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Cognitive Status and Initiation of Lifestyle Changes Following Acute Coronary Heart Syndrome: A Dissertation
Authors
Hajduk, Alexandra M.Faculty Advisor
Jane S. Saczynski, PhDAcademic Program
Clinical and Population Health ResearchUMass Chan Affiliations
MedicineDocument Type
Doctoral DissertationPublication Date
2014-03-27Keywords
Dissertations, UMMSAcute Coronary Syndrome
Caregivers
Cognition
Cognition Disorders
Life Style
Outcome Assessment (Health Care)
Prospective Studies
Secondary Prevention
Self Report
Acute Coronary Syndrome
Caregivers
Cognition
Cognition Disorders
Life Style
Outcome Assessment (Health Care)
Prospective Studies
Secondary Prevention
Self Report
Behavior and Behavior Mechanisms
Cardiovascular Diseases
Community Health and Preventive Medicine
Health Psychology
Health Services Administration
Mental Disorders
Public Health
Social Psychology
Metadata
Show full item recordAbstract
Background: Cognitive impairment is prevalent in survivors of acute coronary syndrome (ACS) and increases risk for poor outcomes. Lifestyle changes are recommended to patients after ACS to reduce their risk for recurrent events, but cognitively impaired patients may encounter difficulties initiating these changes. This dissertation had three aims: (1) to examine cognitive status as a predictor of lifestyle changes after ACS, (2) to examine whether caregiver support moderates the association of cognitive status and initiation of lifestyle changes, and (3) to assess the reliability of self-reported lifestyle changes in cognitively impaired patients through comparison of their reports of lifestyle change with those from their caregivers. Methods: For aims 1 and 2, Poisson regression with robust error variance was used to examine the association of cognitive status and caregiver support with patient-reported initiation of five lifestyle changes (improving diet, increasing exercise, quitting smoking, reducing stress, and attending cardiac rehabilitation) in 881 patients from TRACE-CORE, a prospective longitudinal observational study of outcomes in ACS. For aim 3, pilot data from 78 patient-caregiver dyads from TRACE-CARE, an ancillary substudy, were used to examine whether patient-caregiver congruence on reports of lifestyle changes varied according to patients’ cognitive function. Results: Patient-reported rates of lifestyle change did not vary according to cognitive status, except for participation in cardiac rehabilitation. Caregiver support improved patient-reported rates of lifestyle change among cognitively intact patients but not cognitively impaired patients. Patients’ cognitive function was positively associated with patient-caregiver congruence on reports of initiation of lifestyle changes and patients with decreased cognitive function tended to over-report initiation of lifestyle changes compared to reports by their caregivers. Conclusion: Although cognitive status was not associated with initiation of most lifestyle changes and the influence of caregiver support on initiation of lifestyle changes was only beneficial to cognitively intact patients in this cohort of ACS patients, these null findings may be explained by the questionable validity of self-report in cognitively impaired patients. This dissertation yields new knowledge about secondary prevention in ACS patients and provides insight into the challenges of conducting patient-reported outcomes research in cognitively compromised populations.DOI
10.13028/M2KP4TPermanent Link to this Item
http://hdl.handle.net/20.500.14038/32059Rights
Copyright is held by the author, with all rights reserved.ae974a485f413a2113503eed53cd6c53
10.13028/M2KP4T
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