Spirituality and well being among elders: differences between elders with heart failure and those without heart failure.

Heart failure is one of the most threatening and potentially disabling diseases. It is a chronic health problem that is typically associated with marked functional limitation and compromised quality of life (QOL) for the affected individuals and their families. It also may be coupled with clinically relevant psychological impairments such as depression, anxiety, uncertainty, and anger. In the US, there are approximately 5 million individuals living with heart failure (NHLBI 2006) with 5% aged 60 to 69 years and 10% over the age of 70 years. There are 550,000 new patients diagnosed with heart failure every year in the US, predominately males (NHLBI 2006). Several studies have explored depression in patients with heart failure. Patients with heart failure were more likely to have a higher rate of depression (24%) than those in a control group (9.7%) (Havranek et al 1999). Depressive symptoms were found in 42% of ambulatory patients with heart failure (Skotzko et al 2000). Researchers also have found that depressed heart failure patients were at increased risk of mortality in comparison to their counterparts who did not experience depressive symptoms along with heart failure (Rozzini et al 2002). Spirituality has been conceptualized as including an individual’s transcendent relationship with a higher being or with the universe and has been positively linked to hope, coping, and religiosity (O’Neill and Kenny 1998). It has been found to be particularly important among older adults, and positively linked to self-appraised good health among elders (Daaleman and Frey 2004). Previous researchers have studied spirituality in heart failure patients. Spirituality and quality of life were studied among 58 persons with heart failure being treated medically or by transplant (Beery et al 2002). The average age of the participants ranged from 22 to 68 years with the majority being male. The sample included 90% European American and 10% African American. Gender differences were not significant with regard to spirituality. Results indicated that spiritual well-being as measured by the Spiritual Well Being Scale (SWB) which included religious and existential well-being was significantly related to global quality of life, and disease-specific (heart failure) quality of life. The SF-36 was used to measure the health-related quality of life. The mental composite score was significantly related to spiritual, religious, and existential well-being whereas the physical composite score of the SF-36 was not significantly related. Disease specific quality of life was measured using the Minnesota Living with Heart Failure Questionnaire. The emotional and physical symptoms on this scale were significantly inversely related to spiritual, religious, and existential well-being. Berry et al suggested that spirituality may affect the emotional/mental response to a disease rather than influencing the symptoms of a specific disease such as heart failure. Researchers interviewed 87 patients from two out-patient heart failure clinics to ascertain the role of spirituality in the adjustment to their illness (Westlake and Dracup 2001). The sample was made up of 68.9% males with an average age of 56.1 years (+12.9). Of the 87 respondents, 70.1% were Caucasian, 14.9% Latino and 6.9% African American; 24.1% were New York Heart Association (NYHA) classes I and II and 75.9% were classes III and IV. In the findings regarding spirituality, patients described regret over past behaviors and lifestyles, the search for meaning within the present experience, and hope for the future and reclaiming of optimism. Westlake and colleagues (2002) studied spirituality (as measured by the Spiritual Perspective Scale) and health related quality of life (HRQOL) as measured by the SF-36 in patients with heart failure being evaluated for cardiac transplantation. The majority of the participants (85%) were either NYHA class II or III and 12% were class IV. Of the 61 participants, 74% were male; the average age was 57 years. The majority of participants were Caucasian (84%), with 15% Hispanic and 2% African American. Subjects reported a moderate level of spirituality; women were more spiritual than men. There was no significant relationship between spirituality and HRQOL. Hardin and colleagues (2003) studied 29 patients with heart failure to determine the relationship between spirituality and New York Heart Association (NYHA) heart failure functional classes I through IV. Seventy percent of the patients were men; the average age was 72.76 years. Eighteen of the 29 patients were NYHA Stage I and II; 11 were stages III and IV. Patients with advanced stages of heart failure had significantly lower scores on the spiritual involvement and belief scale (SIBS) than patients in earlier stages of heart failure. Patients with late stage illness agreed significantly with two of the statements on the SIBS compared to those with Stages I and II. These statements indicated that prayers do not really change what happens, and that they would probably not reexamine their spiritual beliefs. Hardin et al suggested that patients with late stage heart failure may be more concerned with physiological needs as opposed to spirituality. There was no significant difference between men and women on the SIBS scores. Research results regarding spirituality among heart failure patients are inconclusive; no two studies used the same measures of spirituality. No previous research is available comparing patients with heart failure to those without heart failure. Researchers who studied spirituality and quality of life, while concluding that spiritual factors appear to be related to overall physical health, found no relationship to mental components of health. Thoresen and Harris (2002) recommended additional research, particularly attention to psychological factors. This present study was an attempt to address one dimension of psychological health (depressive symptoms) and its relationship to spirituality in heart failure and non-heart failure patients.