Exploring the Effects of Health Education and Chronic Disease Management Nursing in the Management of Hypertension in Elderly Patients in the Community

Objective:To explore the effects of health education and chronic disease management nursing in elderly community patients with hypertension,in order to provide scientific evidence for improving the health management level of these patients.Methods:Sixty-four elderly hypertension patients treated at this hospital between March 2022 and March 2024 were selected and randomly divided into two groups,with 32 patients in each group.One group received conventional management,designated as the control group,while the other group received a combined management strategy involving health education and chronic disease management,designated as the experimental group.The study compared the management outcomes of the two groups to evaluate the value of the combined management approach in elderly hypertensive patients in the community.Results:The study found that the experimental group showed significantly lower systolic blood pressure(SBP),diastolic blood pressure(DBP),and scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS)compared to the control group,with statistically significant differences(P<0.05).Additionally,the experimental group demonstrated significantly higher scores in disease cognition levels regarding awareness of normal blood pressure ranges,prevention of complications,identification of high-risk factors,and healthy lifestyle practices,with statistically significant differences(P<0.05).Moreover,the experimental group showed significantly better rates of self-management behaviors,such as quitting smoking and alcohol,self-monitoring of blood pressure,dietary control,regular medication adherence,and consistent exercise,compared to the control group,with statistically significant differences(P<0.05).Conclusion:This study indicates that a combined management model integrating health education and chronic disease management effectively improves the emotional state of elderly hypertensive patients in the community,significantly enhances their disease cognition levels,and boosts their self-management abilities.Furthermore,this model can effectively lower patients’blood pressure,thereby achieving better health management outcomes for elderly hypertensive patients in the community.

Management of portopulmonary hypertension:New perspectives

Portopulmonary hypertension(PPHTN)is a known complication of cirrhosis.Moderate-to-severe PPHTN implies an extremely poor prognosis.It occurs in 5%-10%of patients referred for liver transplantation(LT),and probably with an higher incidence in patients with large portosystemic shunts.Patients with moderate-tosevere pulmonary hypertension have been previously excluded from LT because of the extremely high surgical risk and since the post-transplant outcome reported was poor.Recently,new perspectives in the management of patients with portopulmonary hypertension are emerging.In fact,some pulmonary vasoactive drugs have become routine in the treatment of patients with idiopathic pulmonary hypertension.These drugs,particularly epoprostenol,have been recently introduced in the treatment of patients with PPHTN,and have been shown to be effective in reducing pulmonary artery pressure as well as pulmonary vascular resistances.Furthermore,recent studies seem to demonstrate that treatment with pulmonary vasoactive drugs could allow liver transplantation with acceptable surgical risks and excellent survival.Although there are not large series nor prospective studies addressing this topic,the clinical scenario of patients with PPHTN seems to be positively changing.

Hypertension Screening and Follow-up Management by Primary Health Care System among Chinese Population Aged 35 Years and Above

Objective To describe hypertension screening and follow-up management among Chinese population aged 35 years and above within the primary health care system. Methods Data from 2010 China Chronic Disease and Risk Factor Surveillance System were used. We investigated previous hypertension diagnosis, screening, and follow-up assessments within the primary health care system. The prevalence of self-reported and criterion-based hypertension, screening rates, demographic and socioeconomic characteristics associated with screening, and patterns of follow-up assessments were recorded. The SAS software system was used for statistical analyses. Results About 17.1% reported a previous hypertension diagnosis. The rate difference between the two measures of prevalence was 27.2%. Among those without self-reported hypertension, 27.7% reported never visiting a clinic during the past I year and 60.4% of those attending a clinic reported ever being screened. Younger age group was associated with lower screening proportion; odds ratios of 35-, 45-, 55-, and 〉65 years were 1.7 （95% CI： 1.5-1.9）, 1.5 （95% CI： 1.3-1.7）, 1.3 （95% CI： 1.2-1.4）, and 1.0, respectively. About 35.1% of the patients had undergone follow-up assessments four or more times during the past I year. Conclusion Majority of the Chinese population aged 35 years and above, particularly the less educated, elderly population, and rural residents were unaware of that they were suffering from hypertension. Most patients did not receive enough management services by the primary health care system. Thus, strengthening both the screening and follow-up management is needed.

