By Serena Agusto-Cox | News & Views

Cardiac rehabilitation is no longer the exclusive domain of older adults in their 60s and 70s – many of today’s patients are in their middle years of life. Each age cohort, meanwhile, carries stressors that differ from previous generations.

Lisa Carlson-Hill, MSW, LICSW, a medical social worker at Emerson Health in Massachusetts, encourages CR teams to take a moment with their patients to recognize generational diversity factors and the potential supports available to them. Together they can craft realistic care plans and goals, which can lead to improved outcomes and better relationships with their patients. “Both patients and CR professionals need to give themselves permission to slow down and think about the best treatment approach, which includes meeting people where they are mentally, physically, emotionally, and socially to provide them with a sense of empowerment,” she says.

Psychological resiliency enables empowerment, particularly when it comes to recovery. As part of that equation, CR professionals need to assess where the patient is, looking at what support systems they have in place, how much time they have to perform exercises in light of other obligations and what kinds of stressors they face – such as whether the patient is a caregiver or isolated from their cohort community. Other factors that come into play include socioeconomic, cultural and other demographic criteria.

In an AACVPR live webinar on May 18, Carlson-Hill provided a framework to improve awareness and sensitivity to patients’ unique needs based on life stage factors and their age. The approach can assist in crafting tailored treatment programs that help patients reach their goals and bolster their self-awareness at the same time. CR professionals who attended the presentation left with the ability to identify demographic trends with regard to age in patient populations of recent years, to name unique stressors to screen for different age/life stages of cardiac patients and to search/create a resource list for increased support for patients. 

By considering the allostatic load, or the cumulative burden of chronic stress and life events, Carlson-Hill points out that CR professionals and patients “can recognize what the stressors, strengths and components of resilience are in order to determine how those strengths and resiliency factors can be increased to bring those stressors back into balance.” Patients and CR professionals can work together to engage those generational factors – such as personality, life stage, career, caregiving responsibilities and other pressures – to set realistic goals given the time available for exercises and to achieve stress reduction and management.

“For some patients that might look like a checkmark on the calendar, for others that might involve the help of an app on their phone, but whatever tools or motivators they need to achieve cardiac rehab goals should be made available to them,” says Carlson-Hill. “CR professionals’ expectations need to be in line with the context of each patient. We cannot simply look at the age of the patient and understand their life stage.”

According to Carlson-Hill, “just because someone is in their 60s and 70s does not mean that their caregiving days are over. Some of those patients could be parenting their grandchildren or have embarked on a second career, leaving them feeling isolated from their traditional age cohort because of those life circumstances.”

Stress management plays a key role in the success of cardiac rehab, and CR professionals can work in parallel with their patients to empower each patient to set realistic goals, relearn their own bodies and build momentum throughout the rehabilitation process. “I think we are along for the ride with them,” says Carlson-Hill. “But being able to provide our patients with the resources and education they need to set concrete, realistic goals that fit into their current stage of life can ensure they stick to the treatment plan and have a successful recovery.”

The recorded webinar, "Generational Diversity," is available at no cost to AACVPR members.