Effects of the self-management training program on self-management behavior and blood pressure levels among elderly people with hypertension

Objective:To determine the effects of the Self-Management Training Program on self-management behavior and blood pressure(BP)levels among elderly people with hypertension(HT).Methods:This study was based on a quasi-experimental design using sampling groups composed of elderly residents of Pathum Thani Province with HT.Simple random sampling was applied to two sampling groups,an experimental group and a control group.However,the experimental group had been on the Self-Management Training Program based on the Creer concept.The Program’s contents included small-group health-education sessions and the patients’manual,Self-Management Training Skills for Self-Management Behavior.Small group discussions were held for self-reflection,to stimulate follow-up for self-management behavior training during home visits.The Self-Management Training Program was compared with programs involving the more usual care.Data were collected using the Self-Management Behavior for Hypertension Control Questionnaire and BP assessment tests.Data were analyzed using a descriptive statistic,chi-square test,pair t-test,repeated-measures Analysis of Variance(ANOVA),and repeated-measures Analysis Covariance(ANCOVA).Results:It was found that at 13 weeks after entering the program,the experimental group demonstrated a significantly lower systolic and diastolic BP with a baseline statistical significance(P<0.005),and that at the 4th week and the 13th week,there was a decrease in BP in the experimental group.The experimental group also had above-baseline self-management behavior scores that were higher than in the control group(P<0.01).Conclusions:Results from this study show that the Self-Management Program was useful for BP control and promoted sustainable self-management behavior.

Heart failure in the elderly

The aging of the population is, currently, a major phenomenon, drawing the attention of a number of investigators. The significant increase of life expectancies over the past few decades, in addition to social and economic consequences, has lead to a major change in the morbidity and mortality profile of elders. Heart failure （HF） is a condition in which the heart can not pump enough blood to meet the body＇s needs. HF is predominantly a disorder of the elderly with rates increasing exponentially. The prevalence of HF approximately doubles with each decade of life. As people live longer, the occurrence of HF rises, as well as other conditions that complicate its treatment. Impaired heart function implies a reduced duration of survival. Fortunately, many factors that can prevent HF and improve outcome are known and can be applied at any stage. This review emphasizes the importance of factors inherent in aging itself, focusing on heart disease, particularly as a disease of aging, can help critically refine management of this acute and chronic disease, as well as foster preventive strategies to reduce the incidence of this common malady.

斯金纳健康教育结合ABC情绪管理在中老年高血压病人中的应用

目的:探讨斯金纳健康教育结合ABC情绪管理模式对中老年高血压病人自我管理的效果。方法:采用方便抽样法选取2021年1月—2022年4月在某三级甲等医院高血压科住院治疗的220例中老年原发性高血压病人作为研究对象,采用单盲法、按照住院时间先后顺序将研究对象分为试验组和对照组,各110例。对照组给予常规健康教育,试验组在对照组的基础上,给予斯金纳健康教育结合ABC情绪管理模式,比较两组病人干预前、干预1个月、干预3个月、干预6个月后血压水平、疾病知识掌握程度、自我感受负担和自我管理行为。结果:剔除脱落病人,最终试验组纳入105例、对照组105例。重复测量方差分析结果显示,不考虑测量时间,两组病人的血压水平、知识掌握程度、自我感受负担、自我管理行为的主效应差异均有统计学意义(P<0.001);不考虑分组,不同时间的两组病人的血压水平、知识掌握程度、自我感受负担、自我管理行为主效应差异有统计学意义(P<0.001);分组和时间因素存在交互效应,试验组和对照组在不同时间点血压水平、知识掌握程度、自我感受负担、自我管理行为变化趋势存在差异(P<0.001)。简单效应分析显示,干预1个月、3个月、6个月后试验组血压水平、知识掌握程度、自我感受负担、自我管理行为均优于对照组(P<0.001)。结论:将斯金纳健康教育结合ABC情绪管理模式应用于中老年高血压病人的健康教育,在降低病人血压的同时,有助于提高病人知识的掌握程度及对疾病的自我管理能力,减轻病人的自我感受负担。