Compliance to Medication Management and Mental Health Status of Elderly Hypertensive Patients: Basis of Educational Health Program

Objective:The study aimed to assess medication management compliance and mental health in elderly patients with hypertension.Method:The study evaluated medication compliance and mental health status of elderly hypertensive patients in China using simple random sampling.Data was collected using the Morisky Medication Compliance Questionnaire,Hospital Anxiety and Depression Scale,and a checklist.Ethical practices were strictly observed.Results:A study of 100 elderly hypertensive patients found poor drug management compliance,with female patients showing worse compliance.Female patients were more vulnerable to anxiety and depression.The study also found no significant association between gender,age,education level,marital status,living standards,and medication compliance.Barriers to medication management included food and daily necessities,lack of awareness about the importance of drug treatment,and basic family needs.The lowest-ranked barriers were lack of support from government health clinics,low income,and lack of family support.Conclusion:Based on the results,the study proposes an educational plan for elderly hypertensive patients and their families,to be evaluated and implemented by the hospital and township community service center.The plan aims to improve medication management and lifestyle modification compliance,encourage active participation,and provide access to medical and mental health clinics,support groups,and counseling services.

Management of erectile dysfunction in hypertension:Tips and tricks

Arterial hypertension is a major risk factor for cardiovascular disease and affects approximately one third of the adult population worldwide. The vascular origin of erectile dysfunction is now widely accepted in the vast majority of cases. Erectile dysfunction is frequently encountered in patients with arterial hypertension and greatly affects their quality of life of hypertensive patients and their sexual partners. Therefore, the management of erectile dysfunction in hypertensive patients is of paramount importance. Unfortunately, erectile dysfunction remains under-reported, under-recognized, and under-treated in hypertensive patients, mainly due to the lack of familiarity with this clinical entity by treating physicians. This review aims to discuss the more frequent problems in the management of hypertensive patients with erectile dysfunction and propose ways to overcome these problems in everyday clinical practice.

The Clinical Study of a New Management Model Using Mobile Health for Senile Hypertension

Objective: To evaluate a new management model using mobile health for senile hypertension. Methods: This medical service combined traditional medical treatment with Mobile Health. We use it to explore a new and effective model of elderly hypertension management and the most effective and lowest cost management crowd. According to the randomized controlled design of trial, 105 old hypertensive patients participated in the study voluntarily in the Qingdao Municipal Hospital were randomly divided into the experimental group (75 cases) and control group (30 cases). Experimental group is divided into geriatric specialist group (25 cases), general practitioner group (25 cases) and nurse group (25 cases). Blood pressure was administered in experimental (with the new model) and control groups (with the traditional model) for 2 months to compare their blood pressure and the decrease of them. Results: Blood pressure was compared between the two groups before and after administration. The systolic blood pressure (SBP) of experimental group is 162.44 ± 13.970 mmHg before administration. SBP of experimental group is 147.69 ± 13.509 mmHg after administration, the difference is statistically significant (P = 0.000). The diastolic blood pressure (DBP) of experimental group is 91.58 ± 10.822 mmHg before administration. DBP of experimental group is 84.64 ± 10.412 mmHg after administration, P = 0.003. SBP of control group is 159.93 ± 15.238 mmHg before administration. The systolic blood pressure of control group is 152.33 ± 14.115 (mmHg) after administration. P is 0.167 (P > 0.05). The difference was not statistically significant. DBP of control group is 94.73 ± 12.401 (mmHg) before administration. DBP of control group is 90.60 ± 11.115 (mmHg) after administration. P is 0.345 (P > 0.05). The difference was not statistically significant. The decrease of SBP of geriatric specialist group, general practitioner group and nurse group is 18.40 ± 11.764 mmHg, 14.47 ± 9.44 mmHg, 10.80 ± 6.026 mmHg. The difference was not statistically significant (P > 0.05). The decrease of DBP of geriatric specialist group, general practitioner group and nurse group is 9.33 ± 7.451 mmHg vs. 5.33 ± 6.287 mmHg vs. 6.13 ± 5.069 mmHg (P > 0.05). Conclusion: The new model is effective and it works well for controlling blood pressure of elderly hypertensive patients. Especially with the doctors and patients’ families, the management effect has been obviously improved. Medical interventions make the new model more scientific. The management of geriatric specialists, general practitioners and nurses is equally valid.

