Introduction
Hypertension is one of the common health issues affecting the aging population. This disorder has an adverse impact on people’s quality of life as its symptoms include visual impairment, metabolic syndrome, heart failure, aneurysm, cardiac arrest, stroke, and dementia (Currie & Delles, 2018). In 2014, the leading cause of death in the USA was heart attacks that were directly linked to hypertension (Forouzanfar et al., 2017). Although the changes associated with aging are inevitable, the severity of hypertension can be controlled effectively with the help of various interventions. This paper includes a brief description of the project aimed at the development of an effective intervention to improve the health status of elderly patients with hypertension.
The Spirit of Inquiry Ignited
As mentioned above, several types of treatment have been developed to address the illness under analysis. Medication-based interventions are common among the target population (Sluyter et al., 2017). However, lifestyle changes and proper diet are also regarded as more effective strategies to control blood pressure as compared to the ones based on pharmacological methods (Yang et al., 2018; Neupane et al., 2018). Patient education is seen as a key component of such treatment plans. Comprehensive interventions that involve the intake of medication, a healthy diet, and lifestyle have proved rather effective as well (Wei et al., 2017). At the same time, it is quite unclear whether patients’ health literacy increases as a result of such interventions. Clearly, it is essential to raise older patients’ awareness of their health status, possible outcomes, and effective prevention. This knowledge can be instrumental in developing appropriate lifestyle and dietary patterns. It is hypothesized that lifestyle changes do not only improve older patients’ health status but can also enhance their understanding of certain health-related issues, which increases their adherence to treatment.
The PICOT Question Formulated
The PICOT question can be formulated as follows: PICOT question – (P) In elderly patients of 60-75 years old suffering from hypertension, (I) does patient educational intervention like routine 30-minute walks, and healthy diet, (C) compared with only medication treatments, (O) increase their health literacy about their diseases and improve their health status (T) in a 6-month period?
Search Strategy Conducted
In order to review the evidence on the topic under consideration, such research tools as PubMed, CINAHL, and TRIP Database were used. The following keywords were utilized: hypertension, elderly, diet therapy, and educational intervention. The search was limited to the sources published between 2013 and 2018 as these are the most recent articles that include the most up-to-date findings. As a result, level II and level III evidence studies were reviewed.
Critical Appraisal of the Evidence Performed
The use of valid evidence and reliable data is central to the development of effective interventions or making evidence-based decisions. This study is based on the utilization of level I and level II evidence studies. Brown (2016) states that in the hierarchy of studies, the highest levels equip researchers with valid information that can be the starting point and the background for their studies. Level I evidence studies are reviews that provide the data concerning the existing trends and the latest advances in the field. For instance, the articles by Currie and Delles (2018) and Forouzanfar et al. (2017) provide valuable details concerning the degree of the public health issue and some general facts about the disorder. This information assists in placing the present study in a larger context.
Level II evidence articles are reviewed to obtain the exact outcomes associated with the implementation of certain interventions. This knowledge was essential for the development of the project that involved the use of the strategies that have proved to be effective in some populations under certain conditions. The review of these studies also helped in choosing the most appropriate theoretical framework for this study that is based on the self-care theory.
Evidence Integrated with Clinical Expertise and Patient Preferences to Implement the Best Practice
The suggested project will involve the implementation of a quasi-experimental study with two groups of participants. The experimental group will receive educational interventions that will include 30-minute walks and a discussion of proper diets and lifestyles. The control group will receive medication-based treatment only. The participants will be able to choose the group they preferred or will be randomly placed in one of the groups. Overall, 500 patients between 60 and 75 years old will take part in the study. The confidentiality of the participants will be ensured by using codes instead of their names.
The outcome of Practice Change Evaluated: Evaluation Plan: Methods
Purpose
The purpose of the evaluation is to identify the exact health outcomes and patients’ attitudes towards the present intervention.
Clinical Question
- Did the blood pressure improve in patients in the experimental group after the intervention termination?
