Instrumental Activities of Daily Living Among Patients with Heart Failure

Abstract

Heart failure (HF) is a prevalent public health concern affecting 6.2 million Americans. HF is associated with decreased cognitive and physical functioning that may decrease patients' ability to perform instrumental activities of daily living (IADL). IADL are central to maintaining independent living, taking care of oneself, and having a satisfactory quality of life. Little is known about theory-based approaches to IADL in HF and about the facilitators and barriers to treatment fidelity of cognitive interventions, which limit the ability to identify factors amenable to intervention to improve IADL. Thus, a theoretical model was developed to identify explanatory variables influencing IADL in HF based on theoretical and empirical literature. The overall purpose of this dissertation was to establish a theoretical model for IADL and assess the treatment fidelity of supporting clinical trials. Specific aims included: (1) characterizing IADL performance in patients with HF, (2) testing the newly developed theoretical model to assess the relationship between the explanatory variables of age and gender, HF severity, depressive symptoms, physical and cognitive dysfunctions, and IADL performance; and (3) identify facilitators and barriers to treatment fidelity perceived by intervenors while delivering computerized cognitive interventions to patients with HF. The study findings provide knowledge about the level of IADL performance in HF and identify factors that could be targeted for intervention in future studies.