Cardiac Rehabilitation in Older Adults - An Overview

Introduction:

Cardiac rehabilitation programs are designed to offer support in making lifestyle changes, as well as helping people build confidence and get back to their normal daily activities. The nature of the service is contingent upon the type of event a person has come across. Some services provide telephonic help or online support programs, but most programs will offer face-to-face group-based exercises and education classes. Cardiac rehabilitation is offered to everyone diagnosed with a heart attack, and the program varies for other cardiac conditions as well. It is much as part of the treatment plan as the medications used during any event. It also aims to provide information to care for the heart and keep it healthy in the future. There are 1.2 million heart attacks every year, and one-third of them are fatal. For survivors, cardiac rehabilitation reduces the risk of recurrence and improves the quality of life. Cardiac rehabilitation patients are 47 % less likely to die, and 37 % are less likely to experience a heart attack within the upcoming five years.

What Are the Components of Cardiac Rehabilitation?

Generally, a team of seven members, which includes a cardiologist, specialist nurse, physiotherapist, dietician, psychologist, exercise specialist, and occupational therapist, are involved, and they make a treatment plan which consists of the following things-

1. Lifestyle risk factor management for weight and nutrition.

2. Psychosocial health for stress and anger management.

3. Cardioprotective therapies to improve heart health.

4. Medical risk factor management due to polypharmacy.

5. Health behavior change and education for active participation in rehabilitation.

What Is the Process of Cardiac Rehabilitation?

There are four phases in cardiac rehabilitation-

1. Acute Phase (Phase 1)- It is an inpatient setting and refers to the period of hospitalization after an acute cardiac event and usually lasts for one week. It involves a physical assessment which is done individually along with a discharge plan. The patient is also given education on lifestyle changes and risk factors.

2. Convalescent Phase (Phase 2)- It involves an outpatient setting that lasts for three to six weeks, and the progress of the exercises is monitored. It also aims to provide psychosocial support along with lifestyle changes.

3. Training Phase (Phase 3)- It is an outpatient setting in which there is less monitoring, and the patients are mostly asked to self-monitor their progress, and the exercises are mostly home-based or gym based. This period lasts for six to twelve weeks, and it also consists of stress and lifestyle management.

4. Maintenance Phase (Phase 4)- This phase consists of long-term maintenance of lifestyle changes and professional monitoring of clinical status.

What Are the Benefits of Cardiac Rehabilitation?

Cardiac rehabilitation is mostly indicated after conditions like coronary artery bypass grafting (CABG), angioplasty with or without stenting, valve replacement, heart transplantation surgery, etc., and the following benefits can be achieved-

• Improved Physical Health: CR can help older adults improve their physical fitness, strength, and endurance, resulting in improved overall health and reduced risk of future heart problems.

• Reduced Symptoms: CR can help reduce indications of heart disease, including sensations of chest discomfort and difficulty breathing, making it easier for older adults to perform daily activities.

• Emotional Support: CR can provide emotional support to older adults who may be struggling with the physical and emotional toll of heart disease.

• Reduced Hospital Readmissions: Older adults who participate in CR are less likely to be readmitted to the hospital for heart-related problems.

• Improved Quality of Life: CR can help older adults improve their quality of life by enabling them to continue doing the activities they enjoy.

What Are the Barriers to Cardiac Rehabilitation?

Despite being an effective method, there is a lack of referrals to the programs, even by physicians, and also a lack of participation by patients due to less information about the program or hesitancy in participation.

What Are the Benefits of Cardiac Rehabilitation in the Older Population?

The program is designed to recover patients from past cardiac conditions more quickly and helps improve overall physical, mental, and social well-being. The goal is to stabilize, slow down or even reverse the progression of cardiovascular diseases, which in turn reduces the risk of another cardiac event. The elderly population, with comorbidities such as diabetes, hypertension, frailty, heart diseases, etc., can benefit highly from a cardiac rehabilitation program. The rehab program is an individually recommended exercise routine during which the heart rate, blood pressure, and EKG (electrocardiography) are monitored. Likewise, the risk factors associated with heart disease are identified and evaluated. These areas are targeted to help reduce the risk of further heart diseases. The benefits of the program among the older population are mentioned below-

• Evidence has shown a reduction in cardiac morbidity and mortality rate after enrollment in cardiac rehab programs among the elderly.

• The exercise training in the program can greatly improve the frailty that comes with aging.

• The elderly person can build more capacity to complete more physical activities without breathlessness and fatigue.

• It also helps them to improve their muscle strength.

• It can help reduce the symptoms of dyspnea (shortness of breath) and palpitations (feeling of fast heartbeats).

• The program also benefits older individuals with psychological disorders and people with depression.

• The sessions are also tailored in a manner to help older people who are dealing with the additional challenge of being overweight.

• One of the critical components of cardiac rehabilitation is socialization which can highly benefit older patients. Older patients are more vulnerable to isolation, and by participating in group therapies, they can tackle it efficiently.

• Geriatric patients are often associated with stress and anxiety due to age-related issues, and group therapies in the cardiac rehab program can help them manage their stress and live independently.

Conclusion:

It is a common myth among the older population that due to their age and weak muscle strength, the elderly cannot perform exercises given in the rehab programs. But by participating in a cardiac rehabilitation program, one can make sure to exercise at a safe and effective level for the elderly person. It is crucial to recognize that cardiac rehabilitation is not just an exercise program, but it is a multidisciplinary approach toward physical and mental well-being as well. The older population can benefit from it by managing their diet and lifestyle and also improving their strength. Even after the end of the program, one should strive to engage in regular physical activity and maintain their nutrition.