Prevalence of hypertension among individuals aged 50 years and over and its impact on health related quality of life in a semi-rural area of western TUrkey

Background Hypertension is common, especially in individuals aged 40 years and over, and it affects about half of the population aged 60 years and over. This study aimed to determine the frequency and risk factors of hypertension among individuals aged 50 years and over, and to examine its effect on the health related quality of life （HRQOL）. Methods This population-based cross-sectional study was conducted in two settlements in a region of western Turkey between March 1 and April 30, 2007. A questionnaire concerning life habits associated with hypertension, medical histories, and demographic characteristics was filled in by a face to face interview. The SF-36 scale was used to assess HRQOL. Body mass index （BMI） was calculated by measuring the weight and length of the body. Results Of 1599 individuals living in the region, 1193 participated in the survey （48.3% men and 51.7% women）. The overall prevalence rate of hypertension was 59.5% （n=-710）, being 58.0% in men and 60.9% in women （P 〉0.05）. The variables that most positively influenced hypertension （P ≤0.05, for each one） were older age （especially the age group of those aged 60 and over）, single, no health insurance, consumption of animal fat in meals, and family history of hypertension. The HRQOL of the patients with hypertension was lower than that of those without hypertension （P ≤0.05）. The HRQOL was better in hypertensive patients whose blood pressure was under control, whereas it was worse in those with at least one chronic disorder accompanying hypertension （P≤0.05, for each one）. Conclusions Great emphasis should be placed on the need for a public health program for the detection, prevention, and control of hypertension, including other risk factors, as well as for the modification of foods and life habits, specifically in individuals who are most likely to be at risk of hypertension.

不同证型老年男性高血压病患者性激素相关调控因素的比较研究

目的:探讨男性老年人高血压病肾气亏虚证、肝火上炎证与性激素相关调控因素的关联性,从而为研究老年人高血压病肾气亏虚证、肝火上炎证证候表现的病理生理基础提供依据。方法:根据高血压诊断与分级标准、中医辨证标准选择了男性高血压病肾气亏虚证、肝火上炎证患者各30例和健康老年男性30例,采用酶联免疫吸附法检测白介素-2(IL-2)、瘦素(Leptin)、肿瘤坏死因子(TNF-α)、促性腺激素释放激素(GnRH)和硫酸脱氢表雄酮(DHEA-S)的水平。结果:男性老年人高血压肾气亏虚证患者的性激素相关调控因素水平的异常变化与男性老年人高血压病肾气亏虚证的发病有关,预示血清白介素-2、瘦素、促性腺激素释放激素和硫酸脱氢表雄酮水平的异常变化可能是男性老年人高血压病肾气亏虚证形成的病理基础之一。

银川市社区老年人高血压及糖尿病防治知识知晓状况调查

目的了解银川市社区老年人高血压、糖尿病防治知识知晓状况及需求,为制定城市社区老年人健康教育策略,开展老年人社区卫生保健教育提供依据。方法自行编制调查问卷,采取整群随机抽样方法抽取银川市四个社区,对辖区内≥60岁的老年人进行面对面的调查。调查内容包括老年人高血压、糖尿病防治知识知晓状况及需求情况。结果 82.0%的老年人想了解高血压、糖尿病防治知识,其中81.7%的老年人想了解高血压、糖尿病预防方面的知识。饮食习惯方面,37.8%的老年人不太控制食盐量,49.1%的老年人不注意五种基本食物搭配,29.6%的老年人不常吃粗粮、蔬果,57.3%的老年人不常吃蛋、奶类食品,47.2%的老年人不常吃豆类食品,62.8%的老年人不常吃肉类食品。获取高血压、糖尿病知识的途径主要是电视,占53.7%。结论银川市社区老年人存在多种社区健康教育需求,社区护士要通过老年人易于接受的方式对社区老年人进行高血压、糖尿病的社区卫生保健教育。

