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Occupational Therapy’s Role In Cardiovascular Disease

Published On 4.11.19

By Carlie Papaccio, MS, OTR/L

Geriatric Fellow

Occupational therapists have a great impact when treating older adults, specifically older adults with a diagnosis of cardiovascular disease.

As defined by AOTA, occupations are various kinds of life activities in which individuals, groups or populations engage, including activities of daily living, instrumental activities of daily living; rest and sleep, education, work, play leisure and social participation. At FOX we believe in the strength of the people and empowering our patients while using clinically excellent care to get the most optimal results.

How does this apply to cardiovascular disease? Let’s explore.

CARDIOVASCULAR DISEASE

According to the World Health Organization, cardiovascular disease (CVDs) steals the lives of 17.9 million people every year, 31 percent of all global deaths with 85 percent coming from heart attacks or stroke. Cardiovascular disease is one of the top non-communicable diseases that are a major cause of mortality and morbidity worldwide (Purtee Mann, Javaherian-Dysinger, & Hewitt, 2013). According to the Centers for Disease Control, about 1 in every 6 U.S. dollars is spent on cardiovascular disease. It is expected that by the year 2030 we will be spending $818 billion directly relating to annual medical costs associated with CVDs, and by 2035 the cost will drastically increase to $1.1 trillion, according to the American Heart Association. By 2035, nearly half of the U.S. population will have some form of CVDs.

According to the U.S. Census Current Population Report, the older adult population (65 years and older) will almost double from 43.1 million in 2012 to 83.7 million in 2050 as a result of the aging Baby Boomers and increases in life expectancy (Ortman, Velkoff, & Hogan, 2014). By age 45, your risk for CVDs is 50 percent and 90 percent by the age of 80, according to the AHA.

HOW OCCUPATIONAL THERAPY CAN HELP THOSE WITH CARDIOVASCULAR DISEASE:

1. EDUCATION

Occupational therapists have a duty to provide education to our patients to increase their safety, quality of life, and health. While treating a patient with a diagnosis of CVDs, we educate them for self-management of signs and symptoms of high blood pressure, high blood sugars, and how to monitor heart rate. Since we see patients between 1-5 times per week for 1-3 months at a time, we are able to assess our patients more frequently and determine trends. At the evaluation, we gain a baseline and are able to monitor this patient throughout their plan of care while providing consistent education on the signs and symptoms of CVDs. From there, we follow up with physicians as needed.

Please see below for signs and symptoms and monitoring of CVDs.

2. HOLISTIC APPROACH

As occupational therapists, we see the patient holistically. We are not there to treat one diagnosis but rather dive into their habits and routines. What lifestyle choices are they making? We can help them become more aware and educate on certain life choices to avoid or refrain from doing to decrease their risk of CVDs or worsening their symptoms such as smoking, sedentary lifestyle, overuse of alcohol, and obesity to name a few. We can also educate on how to increase their lives by adding in appropriate exercises throughout the day, providing nutritional education and medication management techniques.

3. EXERCISE DOSING

As occupational therapists, we are skilled and trained in appropriate dosing of exercise for patients with a diagnosis of CVDs. 52 percent of all older adults do not meet the recommended guidelines for aerobic exercise or physical activity and only 16 percent met national guidelines for muscle strengthening and physical activity (Lee, 2017). Risks of sedentary lifestyle include but are not limited to metabolic and cardiovascular risks and all-cause mortality and morbidity (Yen, 2017, Lee, 2017). A carefully developed and individualized strength training program may have significant health benefits for older adults, according to the American Physical Therapy Association.

As an occupational therapist specifically trained and skilled in appropriate dosing of exercise, the clinician works closely with the patient to determine their 30 percent-60 percent one rep max (1RPM) in order to apply proper intensity and to see the best functional outcomes. We then monitor their exercise response through blood pressure (rise of SPB 20-30 mmHG) while returning to within 10mmHG and heart rate within 10BPM of pre-exercise values at 5 minutes of stopping the exercise and seated rest (Brewer, p.41).

4. ALLOWING INDEPENDENCE

Our patients must continue to live their lives at an optimal level. If our patients are unable to stand due to decreased strength or endurance, we are able to appropriately assess and understand these deficits. We understand that this patient is no longer able to engage in what once was so simple. We can provide environmental adaptions: compensatory strategies and appropriate dosing of exercise to gain back their strength or endurance.
For example, Eileen wants to get back to making her holiday cookies but does not have the strength or the activity tolerance to prepare the cookies due to her recent diagnosis of cardiovascular disease, which now causes fatigue with minimal exertion and difficulty breathing. The occupational therapist would assess her environment to accommodate energy conservation strategies. The OT would provide an exercise program appropriately dosing exercise while monitoring her vitals (blood pressure, heart rate, and oxygen saturation levels) to ensure physiological changes occur. Using the modified BORG enables the clinician to monitor the patient’s perceived exertion to provide the appropriate care. Eileen may need energy conservation techniques for example; she may sit for 50 percent of the activity to conserve her energy to mix the ingredients. Eileen may have to ask her husband to gather the ingredients from the cabinets so that she can then save her energy for rolling the dough. We would also educate Eileen on how to monitor her heart rate while engaging in this type of activity so that she does not place too much pressure on her heart. We can adapt the activity to allow Eileen to be successful and maintain her quality of life while engaging in what is most meaningful to her.

ADVOCACY AND PREPAREDNESS

An occupational therapist can work closely with their patient to develop an emergency plan. This can include a list of medications and living will placed somewhere accessible (laminated on their fridge, first dresser drawer in the bedroom, wherever is the easiest access.) We can collaborate to have the neighbors aware of the location of the documents and current health conditions as well as any caregivers or family. We would discuss emergency response methods. We can work on communication management and how to properly use their phone. Our patient may also have a visual deficit that prevents them from being able to make those important phone calls so we can work together to adapt their phone or provide them with recommendations on specific phones that allow the patient to independently use the phone efficiently.

It is simple strategies developed by the clinician with the patient that can save their lives and make them feel they can age in place and feel safe at home.

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