most common complications of cardiac diseases, especially in the elderly hospitalized in coronary care units (CCUs), which threaten the lives of these individuals. Since patients are considered the customers of the health system, and assessing their views is an important factor for improving their psychological and physical health, attention to their psychological and physical needs can increase their satisfaction and decrease issues such as depression and anxiety during their hospitalization. Ultimately, this technique can result in faster recovery of patients and shorter hospitalization period. This study aimed to determine hospital depression and anxiety in the elderly with CHF hospitalized in Firoozabadi Hospital during 2018-2019.
Materials & Methods: This cross-sectional study was performed on 250 elderlies with CHF hospitalized in Firoozabadi Hospital. The research population included all elderlies with CHF in various cardiac wards (CCU1, CCU2, Post CCU), and the participants were selected by a continuous sampling method among those who met the inclusion criteria. Data were collected using a demographic characteristics questionnaire (age, gender, marital status, occupational status, level of education, insurance status, history of hospitalization, accompanying diseases, smoking, and family history of cardiac diseases), abbreviated mental test, and hospital anxiety and depression scale. The research tools were completed during 15 to 20-minute in-person interviews with the researcher. Sampling started February 19^th, 2018, and ended on June 20^th, 2019 after four months. Data analysis was performed in SPSS version 16 using descriptive statistics, such as setting frequency distribution tables, estimating numerical indicators, and inferential statistics, independent t-test, and analysis of variance. Notably, a P-value of below 0.05 was considered statistically significant.
Results: In this study, the participants were in the age range of 60-74 years, having the highest frequency (64.8%) among the elderly. According to the world health organization’s classification, this group of elderlies is considered young old. Overall, 52% of the participants were male and the rest (48%) were female. More than half of the elderly were married and in terms of educational status, only 33.6% of the subjects were illiterate while the rest were literate and educated. Regarding the occupational status, only 4.4% of the elderly were unemployed, and more than half of them received a retirement salary. In addition, 78.8% of the participants had health insurance. According to the results of the anxiety and depression scale, the mean score of anxiety in the elderly was 1.52 with a standard deviation of 1.14 and the mean score of depression was 2.18 with a standard deviation of 1.51. It is notable that anxiety and depression were below eight in all participants. Findings on numerical indicators of anxiety and depression in the elderly with CHF showed a significant relationship between anxiety (P=0.024) and depression (P=0.027) and only the variable of gender, in a way that anxiety and depression were significantly higher in female elderlies, compared to male elderlies.
Conclusion: According to the results of the present study, none of the participants had an extreme and abnormal level of hospital anxiety and depression. In addition, the elderly with CHF had a low level of hospital anxiety and depression. This can be due to the educational and academic nature of the hospital in question and launching the process of clinical governance and accreditation and improving the quality of services and care to patients. Clinical governance is an inclusive and powerful mechanism used to ensure adherence to the highest levels of standards for providing medical services with the least complications and unfavorable consequences. The evaluation and treatment of anxiety and depression in patients are crucial since their frequency in cardiac patients is relatively high and they can have negative impacts on the functional status, quality of life, length of hospital stay, and even treatment outcome of these individuals during hospitalization. In general, serious and acute diseases lead to the sudden and unalarmed hospitalization of individuals in intensive care units. In this regard, some of the patients, who fail to comply with the situation, experience psychological damages, including hospital anxiety and depression. Since the provision of care with proper quality in the field of nursing is a priority in the healthcare system, attention to and evaluation of mood and psychological disorders in different groups of patients admitted to a hospital or training center, which is associated with several factors, is of paramount importance. Desirable outcomes can be achieved such as promoting the health and recovery of elderly patients and their participation in the treatment process, especially in elderly women, by decreasing hospital anxiety and depression and increasing satisfaction and quality of care. Given the fact that even low levels of depression and anxiety in the elderlies can disrupt the interaction and participation between the elderly patient and caregivers, data and information based on scientific evidence can be used in the development of planning to create elderly-friendly hospitals for care managers and policy makers in order to improve the quality of standard nursing care.