Public Health Issues Relating to Leadership in Inter-Professional
The current paper in based on the concept of hypertension in the elderly people. In the introductory part, the problem is defined and a distinction between primary and secondary hypertension is highlighted. The second section tackles significance of the problem of hypertension among the elderly. This is achieved through reviews of various records of the World Health Organization from various states of the world. The third section handles socio-ecological determinants for hypertension among the elderly, while the last section offers various forms of solutions to the problem among the elderly.
Hypertension is a chronic medical condition in which blood pressure in arteries is elevated beyond the normal rate. Blood pressure depends on systolic and diastolic functions of cardiac muscles. A balance between these two cardiac functions should result in a normal blood pressure, which is measured at a range between 100-140 mmHg top reading and 60-90 mmHg bottom reading. High blood pressure is thus recorded if pressure is measured at or above 140/90 mmHg (Fisher & Williams, 2005).
Hypertension can also be either primary or secondary. Primary hypertension occurs if the condition of abnormal rise in blood pressure cannot be accredited to a specific medical cause. This case concerns at least 90% of all reported hypertension causes among the elderly and is also known as essential hypertension. Secondary hypertension is caused by identifiable conditions such as kidney problems, endocrine disease, or glucose intolerance (Fisher & Williams, 2005).
Rationale for Significance of Hypertension in the Elderly
A survey of prevalence of hypertension reveals that the condition has emerged as one of the most challenging and common health conditions among the elderly across the globe. In some countries, the condition is reported among 20% to 30% of entire aging populations. In the WHO report published in 2010, 44% of the European population above 60 years was suffering from hypertension. The survey also revealed that the American population recorded 28 hypertension cases within the same age bracket, while in Africa it was estimated that the rate could be twice as that of the Americans.
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In Europe and America, the highest prevalence rates have been reported for age groups between 65-74 years. Females are more vulnerable to hypertension than males within the same age bracket. For instance, a study conducted in 2010 in Greece revealed that 49% of hypertension patients were males while the rest were females. Hypertension cases thus increase by age, varying according to sex and recording different rates in various regions of the world (Chaib, 2012). According to the WHO report of 2002, a number of people in the world who suffered from hypertension amounted to 600 millions. Out of these, it was further reported that annual mortality rate caused by hypertension was 7.4 million deaths. Within this period of time, most deaths reported among people aged 60 years and above were a result of hypertension. In the entire Europe, it was also reported that hypertension was responsible for 17% of the total annual mortality rate (Chaib, 2012).
The rationale of the problem of hypertension among the elderly is also justified by its effects on patients as well as the society at large. These consequences are clinical, psychosocial, and economic. From a medical point of view, those who suffer from high blood pressure often report medical cases such as extensive headache, dizziness, and visual deterioration. In other cases, complications that relate to breathing due to heart failure can emerge. Hypertension can also lead to malaise that is associated with renal failure among the elderly (Elliot, 2007).
Hypertension emergency is also common among the elderly who suffer from high blood pressure. This case happens when hypertension has escalated to a direct damage of one or more organs in the body. For instance, severe hypertension among the elderly can lead to hypertensive encephalopathy, which is caused by swelling and dysfunction of the brain. When this condition persists, patients can experience severe headaches that can result in confusion, temporary unconsciousness, or drowsiness (Kearney, Whelton, Reynolds, Whelton, & He, 2004).
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When effects occur in the heart, severe chest pain that is a result of damage of heart muscle or aortic dissection is often experienced. In other cases, breathlessness, coughs, and blood-stained expectoration can be witnessed. In addition to these, swelling of lungs can also emerge as a result of inability of the heart to function optimally and pump blood from lungs into the arterial system. Hypertension among the elderly can also lead to rapid deterioration of kidney function and destruction of blood cells, which can cause a medical condition known as micro-angiopathic hemolytic anemia. In such situations, radical reduction of blood pressure can be effected to stop the damage of organs (Kearney, Whelton, Reynolds, Whelton, & He, 2004).
