*4.5.9 Preventing falls*

In parallel with existing symptoms and the age of patients with advanced heart failure, evaluations of the risk of falling, drug-related risks, exercise capacity, and walking and balance are included in the clinical practice guidelines of risk management [48].

## *4.5.10 Psychosocial support*

There has been increasing interest in the use of stress management interventions, including mindfulness-based interventions [MBIs], for the alleviation of psychological problems and the improvement of physical health outcomes [49].

## *4.5.11 Protection against infection*

Vaccination against influenza and pneumococcal infections is recommended by the European Society of Cardiology. Unless there are contraindications, it is recommended that heart failure patients are vaccinated against influenza every year and against pneumococcal infections once every 5 years.

Self-care in heart failure patients is very important for the improvement of patient outcomes, including quality of life, and lower hospitalisation and mortality rates. In this chapter, the information has been reviewed related to the factors affecting the self-care of patients with advanced stage heart failure, the behaviours necessary for

self-care [how diet can be adhered to, which symptoms are to be monitored], and how self-care can be managed and monitored. Symptom management and treatment compliance behaviours in patients with advanced heart failure are the most important self-care behaviours that affect the patient's quality of life and survival, and it is not possible for these behaviours to be managed only by the patient and their relatives. The biggest risk for patients and their relatives is that they may not even be aware of the incomplete/incorrect information or practices in the self-care behaviours they learn and apply. Collaboration of multidisciplinary health professionals such as physicians, nurses, psychologists, and dietitians who are autonomous in the field of heart failure is the golden criterion in the management of the advanced stage heart failure self-care process. Autonomous healthcare professionals in the field of heart failure know what needs to happen before taking action on issues related to their patient; notice what is not; perceive, interpret, and associate new situations; and ensure that the process progresses positively by directing and monitoring the patient to the right team member in a timely manner.