- To what extent were the patients in both groups satisfied with the intervention?
Time
The evaluation will be gradual as vital signs will be examined monthly, and the final evaluation will be conducted after the termination of the program.
Stakeholders
The patients will receive questionnaires, and nurses will help them complete answers to the questions.
Theoretical Framework
The self-care theory is applicable in this case as patients are trained to adjust their dietary habits and lifestyles to their health conditions.
Design
The use of quasi-experimental design is justified as the partial randomization will contribute to the patients’ adherence to the treatment they will be prescribed.
Confidentiality
Confidentiality is properly ensured as the personal information of the participants will not be disclosed. They will also be protected by their right to withdraw from the study at any point.
Sample/Setting/Procedure
The sample size is sufficient to identify the potential benefit of the intervention and possible flaws of the methodology. The intervention is age-appropriate and is quite common for the target population. The clinical setting is also beneficial since the patients’ health status can be closely monitored.
Instrument
Surveying is an appropriate tool since it enables researchers to analyze the attitudes of a large number of people.
Data Analysis
Statistical analysis software will be employed to eliminate possible errors.
Outcomes to be Evaluated
The participant’s blood pressure will be examined before the intervention and after the termination of the program. This vital sign will be checked each month during the 6-month program. At the end of the intervention, all the participants will complete brief questionnaires that will help identify their attitudes towards the program, their health status and quality of life, as well as their adherence and willingness to adhere to the proposed intervention. The questionnaires will include Likert-scale questions, which will be necessary for the comparison of the degree of satisfaction between the two groups.
Project Dissemination
The results of the study were described in a peer-reviewed article and discussed on several online forums. The research was also regularly referred to and evaluated at a healthcare facility during its implementation period. The project also became a part of the standard practice in a healthcare facility providing services to the aging population.
Conclusion
On balance, it is necessary to note that the suggested intervention can be effectively implemented in various settings. One of the potential benefits of the proposed intervention is the effect it can have on the patients’ awareness. The research is evidence-based as it was developed on the basis of other similar studies that involved medication-based and educational treatment provided to older patients with hypertension.
References
Brown, C. (2016). The evidence-based practitioner: Applying research to meet client needs. Philadelphia, PA: F. A. Davis.
Currie, G., & Delles, C. (2018). Blood pressure targets in the elderly. Journal of Hypertension, 36(2), 234-236.
Forouzanfar, M. H., Liu, P., Roth, G. A., Ng, M., Biryukov, S., Marczak, L., … Murray, C. J. (2017). Global burden of hypertension and systolic blood pressure of at least 110 to 115 mmHg, 1990-2015. JAMA, 317(2), 165-182.
Neupane, D., McLachlan, C. S., Mishra, S. R., Olsen, M. H., Perry, H. B., Karki, A., & Kallestrup, P. (2018). Effectiveness of a lifestyle intervention led by female community health volunteers versus usual care in blood pressure reduction (COBIN): An open-label, cluster-randomised trial. The Lancet Global Health, 6(1), e66-e73.
Sluyter, J. D., Camargo, C. A., Stewart, A. W., Waayer, D., Lawes, C. M., Toop, L.,… Scragg, R. (2017). Effect of monthly, high‐dose, long‐term vitamin D supplementation on central blood pressure parameters: A randomized controlled trial substudy. Journal of the American Heart Association, 6(10), 1-18.
Wei, X., Walley, J. D., Zhang, Z., Zou, G., Gong, W., Deng, S.,… Yu, M. (2017). Implementation of a comprehensive intervention for patients at high risk of cardiovascular disease in rural China: A pragmatic cluster randomized controlled trial. PloS One, 12(8), 1-19.
Yang, G. H., Zhou, X., Ji, W. J., Liu, J. X., Sun, J., Shi, R.,… Li, Y. M. (2018). Effects of a low salt diet on isolated systolic hypertension: A community-based population study. Medicine, 97(14), 1-8.