From a sociological point of view, hypertension exposes patients to a vast number of psychosocial problems. For instance, management of the condition demands that affected people adopt certain eating habits. Change from a usual diet to a new one can be very stressful for the elderly. It has also been observed that hypertension is likely to cause more psychological problems to the younger generation like children who have to nurse their loved ones suffering from hypertension for a long time (Rumsey, Clarke, & White, 2003).
As already stated, hypertension causes many other related medical conditions and complications. This implies that affected people have to spend a lot of money to meet medical expenses of hypertension or other related complications. This causes economic strains for the elderly who, according to their age, do not possess the capacity to work and meet the demanding cost of medication. In other contexts, such as the rural and poor populations, access to the medication is limited and unaffordable. In very severe cases, patients are often exposed to clinical and therapeutic treatments, a process that can be stressful and tedious for the elderly. As a result of this, many can end up absconding therapies, hence failing to achieve blood pressure goals (Elliot, 2007).
Socio-Ecological Determinants for Hypertension among the Elderly
From a medical point of view, specific causes of hypertension are usually unknown. Nonetheless, factors that render one vulnerable to hypertension are various. These include excessive smoking, overweight, diabetes, sedentary lifestyle, and lack of physical exercise. In other cases, high levels of salt intake can also lead to hypertension. Nutritionists indicate that insufficiency of certain minerals such as calcium, potassium, magnesium, and vitamin D also causes hypertension (Fisher & Williams, 2005). To justify this stand, Komaroff & DeLisa (2009) conducted a study to examine effects of excess salt intake on hypertension. In a medical trial on mice, the study established that excess salt led to expansion of intravascular volume and proliferation of lymphatic vessel under skin that stored excess fluids. Researchers thus established that defects resulting from high salt content in the body system were associated with salt-sensitive hypertension.
Stress is another acknowledged cause of hypertension. The condition is also associated with excessive alcoholism and overreliance on birth control pills for a long period of time. Other medical conditions such as adrenal and thyroid or tumors can also cause hypertension. Cases of hereditary hypertension that is genetically transmitted from parents to children have also been acknowledged (Gierman-Riblon & Salloway, 2013).
Although age has been generally perceived as a risk factor for hypertension, reasons behind this illness are still poorly understood, hence giving way to mere speculations rather than offering accurate scientific justifications. Systolic hypertension increases with age even among patients who have a record history of high blood pressure. This increase is likely to be recorded even if the patient is put on medication that regulates the condition (Gierman-Riblon & Salloway,. 2013).
Factors behind prevalence of hypertension among the elderly include changes in hormonal profiles. It has also been argued that decrease in taste bud sensitivity makes the elderly over-salt their food, hence increasing salt concentration in the body. Besides, the elderly are likely to suffer from hypertension due to changes that occur in arterial walls and other blood vessels. As their body tissues grow weary, decreased efficiency of heart can also be responsible for the condition. Although most of these causes are perceived as unavoidable among the elderly, a healthier lifestyle is known to minimize the risks (Ong, Cheung, Man, Lau, & Lam, 2004).
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To justify socio-ecological causes of hypertension, a research was conducted in 1974 among the black Americans. In this study, it was confirmed that socio-economic factors such as low economic status, high crime rate, high population density, residential mobility, and marital breakups were responsible for a high level of stress, which in turn caused hypertension. This revealed that black Americans who suffered from various socio-economic segregations and discriminations were more prone to hypertension that the whites who lived a better economic life. The study also confirmed that other emotional disorders such as suppressed hostilities, anger, and prolonged feeling of guilt could increase risks and make people vulnerable to hypertension. Although the study targeted people aged 25 to 80, it was confirmed that more than 60% of the recorded cases were among the elderly whose age was at least 60 (Becket et al., 2008). This study has thus confirmed that hypertension is a condition that is related to and caused by diversified socio-economic factors in the society. To counter this conclusion, a more comprehensive and interdisciplinary approach is necessary.
Intervention for Hypertension in the Elderly People
Interventions for hypertension require an interdisciplinary approach and include treatment, prevention, and management. Based on the observation that the majority of people diagnosed with high blood pressure are not necessarily hypertensive, control measures have been the most preferred intervention, especially as the first line treatment. As a result of this, community health workers are encouraged to play the role of disseminating relevant information in relation to the disease (Heinemann & Zeiss, 2002).
