Heart disease is the number one cause of death and leading cause of disability in adults in the United States and worldwide (Centers for Disease Control and Prevention [CDC], 2013). Coronary heart disease (CHD) is the most common form of heart disease with heart attack as its acute manifestation. Health Related Quality of Life (HRQoL) is a multidimensional concept of self-perception of physical, emotional health, and overall sense of well-being (Stewart & Ware, 1992; Centers for Disease Control and Prevention [CDC], 2012). Hope, an inner process focusing on maintaining physical and mental well-being, is considered necessary for survival of chronic illnesses, such as CHD (Herth, 1993; Duggleby, et al., 2012).
This study is significant because it focused on older women who have had heart attacks and it examined the relationship between HRQoL, as multidimensional assessment of health perceptions and hope, as an inner process related to physical and mental health. The population of women over age 65 is growing and they are a vulnerable group because they are likely to live alone and in poverty. The incidence and prevalence of heart attacks is greatest among women, age 65 and older, as approximately 200,000 women die from heart attacks in the US annually (CDC, 2013). However, there are few research studies that focus upon women who have had heart attacks, their consequent perceptions on the quality of their lives or their perceived levels of hope. Healthy People 2020 and the Institute of Medicine have identified HRQoL as a focus of the US health agenda (Healthy People, 2013).
Previous studies of HRQoL have focused upon adults of all ages and gender with specific diseases such as heart disease, cancer, arthritis and diabetes mellitus type 2 (Khanna, et al., 2011; White, Wheelwright, Fitzsimmons & Johnson, 2012; Williams, et al.,2012) or adults living in long term care facilities (Kanwar, et al., 2013; Van Malderen, Mets & Gorus, 2013). There is a gap in research studies from 1990's and 2014 that focuses upon women, heart attacks and the relationship between hope and HRQoL.
Methods: Older women with history of heart attacks (N=91) volunteered for this quantitative non-experimental correlational study. Instruments: demographic questionnaire, SF12 (HRQoL), Herth Hope Index (HHI). Parameters for inclusion in the sample of 84 voluntary participants are female gender, age 65 years and older, history of a heart attack, living in community, ability to speak and read English without need of interpreter services, no diagnosis of cognitive impairment and ability to independently complete questionnaires with minimal prompting.
The HHI is a 12 question tool measured on a 4 point Likert scale in which the higher scores represent the greater level of hope. The HHI questions probe inner thoughts and feelings about outlook on life, goals and fears. Scores can range from 12 to 48, with 12 as the lowest score and 48 as the highest. One point is assigned to responses of “strongly disagree” and four points is assigned to responses of “strongly agree.” Lower scores represent less hope and higher scores represent more hope.
The SF 12 is a 12 question tool measured on a 4 point Likert scale in which higher scores represent a higher level health related quality of life (HRQoL). Scores can range from 0 to 100, with 0 as the lowest score and 100 as the highest. Lower scores indicate lower health related quality of life and higher scores indicate higher health related quality of life.
Results: Marital status correlated to HHI scores, t(90) = -2.70, p = .041, married participants having greater mean score (40.87) compared to singles (38.39). General Health, r(89) = .244, p = .02; Mental Health, r(89) = .352, p = .001; Vitality, r(89) = .221, p = .035; Social Functioning, r(89) = .333, p = .001 and Role Emotion , r(89) = .223, p = .034 correlated with HHI. Marital Status, t(89) = 2.07, p = .041 and Mental Health, t(88) = 3.40, p = .001.
Conclusions : Registered nurses and advanced practice registered nurses who include evaluation of hope and HRQoL when performing comprehensive assessments of older adults will uncover health problems and unmet needs such as low vitality in women under 70, pain management in Non-White women and risk for depression. This information will serve as the bases for comprehensive plans for health and wellness.