Aging & Health A to Z

Heart Failure

Unique to Older Adults

This section provides information to help older adults and their caregivers consider their disease or condition in conjunction with other health issues. 

As older adults live longer, they may have more than one chronic disease.  Or, they may have a health problem that can lead to another condition or injury if not properly managed.   The older adult may also experience healthcare in various settings, such as the hospital, assisted living facility or at home.  These situations can affect the health and function of the older adult and therefore require careful management to ensure proper care and improve or maintain quality of life. 

Urinary Incontinence and Heart Failure

If you have heart failure, you may experience urinary symptoms such as:

• incontinence (passing urine or leaking as you are rushing to the toilet)
• urgency (a sudden strong urge to urinate because of an overactive bladder)
• frequency (passing urine more than eight times in a day),
• nocturia (urinating more than twice at night). 

More than half of all people with heart failure—both men and women—have problems with urinary incontinence. 

Fluids tend to build up in your body when you have heart failure. Your bladder may fill up quickly and excessively. Also, your doctor will probably prescribe diuretic medicines (water pills) and other medications to help your body get rid of the excess fluid. These fast-acting medications stimulate your kidneys even more and will probably make you urinate more often. They may produce urgency and frequent night-time urination. 

Urinary incontinence can affect your quality of life and your mood. You may become depressed and be afraid to go out and enjoy your usual activities because you worry about not finding a bathroom in time and having an “accident”. Having to get up several times every night can leave you feeling even more tired than before. 

If you have urinary incontinence, let your doctor or healthcare professional know. The diuretic medications are very helpful for chronic heart failure and your doctor will probably want you to continue taking them, but there are many things that you can do to help you manage your incontinence. Speaking to an incontinence specialist or nurse is the first step. You may find that special leak-proof pads or other incontinence products sold in pharmacies will help you manage the problem. Changing the time of day for taking your medicines or lowering the dose may also help. Special non-spill bottles may be a good idea for night-time use, eliminating the need to get out of bed each time you have to urinate. 

Renal Insufficiency and Heart Failure

One of the common conditions that occurs along with heart failure is renal (kidney) insufficiency—a situation in which your kidneys are not able to filter your blood as well as before.

Healthcare professionals are still not sure if renal insufficiency causes heart failure or heart failure causes renal insufficiency. But, they do know that impaired kidney function can cause your health to deteriorate and puts more of a strain on your heart.  Your healthcare professional will measure your kidney function with other blood and urine tests. 

If you have heart failure, you may develop swelling, especially in your feet, ankles and lower legs.  This happens because your kidneys are no longer able to maintain normal water levels in your body.  Your healthcare professional will probably give you diuretic medicines (water pills) to help you urinate more and get rid of the extra water. But for some people with heart failure, the diuretics can make your kidney function and your heart function, worse.  If this happens, you may have to lower the dose or stop taking it. Similarly, if your healthcare professional has prescribed an ACE inhibitor medication for your heart failure, you may also have to decrease the dose or discontinue it because ACE inhibitors may worsen your renal function. If this happens, your provider may suggest other ways to help your body reduce the extra fluid. 

Depression and Heart Failure

If you have chronic heart failure, there is a serious risk that you will suffer from depression at some point. This type of severe depression is more than the normal, temporary feeling of sadness that all patients experience from time to time. The older you are, and the worse your heart failure symptoms get, the greater the chance that you will become seriously depressed. Although estimates vary, researchers now believe that about one-third of heart failure patients suffer from clinical depression sometime during their illness. There are many reasons for depression to occur, so being aware of your risk can help you keep from slipping into a depression or reduce its severity if you are already depressed. 

Frequent causes for a depressed mood in individuals with heart failure include:

• fatigue (being too tired to enjoy your usual activities or to exercise)
• increased stress due to worry and uncertainty about the future
• physiologic changes in your body that can affect your mood
• hospitalizations
• loss of independence
• feeling isolated
• lower quality-of-life in general. 

If you notice that you are feeling blue more often, tell your healthcare professional right away. Depression in itself can make your heart condition worse, because when you are depressed, you produce hormones and other chemicals in your body that can be damaging to your heart and circulatory system. Getting treatment as soon as possible will not only improve your mood, it may also make you feel healthier, keep you functioning more fully in your daily life and may even keep you out of the hospital longer. It might even help you live longer. 

Effective treatments for depression include antidepressant medications, talk therapy with a psychologist or counselor, and cognitive-behavioral therapy with a therapist trained in this technique. Other things that may help are

• getting dressed every day
• taking a daily walk
• following an exercise routine
• engaging in social activities and hobbies
• practicing stress reduction techniques
• sharing your feelings with a family member, friend, or member of the clergy
• eating a balanced, low salt diet
• getting as much sleep and rest as possible
• staying away from cigarettes, alcoholic beverages, and overeating. 

If you are feeling suicidal, call a suicide help line or your doctor, or go to the nearest emergency room right away. 

Diabetes and Heart Failure

Heart failure is among the most common complications of diabetes, a disease in which your body cannot regulate blood sugar (glucose) levels properly.  It is also the most frequent reason that people with diabetes are hospitalized. Heart failure is found in people with either type 1 or type 2 diabetes. If you have diabetes, heart failure may develop at a younger age and be more severe than if you don’t have diabetes. The chance of developing heart failure is higher if your diabetes is poorly controlled and your sugar levels are frequently high. Overall, the risk of developing heart failure is almost four times higher for men with diabetes, and five and a half times higher for women with diabetes compared to people without the disease. About one in five people with heart failure also have diabetes. 

Diabetic heart failure is also linked to a specific kind of heart damage known as cardiomyopathy. In diabetic cardiomyopathy, the ventricles (the main pumping chambers of the heart) become damaged, even when there is no other heart disease present. Heart failure may develop because of high blood pressure or narrowed arteries in the heart, both common problems in people with diabetes. 

If you have diabetes, you can lower your risk of developing diabetic heart failure by:

• keeping tight control of your glucose levels
• taking the medications that your healthcare professional prescribes
•  making lifestyle changes such as losing weight, stopping smoking, eating a well-balanced and careful diet, reducing stress, and exercising regularly. 

Recently, research found that a commonly used diabetes drug called rosiglitazone (Avandia) may cause you to retain fluids and can cause or worsen heart failure. It is no longer routinely prescribed in diabetes if there is any sign of heart failure.

Updated: March 2012
Posted:  March 2012