Chapter 11 Special Demographic Populations

Chapter 11: Special Demographic Populations

Dr. Lisa Kappes, Cardiopulmonary, EXP - 3334 (March 2023)

Overview of Content Covered

• Text: Guidelines for Cardiopulmonary Rehabilitation and Secondary Prevention Programs

• Focus: Chapter 11 – Special Populations, covering pages 197 – 222.

Objectives of the Chapter

• This chapter aims to:

  • Define subgroups of Cardiac Rehabilitation (CR) participants based on age, sex and gender, race, culture, and socioeconomic status.

  • Present specific participation data for these subgroups.

  • Discuss group characteristics affecting participation in CR.

  • Provide recommendations for CR program assessment and delivery tailored to diverse demographic needs.

Purpose of the Chapter

• The goal is to outline patient evaluation considerations and strategies for implementing secondary prevention services for selected cardiac patient subgroups, emphasizing ways to overcome barriers to participation in CR across all demographics.

Implementation Strategies for CR/SP in Special Populations

Staff Competency

• Develop a competency plan for staff to equip them with the necessary knowledge and skills to aid special groups effectively.

Initial Evaluation

• Include assessments of special physical and psychosocial needs during the initial evaluation.

• Identify major safety concerns and outline preventive strategies tailored to each specific group.

Plan of Care

• Prepare a care plan specifically designed to modify secondary prevention services addressing the unique problems and issues faced by each subgroup.

• Maintain a list of professionals and support services that may be needed in implementing these services.

Implications of Age in CR/Secondary Prevention

Age Considerations

• Consider how differing patient ages can impact:

  • Program Development: Tailoring programs for younger vs. older patients.

  • Delivery: Adjusting methods of instruction and support.

  • Effectiveness: Evaluating outcomes based on age groups.

Participation Data for Older Patients

• Age ≥65 years: 267,427 participants, 18.7% participation rate.

• Age 65 to 74 years: 84,089 participants, 26.6% participation rate.

• Age 75 to 84 years: 54,012 participants, 18.6% participation rate.

• Age ≥85 years: 11,282 participants, 4.6% participation rate.

• Notable Characteristics:

  • Females (14.3%) have lower participation rates compared to males (22.1%).

  • 19.6% participation among White populations vs. 7.8% among Nonwhite participants.

Evaluation Components for Older Cardiac Patients

Baseline Assessment Considerations

• Key components include:

  • Mental status: Evaluate for cognitive concerns.

  • Gait and Balance: Assess physical stability.

  • Vision and Hearing: Screen for sensory impairments.

  • Physical Function: Review home activity requirements.

  • Transportation Needs: Identify requirements to access services.

  • Psychosocial Assessment: Address issues like social isolation and anxiety.

  • Nutritional Assessment: Evaluate dietary needs.

Optimizing the CR Experience for Patients

General Considerations

• Recognize individuals with increased musculoskeletal dysfunction, decreased mobility, and various comorbidities.

• Ensure all areas are slip-proof, especially around water fixtures.

• Incorporate assistive devices into care.

• Emphasize long-term benefits of participation and activity goals.

Exercise-specific Strategies

• Equipment Safety: Stabilize gear and add safety accessories for proper use.

• Allow adequate time for exercise progression to avoid overuse.

• Concentrate on activities relevant to daily life, alongside preferred recreational activities.

Education-specific Strategies

• Adapt educational materials based on sensory impairments.

• Schedule classes at suitable times, provide concise, repeatable information, and involve family or caregivers.

Special Considerations for Younger Populations

Participation and Characteristics

• Participation among younger women (<40 years) is minimal (1-2%).

• Younger men represent 4-5% of CR attendees and face specific health challenges, including higher obesity rates and associated metabolic risks.

Considerations for Older Populations

• Important factors impacting exercise and physical activity include multimorbidity, polypharmacy, and cognitive or functional declines.

Gender-Based Considerations in CR

Health Disparities for Women

• Coronary heart disease (CHD) is a leading cause of mortality in women.

• Women face worse outcomes than men after cardiac events, such as greater hospitalization rates and increased chances of presenting without traditional symptoms (e.g., chest pain).

Psychosocial Factors

• Similar psychosocial challenges manifest in both prememopausal and postmenopausal women, including anxiety and social isolation.

Barriers to CR/SP Participation

• Only 15-20% of eligible women participate in CR programs, influenced by various barriers including lack of information and sociocultural factors.

Racial and Cultural Considerations in CR

Diversity in U.S. Population

• Projections suggest that non-Hispanic whites will drop to under 35% of the U.S. population by 2050.

• Significant growth in Hispanic and African American populations will necessitate culturally competent care.

Components of Cultural Competence

• Essential elements include valuing diversity, self-assessment capabilities, awareness of cultural dynamics, and using organizational processes for adaptation.

Socioeconomic Factors

Common Considerations in CR

• Accessibility issues include geographical disparities, insurance constraints, and language barriers.

• Effective lifestyle changes require culturally relevant materials and resources.

Conclusion

• Treat each patient as an individual, continuing to assess and adapt to their needs based on initial evaluations and shared information.