Evidence-based care for the elderly with isolated systolic hypertension

Clinical indicators and aetiological factors of sedentary lifestyle in patients with arterial hypertension

AIMS

The aim of this study is to verify the clinical validity of clinical indicators and aetiological factors of sedentary lifestyle in individuals with arterial hypertension.

BACKGROUND

Diagnostic validation is performed to expand nursing taxonomies and to revise or confirm the described concepts. New elements listed in the literature and those identified by the NANDA International definition for sedentary lifestyle need to be evaluated.

DESIGN

This is a cross-sectional and diagnostic validation study. The STROBE guidelines were used in this study.

METHODS

Two hundred and fifty subjects aged over 18 years were evaluated. The diagnostic status of the participants was obtained by latent class analysis. Logistic regression was used to identify aetiological factors with the manifestation of sedentary lifestyle, considering a significance level of 5%.

RESULTS

A total of 57.8% of the study participants met the diagnostic criteria for sedentary lifestyle. The clinical indicators with high sensitivity were as follows: "Average daily physical activity is less than recommended for gender and age"; "Does not perform physical activity during leisure time"; "Preference for activity low in physical activity" and "Overweight." The significantly related factors associated with the diagnosis of sedentary lifestyle were as follows: "Insufficient knowledge on physical activity," "Lack of time," "Negative self-perception of health," "Lack of security," "Lack of appropriate place," "Lack of motivation," "Activity intolerance," "Lack of sports ability," "Having a partner," "Using public transportation," "Perception of physical disability," "Pain," "Having a job/studying," "Laziness," "Impaired mobility," "Living in an urban area," "Education in a public institution," "Female gender," "Lack of confidence to practice physical exercise," "Education level," "Age" and "Lack of social support for the practice of physical exercise."

CONCLUSION

Four out of eight clinical indicators had a good adjustment by the latent class analysis. Of the 27 aetiological factors, 22 were significantly associated with sedentary lifestyle.

RELEVANCE TO PRACTICE

The correct identification of sedentary lifestyle and its elements supports care planning, especially for health promotion and disease prevention.

Revisão do diagnóstico de enfermagem Estilo de Vida Sedentário em pessoas com hipertensão arterial: análise conceitual

Este estudo tem por finalidade revisar os componentes do diagnóstico de enfermagem Estilo de vida sedentário (EVS) propostos pela NANDA-I em indivíduos com hipertensão arterial. A revisão foi desenvolvida a partir da análise de conceito, com o auxílio do método da Revisão Integrativa da Literatura a partir de 43 artigos pesquisados em cinco bases de dados (LILACS, CINAHL, PUBMED, SCOPUS E COCHRANE). Foram utilizadas as seguintes combinações de descritores e equivalentes nas línguas inglesa e espanhola: Estilo de vida sedentário and Hipertensão e Sedentarismo and Hipertensão. O processo de revisão conduziu aos seguintes resultados: modificação da definição do EVS, de nomeações de alguns indicadores clínicos e acréscimo de outros. Considera-se que o estudo subsidiou uma direção para a eficiência diagnóstica de indicadores clínicos do EVS, contribuindo para o refinamento e o aprimoramento desse diagnóstico e seus componentes.

Lifestyle factors associated with blood pressure control among those taking antihypertensive medication

The purpose of this study was to explore the relations between lifestyle factors and blood pressure (BP) control among patients with hypertension who were regularly taking antihypertensive medication as prescribed. From the 2005 Korean National Health and Nutrition Examination Survey data, the 690 individuals diagnosed with hypertension who were regularly taking antihypertensive medication were identified. Slightly more than half of the patients (54.3%) had their BP under control. Younger patients, those having one or more comorbidities and those performing physical activity at least 4 days a week were more likely to have their BP under control, while overweight patients, heavy alcohol drinkers, and those with mild to very severe stress had lower rates of BP control. The study results suggested that to reduce uncontrolled BP, public health efforts should target old and overweight patients and those with unhealthy lifestyles including heavy alcohol drinking, stress, and lack of physical activity.

Effectiveness of case management for community elderly with hypertension, diabetes mellitus, and hypercholesterolemia in Taiwan: a record review

OBJECTIVE

To identify the effectiveness of case management for community elderly with hypertension (HT), diabetes mellitus, and hypercholesterolemia (HC) (the so-called three highs).

DESIGN AND SETTING

Secondary data of the first and 3-month-after visiting records were extracted from 33 Public Health Centers in Taiwan.

PARTICIPANTS

Seven hundred and sixty-six clients were selected who were at least 65 years old and had been diagnosed twice on the Case Management Record with at least one of the three highs.

RESULTS

This sample had a mean age of 72.6 years, 59.7% were female. Approximately 74% of the clients had HT, 55% had diabetes, and 15% had HC. Each elderly revealed 1.4 highs of the three highs. The elderly with HT, and diabetes, their blood pressures (BP) and blood sugars significantly decreased after being managed by public health nurses. Males and the elderly living in urban areas had more decrease in systolic BP. Females had more decrease in fasting blood sugar.

CONCLUSIONS

The study found that the case management of the three highs presented effectiveness on reducing the values of the three highs of the elderly in community.

Aggressive hypertension management in patients of advancing and advanced age

Many older patients are not being aggressively managed for hypertension. Healthcare providers are often hesitant to start or even aggressively titrate antihypertensive medication, especially in the aged. Multiple studies have demonstrated that morbidity and mortality can be significantly reduced by appropriate intervention in all age groups. There are some clinical situations, however, where the provider must approach cautiously, such as in patients with a wide pulse pressure or those with a propensity toward adverse reactions. The data are clear that in the United States, undertreatment, rather than overtreatment, appears to be the issue. This article reviews studies that support the aggressive treatment of hypertension. The nuances of aging, which often influence the healthcare provider's treatment decisions, are also discussed. Suggestions for reasonable approaches to these difficult cases will be considered.