苯磺酸氨氯地平治疗老年单纯收缩期高血压临床观察

目的:探讨苯磺酸氨氯地平治疗老年单纯收缩期高血压患者的疗效和安全性。方法:苯磺酸氨氯地平5～10mg,清晨顿服,qd,起始剂量5mg,依血压调整用量。对40例老年单纯收缩期高血压1～3级的患者进行治疗,用药前及用药后1、2、3、4周分别测血压、心率。结果:苯磺酸氨氯地平治疗4周后使血压平稳下降(P<0.05),心率稍增快,但差异无统计学意义。结论:苯磺酸氨氯地平降压缓慢而平稳,降压效果确切、安全可靠,是治疗老年单纯收缩期高血压患者的理想选择。

社区老年高血压患者用药依从性与主观幸福感相关性分析

目的:了解社区老年高血压患者用药依从性与主观幸福感现状,并探讨两者的相关性。方法:采用MORISKY推荐的用药依从性量表、纽芬兰纪念大学幸福感量表(MUNSN)对随机抽取的333名社区老年高血压患者进行调查分析。结果:社区老年高血压患者用药依从性优者96人(28.8%),中者183人(55.0%),差者54人(16.2%)。主观幸福感得分(32.67±6.02)。主观幸福感和正性因子与用药依从性呈正相关,负性因子与用药依从性呈负相关。正性因子越高、文化程度越高,年龄在70岁以下的患者用药依从性越好。结论:社区老年高血压患者用药依从性偏低,主观幸福感处于中等水平,用药依从性与主观幸福感密切相关,尤其是正性因子。增强患者主观幸福感可提高其用药依从性。

福建省福安市畲族农村1991～1999年中老年高血压患者死因分析

目的 了解福安市坂中畲族农村高血压死亡情况及影响因素,为闽东地区畲族农村人群高血压防治工作提供参考。方法 采用1991年全国高血压抽样调查的3 13 6人群调查资料,经计算机筛查抽取195 0年12月3 1日前出生的男女两性14 17人,进行问卷调查。结果 该组人群8年间,2 79例高血压患者生存176人,死亡10 3人,死亡率3 6.92 % ,占总死亡率的65 .63‰。脑卒中死因为首位,占总死亡率的3 1.3 1‰,5 0～60岁年龄段人口中死亡人数呈增长趋势,男性脑卒中病死率明显高于女性。高血压并发症死因首位是脑卒中,占高血压死因的90 % ,高血压Ⅰ级死亡占2 0 .43 % ,Ⅱ级占3 0 .11% ,Ⅲ级占49 .46% ,Ⅱ、Ⅲ级死亡随血压升高而增多。其次为冠心病、糖尿病和肾病。结论 高血压、饮酒、吸烟、高盐和低蛋白摄入、不合理膳食因素可能是导致福安市畲族农民脑卒中死因的主要危险因素。这些危险因素的持续存在对当地农民的生命与健康构成了严重的威胁。

云南省农村老年高血压患者直接疾病经济负担及其影响因素分析

目的了解云南省农村老年高血压患者的直接疾病经济负担及其影响因素,为相关部门优化卫生费用结构、完善卫生资源的分配提供参考依据。方法于2016年7月-2017年7月采用多阶段分层随机抽样方法在云南省抽取4833名≥60岁农村老年人进行问卷调查;采用二步模型法估算其直接疾病经济负担,并采用结构方程模型分析直接疾病经济负担的影响因素。结果云南省4833名≥60岁农村老年人中,自我报告患高血压者1691例,自我报告高血压患病率为34.99%;高血压患者的人均直接疾病经济负担为2210.3元,其中住院费、门诊费、住宿费及交通费、营养费和药费分别为940.8、458.0、20.0、12.2和779.2元;结构方程模型分析结果显示,云南省农村老年高血压患者直接疾病经济负担的主要影响因素为住院天数、住院医院级别、1年内是否住院、1年内门诊就诊次数和是否患慢性病共病,其标准化回归系数分别为0.60、0.56、0.18、0.16和0.14,其中住院天数和住院医院级别的影响较大。结论云南省农村老年高血压患者的直接疾病经济负担较重,减少住院天数和降低住院级别有助于减轻其经济负担.