Introduction
Hypertension is one of the most common conditions that family health practitioners assess routinely in individuals of all ages and elderly patients, in particular. The prevalence of the given disease substantially increases with age. At the same time, certain factors define older persons’ ability to manage their disorders, as well as the ways they do it. Therefore, there is a need to understand which intervention practices can provoke a better response in people of advanced age and lead to better outcomes.
Behavioral Interventions
Changes in dieting and levels of physical exercising are major treatment solutions used as part of cognitive-behavioral therapies for hypertensive patients. The study by Friedberg et al. (2015), in which they evaluated the efficacy of a multilateral treatment strategy, revealed that, in about six months, the enhancement of a diet could help reduce systolic blood pressure by ≤11 mm Hg. The diet implies a better control over the intake of salt, fat, as well as fresh fruit and vegetables (Friedberg et al., 2015). Additionally, after examining the effects of collective physical exercising on 115 elderly individuals, Xu, Li, and Yao (2016) found out that it does improve not only the functional status of patients but also enhances their mental condition and psychological coping mechanisms. The latter allows reducing such hypertension-defining factors as stress and deals with negative emotions much better. Thus, exercising, as well as healthy nutrition, contributes to more efficient control of hypertension in the elderly.
Pharmacological Interventions
People of advanced age are at a higher risk of developing threatening side effects when taking medications. For this reason, Lim, Sivasampu, and Khoo (2015) state that, in them, “the choice of antihypertensives should be individually tailored depending on the individual’s cardiovascular risk, presence of target organ damage, comorbidities and potential adverse drug effects (especially for postural hypotension)” (p. 291). Although medication helps prevent some serious hypertension-related comorbidities, many elderly patients may need to take a few types of drugs in order to achieve positive results. Moreover, before prescribing pharmacological remedies, practitioners should consider the risks associated with polypharmacy (Rubio-Guerra & Duran-Salgado, 2015). Taking into account the potential hazards linked to drug intake, the implementation of behavioral strategies becomes increasingly important. Additionally, it is necessary to address the problems of adherence to medication and regular practice of self-management procedures as they may affect the overall outcomes.
Promotion of Self-Management
Health literacy and self-motivation can be regarded as the primary predictors of more effective hypertension control in elderly persons. Jin, Kim, and Rhie (2016) define health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (p. 2118). Their study of 172 older adults in Korea revealed that the respondents of 75 years old and over had difficulties in comprehending even simple health information and prescription instructions much more than those aged 66-74 (Jin et al., 2016). The level of education could be another significant factor in determining health literacy levels, whereas high school and college graduates usually show higher medication adherence rates.
Limited knowledge about complications linked to hypertension was correlated with a low level of engagement in self-management practices as well in the qualitative study by Flynn et al. (2013). At the same time, family support, and regular calls from the clinic reminding about oncoming appointments and the necessity to refill prescriptions, were regarded by the researchers as facilitators of self-management (Flynn et al., 2013). Thus, these factors should be evaluated by healthcare practitioners before the initiation of interventions. Appropriate information should be provided if any gap in knowledge and ability to control the health condition is detected.
An effective patient education program should fulfill a few criteria. According to Marcus (2014), it should give information in small amounts, aim to develop problem-solving skills in patients, and motivate them to acquire relevant knowledge independently. It is necessary to provide individuals with opportunities to ask as many questions as possible. Moreover, Marcus (2014) recommends developing relationships with patients in order to reduce their stress and anxiety, which can serve as barriers to the development of health literacy. Only when all the suggestions are met, a designed education intervention can lead to desirable outcomes and stimulate elderly adults’ compliance with the prescribed treatment regime.
Limitations
The reviewed studies have a few limitations, and most of them are related to the utilized sampling techniques. For instance, Flynn et al. (2013) mainly studied a group of African American patients, while Jin et al. (2016) focused on the research of Korean elderly patients residing in the midwestern metropolitan area. It means that their study results may be non-generalizable to individuals from other multicultural backgrounds. Additionally, some researchers utilized qualitative data collection instruments. For example, Marcus (2014) asked nurses to complete a survey in order to evaluate their perceptions. Self-reported information is subjective in nature and may be associated with biases affecting the credibility of findings.
Conclusion
The further study of factors affecting the degree of hypertension control in people of advanced age may have multiple practical implications. It can suggest a way to overcome the barriers to patient motivation and sustaining positive behavioral changes throughout more extended periods. The findings of the literature review indicate that a patient-centered approach is a promising way in this regard. Tailored strategies covering dietary modification, physical activity, adequate drug prescription, evaluation of barriers to and facilitators of engagement in self-management, and counseling can significantly improve blood pressure in a relatively short time. Additionally, the implementation of patient-oriented education interventions targeting hypertension can benefit the hospitals by providing an example of how to achieve optimal health outcomes in the treatment of other chronic conditions as well.
References
Flynn, S. J., Ameling, J. M., Hill-Briggs, F., Wolff, J. L., Bone, L. R., Levine, D. M., … Boulware, L. E. (2013). Facilitators and barriers to hypertension self-management in urban African Americans: Perspectives of patients and family members. Patient Preference and Adherence, 7, 741-749.
Friedberg, J. P., Rodriguez, M. A., Watsula, M. E., Lin, I., Wylie-Rosett, J., Allegrante, J. P.,… Natarajanet, S. (2015). Effectiveness of a tailored behavioral intervention to improve hypertension control: Primary outcomes of randomized control trial. Hypertension, 65, 440-446.
Jin, H., Kim, Y., & Rhie, S. J. (2016). Factors affecting medication adherence in elderly people. Patient Preference and Adherence, 10, 2117-2125.
Lim, K. K., Sivasampu, S., & Khoo, E. M. (2015). Antihypertensive drugs for elderly patients: A cross-sectional study. Singapore Medical Journal, 56(5), 291-297.
Marcus, C. (2014). Strategies for improving the quality of verbal patient and family education: A review of the literature and creation of the EDUCATE model. Health Psychology and Behavioral Medicine, 2(1), 482-495.
Rubio-Guerra, A. F., & Duran-Salgado, M. B. (2015). Recommendations for the treatment of hypertension in elderly people. Cardiovascular & Haematological Agents in Medicinal Chemistry, 12(3), 146-151.
Xu, W., Li, M., & Yao, J. (2016). Intervention of collective exercise on the mental health of elderly hypertensive patients. Iranian Journal of Public Health, 45(3), 314-321.