Unique to Older Adults
This section provides information to help older adults and their caregivers consider their disease or condition together 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 health care 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 (lack of control over urination)
- urgency (a sudden strong urge to urinate)
- frequency (passing urine more than eight times in a day)
- nocturia (urinating more than twice at night)
More than half of all older adults with heart failure 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. Your healthcare provider will probably prescribe diuretic medicines (known as “water pills”) and other medications to help your body get rid of the excess fluid. These fast-acting medications stimulate your kidneys 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 healthcare provider know. The diuretic medications are very helpful for chronic heart failure and your provider will probably want you to continue taking them. But there are many things that you can do to help you manage your incontinence. These may include changing the time you take the diuretics, emptying your bladder frequently before you have feelings of urgency, and reducing foods and beverages that stimulate the bladder, such as caffeine products or products high in sugar. Special leak-proof pads or other incontinence products sold in pharmacies may help you manage the problem. Some individuals may need a bedside commode (a portable toilet). This lowers the risk of falling because they will not have to walk to the bathroom in the middle of the night. Depending upon the reasons for your incontinence or urgency, your healthcare provider may refer you to a specialist in treating incontinence.
Renal Insufficiency and Heart Failure
One of the common conditions that occurs along with heart failure is renal (kidney) insufficiency. This is a situation where your kidneys are not able to filter your blood in comparison to normal kidneys.
Renal insufficiency can contribute to heart failure getting worse. Or heart failure itself can lead to renal insufficiency. Impaired kidney function can cause your health to worsen and this also puts more of a strain on your heart. Your healthcare provider 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 provider will probably give you diuretic medicines to help you urinate more and get rid of the extra water. When someone has both heart failure and renal insufficiency and is taking diuretics, it is very important to monitor the level of electrolytes and kidney function. Aggressive use of diuretics can lead to renal function getting worse. But not taking enough diuretics can make heart failure worse. If your kidney function gets worse, other heart failure medications (such as ACE inhibitors or ARBs) may need to be adjusted to prevent further decline. For these reasons, it is not unusual for your healthcare provider to switch the doses of these medicines frequently when you go for follow up appointments.
Depression and Heart Failure
If you have chronic heart failure, there is a high risk that you will suffer from depression at some point. This type of severe depression is more serious than the normal, temporary feeling of sadness that all people 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 serious 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. It can also help reduce its severity if you are already depressed.
Frequent causes of depression in people 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
- physical changes in your body that can affect your mood
- loss of independence
- feeling alone
- lower quality of life in general
If you notice that you are feeling sad more often, tell your healthcare provider right away. Depression can make your heart condition worse. This is because when you are depressed, you produce hormones and other chemicals in your body that can damage your heart and circulatory system. Getting treatment as soon as possible will do more than improve your mood. Treatment 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.
There are effective treatments for depression. These 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 clergy member
- eating a balanced, low salt diet
- getting as much sleep and rest as possible
- staying away from cigarettes, alcoholic beverages, and overeating
Diabetes and Heart Failure
Heart failure is among the most common complications of diabetes. (Diabetes is a disease in which your body cannot regulate glucose (blood sugar) levels properly). Heart failure 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 didn’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 has 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. These are both common problems in people with diabetes.
If you have diabetes, you can lower your risk of developing diabetic heart failure by:
- keeping good control of your blood sugar levels
- taking the medications that your healthcare provider prescribes
- making lifestyle changes. These include things such as losing weight, stopping smoking, eating a well-balanced and careful diet, reducing stress, and exercising regularly
- If you have high blood pressure along with diabetes, it is very important to maintain good blood pressure to prevent heart disease
Recently, research found that a commonly used diabetes medication called rosiglitazone (Avandia) may cause you to retain fluids and can cause or worsen heart failure. It is no longer prescribed for people with diabetes if there is any sign of heart failure.
Last Updated August 2020