Congestive heart failure in 80 year old

Dear Ask The Doctor: I am a new grad homecare LPN asked to see a friends stubborn grandfather on the side as she is worried about him. After seeing him he still refuses to see a physician so I was wondering if there is anything you would recommend for this man. I did a bit of a systems review and a physical assessment as I had my homecare bag with me. He is previously a 60pack year smoker, but in the last few years he has not been interested, he told me he was told years ago that he was a diabetic but never put on medication. This man has not been to a doctor in over 10 years he is in his 80s now. Morning cough with white to yellow phlegm and occasional daytime cough with phlegm. Sleeps with 2 to 3 pillows and does not wake short of breath. He does not ambulate enough to become short of breath. He denies chest pain. He has swollen feet. Up 2 to 3 times during the night to void. Denies daytime frequency or difficulty passing urine. BP 112 62. P 100 bpm regular. BMI 23. O2 sat 96 percent. Random blood sugar is 6.8 mmol JVP is visible at 4 cm above the sternal angle Fine bilateral basilar crackles and no wheezes. Lower legs have 2 plus edema to mid anterior tibia bilateral. Feet and lower legs have rubra to mid tibia. Skin is shiny and dry, but intact. Cap refill is slow. Pulses are present at DP and PT bilaterally He does not eat well just nibbles at bread and drinks generally 750 mls of red wine per day. There are many other issues with this man but I was wondering if you could tell me what sort of treatment he would need and if this infact sounds like CHF and maybe a chronic bronchitis with the cough. Does he need to be on medication. If so what kind? I just want to bring some information to his granddaughter and unfortunately I do not have the expertise

Dear Len: Your friend’s grandfather may have developed right heart failure with smoking as one of major causative factors. The overall goals of treatment are to correct underlying causes, to relieve symptoms, and to prevent worsening of the condition by removing the excess fluid from the body, improving blood flow, improving heart muscle function, and increasing delivery of oxygen to the body tissues. A reduced-salt diet and elevation of the feet and legs may help to reduce the edema. He should avoid any stress, alcohol, extreme emotional reactions and depression. There are several different medications that work in different ways to lessen heart failure symptoms, to prevent worsening of the underlying disease, and to prolong life such as ace inhibitors, diuretics, digoxin, beta blockers, nitrates, hydralazine. Other options are pacemakers, implantable defibrillators  and surgery, but once the heart's ability to pump blood is severely, permanently, and irreversibly impaired, no surgery can repair the damage. The only alternative is a heart transplant and this option too is for patients who are not elderly and who do not have other medical conditions that would make it unlikely for a heart transplant to be successful. In all a personalised treatment protocol needs to be developed by the doctor in each case based on the age and stage of the disease for maximum benefits.