Decision Making and Memory Function as Predictors of Self-Care in Patients with Heart Failure
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Date
2020-05
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The Ohio State University
Abstract
Heart Failure (HF) is a chronic illness that impairs the heart’s ejection fraction, leading to the inability to provide sufficient oxygenated blood to essential organs. Due to this, patients with HF may exhibit deficits in memory function, decision-making, and self-care. The purpose of this study was to examine two areas of working memory function (i.e., immediate and delayed recall) and decision-making, in relation to age and self-care in patients with HF. Additionally, it was to investigate memory function as a moderator between decision-making and self-care. Especially since maintenance, management, and confidence in self-care abilities may be important for alleviating a patient’s HF symptoms.
The data used in this project came from a current and more extensive intervention study for heart failure patients who experience insomnia. The Brief Behavioral Treatment for Insomnia (BBTI) sample included 23 patients (75% women, 65% white), the average participant age was 55.7 years (SD = 11.3) and ranged from 36 to 77 years old. Participants were recruited from inpatient and outpatient HF clinics at Ohio State; including the Ross Heart Failure Clinic and OSU Outpatient Care East. This study utilized data from the baseline assessment, to measure the following domains: immediate and delayed memory (Verbal Paired Associates I and II), heart failure self-care (Self-care of Heart Failure Index (SCHFI)), and risky decision making ( Game of Dice Task (GDT), Monetary Choice Questionnaire (MCQ), and the Iowa Gambling Task (IGT)).
Results did not support a significant relationship between decision-making and self-care (r = 0.33, p = 0.12), age and self-care (r = -0.26, p = 0.22), short-term memory and self-care (r = 0.35, p = 0.11), and long-term memory and self-care (r = 0.32, p = 0.13). Twelve moderated multiple regressions were performed to investigate the influence of memory function on the relationship of decision-making and self-care. A trending interaction supported (F(3,19) = 2.95, p = 0.06, R^2 = 0.32) that riskier decision-making was associated with lower self-care in the presence of poorer delayed recall. In conclusion, in the presence of poorer memory function, risky decision-making is more strongly associated with poorer self-care in patients with heart failure. Since heart-failure patients experience an exacerbated decrease in decision-making abilities when poor memory function is existent, they are often unable to engage in self-care practices such as maintaining a low-sodium diet or having a consistent sleep schedule. This can possibly exacerbate heart-failure related symptoms. Ultimately, an intervention would be needed to further resolve the memory function issue, consequently leading to better decision abilities and self-care management, maintenance, and confidence.
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Keywords
Heart Failure, Self-Care, Decision-Making, Memory Function, Long-Term Memory, Short-Term Memory