LAUSR

In an innovative and elegantly conducted study in this issue of the Journal, Vidan and colleagues1 report data that confirm what many clinicians caring for elderly heart failure patients have sensed and suspected, namely, that even if persons report that they perform self-care behaviours it may not always happen in reality. In the study of Vidan et al., patients could on average perform three of six important self-care tasks: (i) to stand on a scale to take a reliable weight, (ii) to read and write down the weight, (iii) to assess oedemas, (iv) to identify the prescribed diuretic from a pill box, (v) to adjust the prescribed dose of diuretic treatment based on weight changes, and (vi) to identify highly salted foods. Only 5% could perform all the six tasks correctly. Surprisingly, prior heart failure self-care education only modestly improved the observed self-care ability and also surprisingly, the awareness of heart failure patients regarding their own needs for self-care support was poor, with less than half of patients receiving regular help. We are convinced that many clinicians will read this article with mixed feelings. Many will think ‘I told you so’, in other words: even after patient education, it is still hard for people, especially elderly, to do their daily self-care. Others might think that their patients certainly will do better than those in the study and others might doubt the value of patient education. In our recent work in the ‘Middle Range Theory of Self-care in Chronic Illness’,2 we describe that self-care is an extremely challenging process with several barriers such as experience and skills, motivation, habits, cultural beliefs and values, functional abilities and cognitive abilities, confidence, support and access to care.3 In this theory we describe that performing self-care requires the functional ability to engage in the required behaviours (e.g. balancing on a scale) and that problems with hearing, vision, balance, manual dexterity, cognition, motivation, psychological distress and energy can make self-care difficult.2,4