Self-Management Behaviors of Patients with Hypertension in Daily Life

Background: In a rapidly aging Japanese society, the number of patients with hypertension has seen a steady increase. The basic treatments for hypertension are maintaining blood pressure through medication and preventing complications. It is important for patients with hypertension to perform self-management. This improves their lifestyle while controlling their blood pressure to prevent complications and maintain good health. Purpose: This study aimed to examine the actual self-management behavior ability of patients with hypertension and to clarify the factors involved in their self-management behavior. Methods: A total of 150 patients with hypertension were included in this study. The following data were obtained from the patients as background information: sex, age, years with disease, whether they are receiving antihypertensive agents, type of antihypertensive agent, blood test data, heart thoracic ratio, left ventricular ejection fraction, pulse wave, pulse wave velocity, and height. The levels of self-management skills of the patients were also assessed using the “Instrument to Measure the Self-care of patients with Hypertension” developed by Tsuboi et al. Results: The associations among self-management behaviors in daily life, such as diet, exercise, stress, medication, alcohol intake, and smoking, were analyzed in patients with hypertension. The subjects were classified into the following three groups: aged 65 years or below (Group A), early stage elderly individuals (Group B), and late-stage elderly individuals aged 75 years or over (Group C). The results showed that the subjects in Group C had higher self-management scores for diet, exercise, stress, medication, and drinking than the subjects in the other two groups. The scores of smoking and self-management of the subjects in Group A were high but their other self-management scores were low. All the subjects were taking between 1 to 3 types of oral antihypertensive drugs. The rate of achievement of the target blood pressure was 50% or more in all the three groups. However, the pulse wave velocity was high in all the three groups. Conclusion: The results indicate that the risk of developing disorders of the brain and cardiovascular system is high in all the three groups, owing to the high degree of arteriosclerosis. Therefore, increasing the number of nursing interventions is expected to reduce blood pressure, maintain and promote self-management behavior in daily life, and prevent the onset of complications. The results suggest that nursing interventions involving lifestyle guidance for improving the self-management skills of patients are urgently needed by patients under 65 years of age.

Meta-Analysis the Quality of General Practitioners Management for Elderly Patients with Hypertension in China

Background: Among Chinese adults aged 35 - 75 years, nearly half have hypertension and the prevalence of hypertension is increased with age. But older patients with high systolic pressure and high pulse pressure could not be cured, and will have greater cardiovascular morbidity. This study aims to evaluate the effectiveness of general practitioners (GP) management for Chinese elderly hypertension, and explore reasonable and effective blood pressure management pattern. Methods: We searched the published literature for randomized controlled trials designed to improve blood pressure with community care management delivered by general practitioners or nurses, compared with usual care. Major outcome measures were systolic and diastolic blood pressure;the percentage of patients whose blood pressures are under control with community care management and Revman 5.3 was used in this study. Results: Pooled data from all 13 researches showed a lower outcome diastolic blood pressure (SMD = &minus;0.95, 95% CI (&minus;1.23, &minus;0.67)) and systolic blood pressure (SMD = &minus;1.17, 95% CI (&minus;1.52, &minus;0.81)) respectively in favor of community management. Pooled data from all 11 researches showed a higher percentage of patients with blood pressure under control in favor of community management (OR = 3.85, 95% CI (1.58, 9.37)) and the difference between treatment group and control group on blood pressure control ratio had statistical significance (Z = 2.97, P Conclusions: General practitioners’ management in Chinese elderly hypertension is effective, and complies with the advanced hypertension management guidelines. The multi-patterns are supposed to adopt community blood pressure monitoring and team-based general practitioners.

