title: Symptom recognition in elders with heart failure.
abstract: OBJECTIVE
  Aging is associated with losses in hearing and vision. The objective of this study was to assess whether aging also is associated with less ability to detect and interpret afferent physiological information.
  
  
  METHODS
  A cross-sectional mixed methods study was conducted with 29 persons with a confirmed diagnosis of chronic heart failure of at least 6 months duration. The sample was divided at the median to compare younger (<73 years) versus older (> or = 73 years) patients in the ability to detect and interpret their heart failure symptoms.
  
  
  METHODS
  Shortness of breath was stimulated using a 6-minute walk test (6MWT) and used to assess the ability of heart failure patients to detect shortness of breath using the Borg measure of perceived exertion compared with gold standard ratings of each person's shortness of breath by trained registered nurse research assistants (inter-rater congruence 0.91). Accuracy of ratings by older patients was compared with those of younger patients. In-depth interviews were used to assess symptom interpretation ability.
  
  
  RESULTS
  Integrated quantitative and qualitative data confirmed that older patients had more difficulty in detecting and interpreting shortness of breath than younger patients. Older patients were twice as likely as younger to report a different level of shortness of breath than that noted by the registered nurse research assistants immediately after the 6MWT.
  
  
  CONCLUSIONS
  These results support our theory of an age-related decline in the ability to attend to internal physical symptoms. This decline may be a cause of poor early symptom detection.
  
  
  CONCLUSIONS
  The results of this study suggest that there is a need to develop interventions that focus on the symptom experience to help patients-particularly older ones-in somatic awareness and symptom interpretation. It may be useful to explore patients' statements about how they feel: "Compared to what? How do you feel today compared to yesterday?"
authors.affiliation: School of Nursing, University of Pennsylvania, Philadelphia, PA 9104-6096, USA. briegel@nursing.upenn.edu
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Victoria Vaughan
authors.initials: VV
authors.lastname: Dickson
authors.forename: Janette
authors.initials: J
authors.lastname: Cameron
authors.forename: Jerry C
authors.initials: JC
authors.lastname: Johnson
authors.forename: Stephen
authors.initials: S
authors.lastname: Bunker
authors.forename: Karen
authors.initials: K
authors.lastname: Page
authors.forename: Linda
authors.initials: L
authors.lastname: Worrall-Carter
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000175:diagnosis*; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000451:nursing / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009730:Nursing Assessment; D012648:Self Care; D012647:Self-Assessment