The Impact of Cognition and Depressive Symptoms on Self-Care Among Older Thai Adults with Heart Failure

Background: Cognition and depressive symptoms are commonly found among patients with heart failure and they limit self-care. In Thailand, there is little research focusing on the relationship among cognition, depressive symptoms and self-care in older Thai adults with heart failure. Purpose: This study was 1) to examine the relationship among cognition, depressive symptoms, self-care, and 2) to determine whether cognition mediated the relationship between depressive symptoms and self-care. Method: A cross-sectional study recruited 140 older Thai adults with heart failure at out-patient clinics from four tertiary hospitals. Participants completed the Thai version of Self-Care of Heart Failure Index v.6.2. and the Geriatric Depression Scale. All participants had cognition tested using the Thai version of Montreal Cognitive Assessment. Results: The mean age of this sample was 70.75 years. There were 50% men and more than half (53.57%) were married. Fifty-five percent of the sample had duration of heart failure at seven months or greater. Most of them (73.57%) were in NYHA Class II. Approximately 97% had family members of friends caring for/helping them when they encountered problems. More than half (53%) of subjects showed adequate self-care maintenance while a smaller number of subjects reported adequate self-care management (20.71%) and self-care confidence (41.43%). Most (90%) had impaired cognition and approximately 24% had symptoms that were suggestive of depression. Overall cognition was not associated with self-care maintenance, management, or confidence. Depressive symptoms were negatively associated with self-care maintenance (r = -.247, p <.01) and confidence (r = - .329, p < .001). No correlation between cognition and depressive symptoms was found. Therefore, this study lacked evidence of a mediation effect of cognition on the relationship between depressive symptoms and self-care. Conclusion: Early screening of cognition, depressive symptom and self-care are needed in clinical practice. The self-care interventions for improving self-care ability should focus on patients with heart failure and their caregivers. Future studies to determine whether intervention reduce depressive symptoms and improve self-care maintenance and confidence are needed.