Status of Understanding of the Disease and Self-Management Behavior among Patients with Hypertension

Background: Hypertension is a lifestyle-related disease that has no subjective symptoms but could lead to severe complications. The goals of treatment for hypertension are to maintain blood pressure with medications and prevent complications. Measuring blood pressure at home regularly is critical for patients with hypertension. Purpose: This study aimed to 1) clarify the status of patients’ understanding of hypertension and self-management, 2) identify nursing practices that could support patients with hypertension in making them aware of the need for understanding hypertension, monitoring blood pressure at home, and engaging in self-management. Method: A questionnaire survey on understanding of the disease and self-management behavior was conducted among patients with hypertension who regularly visited outpatient clinics. As for data analysis, descriptive statistics were computed for patients’ attributes, clinical findings, understanding of the disease, and self-management behavior. Cross-tabulation and the chi-square test were used for each item on understanding of the disease and self-management behaviors. Results: Data were obtained from 150 participants (93 males and 57 females) with a mean age of 70 years. Patients with a higher understanding of the disease and those who were aware of the target blood pressure were more likely to engage in self-management behavior, including monitoring blood pressure at home, ensuring regular outpatient visits, and consulting with nurses or physicians. In addition, the percentage of patients who recognized the need to achieve their target blood pressure was higher among those who had a spouse and lived with their family. Discussion: Regular monitoring and recording of blood pressure at home are the most important self-management behaviors. Understanding of the disease and self-management behavior and support from the family are critical for maintaining appropriate self-management. Therefore, in cooperation with physicians, nurses should provide health education to patients and their families to enable them to perform appropriate self-management. Health expenditures increase with age, especially in those aged 65 years and over. The prevalence of hypertension increases with age;patients aged 65 years and over need to engage in self-management to maintain their target blood pressure. Nurses should provide patients with hypertension aged 65 years and over with appropriate nursing care to enable them to measure and record their blood pressure at home appropriately and regularly. Appropriate nursing care may help reduce the health expenditure. This may help reduce the health expenditure.

Perioperative anesthetic management of interrupted aortic arch associated with severe pulmonary hypertension in a young adult: case report and review of the literature

The interrupted aortic arch (IAA) is rare congential heart defect and entails a very poor prognosis without surgical treatment. We describe a young adult patient with IAA associated with severe pulmonary hypertension and discuss the perioperative anesthetic management of single-stage surgical correction in this patient. Preoperative anesthetic preparation with better understanding of the malformation, intraoperative hemodynamic monitoring, and adequate alveolar ventilation in the perioperative period were all important factors contributing to a successful outcome.

The role of TIPS in the management of portal hypertension:a new perspective

Introduction The Transjugular Intra-hepatic Porto-Systemic Shunt(TIPS)was introduced in the early 1990's by Josef Rosch.It rapidly gained popularity in the US where at that time we were performing many per week.Originally,it was utilized to treat variceal hemorrhage with good results but,over time, endoscopic banding procedures have become better and the shunt has fallen into relative disfavor due to its higher than expected closure rate.In the ensuing fifteen years,there have been many changes in the approach to the treatment of portal hypertension and more specific role for this specialized procedure.

