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Sickness behavior in community-dwelling elderly associations with impaired cardiac function and inflammation
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Cardiology in Linköping.ORCID iD: 0000-0001-7431-2873
University of Pennsylvania, Philadelphia, PA, USA.
Swedish Defence Research Agency, Linköping, Sweden.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Anaesthetics, Operations and Specialty Surgery Center, Department of Clinical Neurophysiology.
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2014 (English)In: Biological Research for Nursing, ISSN 1099-8004, E-ISSN 1552-4175, Vol. 16, no 1, 105-113 p.Article in journal (Refereed) Published
Abstract [en]

Sickness behavior is a cluster of symptoms that occur as a response to an infection and alterations in the inflammatory response. Under normal circumstances, sickness behavior is fully reversible once the pathogen has been cleared. Aging and chronic illness such as heart failure are associated with enhanced inflammatory activity that lasts for a long duration and no longer represents an adaptive response. The aim of this study was to explore whether inflammation mediates the relationship between impaired cardiac function and a symptom cluster including anhedonia, fatigue, and sleepiness, which might represent sickness behavior in community-dwelling elders. Structural equation modeling (SEM) showed that the factor impaired cardiac function (i.e., N-terminal fragment of pro-brain natriuretic peptide, left ventricular ejection fraction, and the heart failure medications angiotensin converting enzyme inhibitor, angiotensin receptor blockade, β-blocker, and diuretics) was associated with both inflammation (i.e., C-reactive protein; β = .26) and the symptom cluster (β = .31). Inflammation had a significant direct, but smaller, association with the symptom cluster (β = .21). By this pathway, inflammation also mediated an indirect association between impaired cardiac function and the symptom cluster (β = .05). Including creatinine, blood glucose, ischemic heart disease, previous and current tumor, respiratory disease, age, and body mass index in the SEM model did not change these associations. Our results imply that some aspects of the symptom panorama in elderly individuals with impaired cardiac function or heart failure could represent sickness behavior.

Place, publisher, year, edition, pages
Sage Publications, 2014. Vol. 16, no 1, 105-113 p.
Keyword [en]
heart failure, elderly, inflammation, sickness behavior
National Category
Clinical Medicine
URN: urn:nbn:se:liu:diva-86768DOI: 10.1177/1099800412466170ISI: 000328581900013PubMedID: 23162010OAI: diva2:582190
Available from: 2013-01-03 Created: 2013-01-03 Last updated: 2015-03-31

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Johansson, PeterBroström, AndersAlehagen, UrbanDahlström, UlfJaarsma, Tiny
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Division of Cardiovascular MedicineFaculty of Health SciencesDivision of Health, Activity and CareDepartment of Cardiology in LinköpingDivision of Nursing ScienceDepartment of Clinical Neurophysiology
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