Myocardial Infarction (MI) is the leading cause of death in elderly adults. For those elderly who do recover, results are less than optimal when compared to younger patients. The aging US population and the increasing survival rates for elders demands greater attention be paid to improving health outcomes for this expanding group recovering from MI. The purpose of this longitudinal study is to improve health outcomes for a group of vulnerable, unpartnered elders who are recovering at home from MI. The objectives of the study are threefold: 1) to develop and test a nurse-coached intervention that will positively influence self-efficacy in the elderly to perform activities of daily living, improve general health and quality of life; 2) determine if the provision of social support through a peer confidante improves quality of life and increases the perceived social support for the elderly post-MI to a greater extent than that provided by a nurse or than for those subjects assigned to a control group; and 3) determine if outcomes for elderly patients post-MI are less costly and more positively related to quality of life in the nurse coached, confidante coached or usual treatment groups. The study is a randomized clinical trial consisting of three groups who will be compared in a repeated measures design in which patient data (n=135) will be collected at five data collection points from discharge to one year post-MI. The three groups are: a nurse coached experimental group, peer coaching and support from a MI confidante experimental group, and a standard care control group. Sample criteria include unpartnered, over 65 years of age, medically stable male or female participants of any ethnic group able to speak and read English. The nurse coached intervention utilizes self-efficacy theory to enhance physical functioning, quality of life, and decrease utilization of health services. The peer confidante coached intervention utilizes elders who have previously had a MI, participated in a cardiac rehabilitation program and have been trained to enhance self-efficacy in terms of activity performance. Elders will be matched to each other based on gender and age. The peer coach will telephone the subject to whom they are matched to share their experiences of recovery, to assist in monitoring progress, and to provide support. The standard care control group will receive care normally given to patients in the participating hospital and during outpatient treatment in the community. Data will be analyzed using repeated measures ANOVA/MANOVA. The outcome measures are: general health status, cardiac recovery, quality of life, and utilization of health services. The mediating variables are social support and self- efficacy expectations. General health status will be measured with the MOS SF-36, cardiac recovery with the Duke Activity Status Index, quality of life with an instrument measuring five domains of quality of life, and health services use by readmission rate and cost of interventions. Social support, a mediating variable, will be measured using the Bagley Social Support Inventory, and self-efficacy expectations will be measured using the Duke Activity Status Index-Self Efficacy Scale.
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