Community Health Management and Nursing Strategies for Elderly Hypertension

Objective:To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients.Methods:A total of 64 elderly hypertensive patients who were treated in our hospital from March 2020 to March 2021 were selected.The control group took conventional care and guidance.The research group carried out community health management and nursing strategy guidance on the basis of the control group.Then compare the blood pressure levels of the two groups of patients before and after nursing and the patients’satisfaction with nursing.Results:Through comparison,it can be seen that the diastolic and systolic blood pressure levels of the study group and the control group are not significantly different before nursing.After nursing,the diastolic blood pressure of the patients in the study group was 81.22.1 mmHg and the systolic blood pressure was 126.58.7 mmHg.The diastolic blood pressure of the control group was 90.55.4 mmHg and the systolic blood pressure was 136.412.9 mmHg.There are obvious differences in the comparison of the two sets of data.By comparing the two groups of patients’satisfactions with nursing care,it can be seen that among the 32 patients in the study group:31 were very satisfied and basically satisfied,with a satisfaction rate of 96.87%.Among the 32 patients in the control group,28 were very satisfied and basically satisfied,with a satisfaction rate of 87.5%.The data of the two groups of patients are clearly comparable.Conclusion:Through community health management and nursing strategies,the satisfaction and treatment effect of elderly hypertensive patients can be improved,thereby contributing to the recovery of patients.

Current approaches to the management of jejunal variceal bleeding at the site of hepaticojejunostomy after pancreaticoduodenectomy

Jejunal variceal bleeding at the site of hepaticojejunostomy after pancre-aticoduodenectomy due to portal hypertension caused by extrahepatic portal vein obstruction is a life-threatening complication and is very difficult to treat.Pharma-cotherapy,endoscopic methods,transcatheter embolization of veins supplying the jejunal afferent loop,portal venous stenting,and surgical procedures can be used for the treatment of jejunal variceal bleeding.Nevertheless,the optimal mana-gement strategy has not yet been established,which is due to the lack of ran-domized controlled trials involving a large cohort of patients necessary for their development.

Contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis patients

This editorial describes the contemporary concepts of prevention and management of gastroesophageal variceal bleeding in liver cirrhosis(LC)patients according to the current guidelines.Gastroesophageal variceal bleeding is the most dangerous complication of portal hypertension in LC patients.Risk stratification and determination of an individual approach to the choice of therapeutic measures aimed at their prevention and management has emerged as one of the top concerns in modern hepatology.According to the current guidelines,in the absence of clinically significant portal hypertension,etiological and nonetiological therapies of LC is advisable for the primary preventing gastroesophageal variceal bleeding,whereas its presence serves as an indication for the administration of non-selectiveβ-blockers,among which carvedilol is the drug of choice.Non-selectiveβ-blockers,as well as endoscopic variceal ligation and transjugular intrahepatic portosystemic shunt can be used to prevent recurrence of gastroesophageal variceal bleeding.Pharmacotherapy with vasoactive drugs(terlipressin,somatostatin,octreotide),endoscopic variceal ligation,endovascular techniques and transjugular intrahepatic portosystemic shunt are recommended for the treatment of acute gastroesophageal variceal bleeding.Objective and accurate risk stratification of gastroesophageal variceal bleeding will allow developing individual strategies for their prevention and management,avoiding the first and further decompensation in LC,which will improve the prognosis and survival of patients suffering from it.

Milestones to optimize of transjugular intrahepatic portosystemic shunt technique as a method for the treatment of portal hypertension complications

This editorial describes the milestones to optimize of transjugular intrahepatic portosystemic shunt(TIPS)technique,which have made it one of the main methods for the treatment of portal hypertension complications worldwide.Innovative ideas,subsequent experimental studies and preliminary experience of use in cirrhotic patients contributed to the introduction of TIPS into clinical practice.At the moment,the main achievement in optimize of TIPS technique is progress in the qualitative characteristics of stents.The transition from bare metal stents to extended polytetrafluoroethylene–covered stent grafts made it possible to significantly prevent shunt dysfunction.However,the question of its preferred diameter,which contributes to an optimal reduction of portal pressure without the risk of developing post-TIPS hepatic encephalopathy,remains relevant.Currently,hepatic encephalopathy is one of the most common complications of TIPS,significantly affecting its effectiveness and prognosis.Careful selection of patients based on cognitive indicators,nutritional status,assessment of liver function,etc.,will reduce the incidence of post-TIPS hepatic encephalopathy and improve treatment results.Optimize of TIPS technique has significantly expanded the indications for its use and made it one of the main methods for the treatment of portal hypertension complications.At the same time,there are a number of limitations and unresolved issues that require further randomized controlled trials involving a large cohort of patients.

