Gender Differences and the Influence of Social Support on Functional Decline in Older Persons Living With Heart Failure in Their Community

Abstract

Background. Heart failure (HF) is a prevalent chronic cardiovascular disease that is characterized by progressive functional decline. Given the known links between high levels of support and positive health outcomes the objectives of this study were: 1) to determine the levels and patterns of social support, and related gender differences, 2) to determine the influence of support on functional outcomes as defined by a deterioration in physical function over 1-year following exacerbation of HF, and 3) to describe the effects of gender on social support in influencing adverse outcomes. Methods. Data were obtained from a 1-year prospective cohort study that included male and female participants ≥ 65 years of age (n=435; 164 females; 271 males) with HF. Participants completed questionnaires at baseline, 6 and 12-months containing clinical and demographic information and validated measures of 1) physical function, using derived scores from the Medical Outcome Study SF-12, and Kansas City Cardiomyopathy Questionnaire (KCCQ), and 2) social support using the Medical Outcome Study, Social Support Survey. Results. Women were more likely to be single, widowed or divorced, living alone and earned less annual income compared to men (p < .01). Women tended to report lower mean social support scores than men at all time points. When controlling for clinical and demographic variables, being married (OR 12.2; 95%CI: 5.1, 19.2), living with someone (OR 13.6; 95%CI: 6.2, 21.0), and higher income (OR 0.08; 95%CI: .01, .15), were significantly associated with higher levels of social support at baseline. Although women reported significantly lower disease-specific (p= .01) and generic (p= .01) physical function scores, no significant gender differences existed in the proportion of men or women that experienced functional decline or death at 1-year of follow-up. In a multivariate logistic regression modeling, men with lower levels of social support were more likely to experience generic functional decline or adverse outcomes. This was not the same for women. Conclusions. Women, reported less social support and poorer functioning, but the impact of social support on functional decline was more pronounced in men. Gender-sensitive management should be considered to optimize function for men and women living with HF.