Seniors less likely to enrol in cardiac rehabilitation

Heart patients over 65 are much less likely than younger patients to enrol in cardiac rehabilitation, often because they aren’t informed about the programs or encouraged to take part, a study led by York Professor Sherry Grace has found.

“The older patients are 77 per cent less likely to enrol in cardiac rehabilitation programs after a heart attack, even though they would benefit from the programs as much as younger people. We knew this was happening, but we didn’t know why, so we asked them,” said Grace, a professor in York’s School of Kinesiology & Health Science, a scientist at Toronto General Research Institute and a professor of psychiatry at the University of Toronto.

Right: Sherry Grace

The study, “Barriers to Cardiac Rehabilitation: Does Age Make a Difference?”, is in the May/June 2009 issue of the Journal of Cardiopulmonary Rehabilitation & Prevention, published online.

Heart disease is the leading cause of death and disability. Cardiac rehabilitation programs have been shown to reduce death by 25 per cent in heart patients who are at a greater risk than most people of having another heart problem. In the US and Canada, however, where this study was conducted, only 15 to 30 per cent of cardiac patients take part in cardiac rehabilitation and the rate for older patients is much lower.

Once older patients are enrolled in cardiac rehabilitation they attend as well as younger patients, said Grace. However, they were less likely to enrol in the programs, which typically involve exercise, education and counselling. The study showed that in many cases it was because older patients had not been referred by their doctors to cardiac rehabilitation. This decision may not have been motivated by age discrimination, Grace says, but perhaps because doctors often hear older patients’ reasons why they don’t think they should go.

“We found that older people were more likely to think the programs wouldn’t help them, or worried that the programs would be tiring or painful, and they wouldn’t be able to do them because they had other health problems,” said Grace. “We need to get the word out to older people and their doctors that these programs are tailored very carefully to their individual needs and abilities.”

Left: Seniors are less likely to take part in cardiac rehabilitation than younger people

Grace led a research team of three York students – Shannon Gravely-Witte, Shamila Shanmugasegaram and Janette Brual − as well as Dr. Neville Suskin of the London Health Sciences Centre and University of Western Ontario, and Dr. Donna Stewart of the University Health Network and University of Toronto. They studied 698 heart patients over age 65 and 575 younger patients.

“Older patients assume they are supposed to be sick,” said Grace. “But there’s good evidence that people who go to cardiac rehab programs increase both the quantity of life and, perhaps more important to seniors, their quality of life.”