Self-efficacy for managing hypertension and comorbid conditions

BACKGROUND Self-efficacy is defined an individual’s belief in completing necessary actions to achieve the desired goal.For individuals with hypertension and other chronic conditions,self-efficacy has been an essential factor to predict adherence to treatment behaviors.AIM To examine self-efficacy for managing chronic conditions in individuals with hypertension.METHODS A total of 1087 individuals with chronic conditions in two groups(hypertension and non-hypertension groups)were selected in this study.The two groups’selfefficacy for managing chronic conditions were investigated using the five domains of patient reported outcomes measurement information system selfefficacy for managing chronic conditions measures(PROMIS-SE);daily activities,emotions,medication and treatment,social interactions,and symptoms.Also,the relationships between self-efficacy and other health-related outcomes for the hypertension group were examined using structural equation modeling.RESULTS Among 1087 participants,437 reported having hypertension.The hypertension and non-hypertension groups were statistically different in self-efficacy for managing daily activities[F(1,598)=5.63,P<0.05].Structural equation modeling indicated that for individuals with hypertension,two domains of PROMIS-SE(managing daily activities and emotions)significantly predict global physical health(P<0.001 and P<0.01 sequentially),and one domain(managing emotions)significantly predicts mental health(P<0.001).Hypertension patients’general quality of life was significantly predicted by global physical health(P<0.001)and mental health(P<0.001).CONCLUSION The hypertension group reported deficits in self-efficacy in managing daily activities as compared to the non-hypertension group.In this hypertension group,self-efficacy functioned as an indirect predictor of general quality of life,mediated by global physical and mental health.

Health system strengthening and hypertension management in China

Background:Non-communicable diseases are the leading causes of global burden of diseases,and hypertension is one of the most important risk factors.Hypertension prevalence doubled in China in the past decade and affects more than 300 million Chinese people.In the review we systematically searched peer-reviewed publications that link health system level factors with hypertension management in China and provide the current knowledge on how to improve a country’s health system to manage the hypertension epidemic.Methods:A framework was developed to guide the review.The database of PubMed,CNKI were systematically searched from inception to April 13,2016.Two authors independently screened the searched results for inclusion,conducted data extraction and appraised the quality of studies.Key findings were described according to the framework.Findings:Five hundred seventy-two publications were identified,where 11 articles were left according to the inclusion and exclusion criteria.The study periods range from 2010 to 2015.All about 11 researches linked health system factors to the outcome of hypertension management.And the outcomes were just focused on the awareness,treatment and control of hypertension but not hypertension incidence.One study is about the role of health system governance,investigating the performance of different organized community health care centers;three studies were about health financing comparing differences in insurance coverage;three studies were about health information practicing the hypertension guidelines of China or the WHO,and the rest three about mechanisms of health service delivery.No researches were identified about physical resources for health and human resources for health.Conclusions:Hypertension prevalence has been rising rapidly in China and the management of hypertension in China is a detection problem rather than treatment problem.Limited evidence shows the positive effect of health system factors on hypertension management and joint efforts from health system and epidemiological researchers are warranted to extend knowledge in this area.

Review on the prevalence,risk factors and disease Management of Hypertension among floating population in China during 1990–2016

Objective:To have a basic and comprehensive understanding about the prevalence,risk factors and disease management situation of hypertension among floating population in China.Method:We used“(hypertension or hypertensive or chronic disease)and(floating population or migrant worker)”as the key words,to search in the China academic literature database(CNKI),Wan Fang database,PubMed and Web of Science for relevant literature and extracted the data about the prevalence of hypertension,relevant risk factors and disease management of floating population in China from 1990 to 2016.Result:The 23 related studies that entered into final analysis were all articles in Chinese.The prevalence of hypertension in floating population is lower than that in both general population and local residents.The prevalence of hypertension in male floating population is higher than that in females.In addition,the prevalence of hypertension also increases with age growing.As for the risk factors of hypertension,the rate of drinking in floating population is higher than that in general population and local residents,while the rates of overweight and obesity in floating population are lower than that in general population in China.Finally,the rates of awareness,treatment and control of hypertension are also lower in floating population.Conclusion:The major problem of floating population is focused on their unhealthy lifestyle(drinking)and deficient disease management.Therefore,we should increase the fund and facility support for public health service system so as to improve their service delivery ability,and enforce the education and unhealthy lifestyle intervention to improve their health awareness and compliance to disease management.

Management of chronic heart failure in the older population

Chronic heart failure （CHF） is the leading cause of hospitalization for those over the age of 65 and represents a significant clinical and economic burden. About half of hospital re-admissions are related to co-morbidities, polypharmacy and disabilities associated with CHF. Moreover, CHF also has an enormous cost in terms of poor prognosis with an average one year mortality of 33%–35%. While more than half of patients with CHF are over 75 years, most clinical trials have included younger patients with a mean age of 61 years. Inadequate data makes treatment decisions challenging for the providers. Older CHF patients are more often female, have less cardiovascular diseases and associated risk factors, but higher rates of non-cardiovascular conditions and diastolic dysfunction. The prevalence of CHF with reduced ejection fraction, ischemic heart disease, and its risk factors declines with age, whereas the prevalence of non-cardiac co-morbidities, such as chronic renal failure, dementia, anemia and malignancy increases with age. Diabetes and hypertension are among the strongest risk factors as predictors of CHF particularly among women with coronary heart disease. This review paper will focus on the specific consideration for CHF assessment in the older population. Management strategies will be reviewed, including non-pharmacologic, pharmacologic, quality care indicators, quality improvement in care transition and lastly, end-of-life issues. Palliative care should be an integral part of an interdiscipli-nary team approach for a comprehensive care plan over the whole disease trajectory. In addition, frailty contributes valuable prognostic in-sight incremental to existing risk models and assists clinicians in defining optimal care pathways for their patients.

Sex-specific effects of social networks on the prevalence, awareness, and control of hypertension among older Korean adults

Background Hypertension is a common chronic disease among older adults, and is associated with medical complications and mor- tality. This study aimed to examine the effects of social network characteristics on the prevalence, awareness, and control of hypertension among older adults. Methods The Korean Social Life, Health, and Aging Project （KSHAP） interviewed 814 〉 60-year-old residents and their spouses from a rural township between December 2011 and March 2012 （response rate： 95%）. We evaluated the data from 595 partici- pants. Multivariate logistic regression models were used to assess the effects of network characteristics on hypertension. Results We ob- served strong sex-specific network effects on the prevalence, awareness, and control of hypertension. Among older women, network density was associated with hypertension awareness [odds ratio （OR）： 2.63, 95% confidence interval （CI）： 1.03 5.37J and control （OR： 1.72; 95% CI 0.94-3.13）. Among older men, large networks were associated with a lower prevalence of hypertension （OR： 0.75; 95% CI： 0.58-0.96）. Compared to older women, older men with coarse networks exhibited better hypertension awareness （OR： 0.37; 95% CI： 0.14-0.95） and control （OR： 0.42; 95% CI： 0.19-0.91 ）. Network size interacted with density for hypertension control （P = 0.051）, with controlled hyperten- sion being associated with large and course networks. Conclusions A large network was associated with a lower risk for hypertension, and a coarse network was associated with hypertension awareness and control among older men. Older women with dense networks were most likely to exhibit hypertension awareness and control.