For those who already suffer from hypertension, it is recommended that lifestyle changes be adopted prior to drug treatment. According to the British Hypertension Society’s guidelines and the United States Blood Pressure Education Program, maintenance of normal body weight is one of the recommended strategies to keep the blood pressure normal and to lower high blood pressure. Besides, patients are encouraged to reduce consumption of sodium dietary intakes in the body (Becket et al., 2008). The challenge is that most patients suffering from hypertension and their family members are not willing to embrace the recommendation to change a lifestyle. This is because most people consider such adjustments to be associated with a relatively high cost. However, specialists advocating for this approach push for even non-costly lifestyles such as just keeping physically fit through non-strenuous exercises.
Engaging in regular aerobic physical activity has also been recommended as a prevention measure of this condition. Although vigorous physical activities may not be perfect for the elderly, less active exercises such as taking an easy thirty-minute walk every day are sufficient. It has also been recommended to reduce consumption of alcohol. Instead, the elderly are encouraged to increase consumption of fruit and vegetables in their daily diets. For those who are already affected by hypertension, specialists advocate for a hybrid of preventive measures alongside drug treatment (Becket et al., 2008).
Since hypertension is more related to lifestyle than any other cause, the first line treatment is almost the same as recommended preventive measures. It is asserted that these preventive measures and a change of life style have an effect similar to only medication. From a dietary point of view, foods that are rich in nuts, whole grains, fish, fruits, vegetables, and poultry are recommended (He & McGregor, 2009).
Several techniques such as yoga, relaxation, and meditation are also known to reduce blood pressure. As a result of this, the elderly have been encouraged to adopt a relaxed lifestyle and avoid possible causes of stress and depression. Studies have noted that people approaching old age with frequent and persisting stressful experiences are prone to hypertension. To counter this, communities should be sensible and friendly to the elderly and adopt possible measures that would help them live a more relaxed life (Royeen, Jensen, & Harvan, 2009).
From a clinical perspective, drugs that are referred to as anti-hypertensive are administered. However, this should be done with account for the person’s cardiovascular risk as well as blood pressure readings. It has also been reported that such medications are not acceptable for people with pre-hypertension or normal blood pressure. Studies have also proved that medication that reduces blood pressure by 5 mmHg can minimize the risk of other complications such as stroke, ischemic heart disease, dementia, heart failure, and cardiovascular disease (Royeen, Jensen, & Harvan, 2009).
In case there is no positive progress in achieving the pressure reduction goal, a therapeutic approach is necessary. This should be interdisciplinary and holistic in approach. Family members of patients should provide moral and psychological support during and after treatment. Besides, community health workers should enhance proper community-based counseling that intends to achieve acceptability of the affected people and preventability of the disease among the rest of the community. In effective counseling program, effective follow-up should be enhanced to evaluate progress of patients. In this process, corporation from a patient should be pursued and encouraged (He & McGregor, 2009).
To justify the corporate and holistic approach to treatment of hypertension, a study was conducted by the hypertension care community in China in 2010. Care programs that were initiated among hypertension patients included health education, family support, self-management, and community training programs. In this research, eligible participants were those who had been diagnosed with hypertension in several geographical regions. Interventions were offered by village doctors, nurses, general practitioners, and family members. After a period of six months, it was revealed that the blood pressure had significantly reduced among patients who were exposed to interventions. After a series of follow-ups, it was affirmed that the ability of patients to respond to a variety of interventions improved the response to reduction of blood pressure (Qian, Lucas, Chen, Xu, & Zhang, 2010).
Hypertension is a condition that elevates arterial blood pressure above normal rates. This condition is more common among the elderly than among younger people. Hypertension can also be either primary or secondary. Primary hypertension is diagnosed when the cause is not accredited to a specific medical cause. Although primary hypertension is most common among the elderly, it is known to cause other heath complications such as heart failure, kidney failure, and stroke. Causes of hypertension are associated with a number of psychosocial issues that prevail in various societies. These include poor feeding habits, lack of physical exercise, overconsumption of alcohol, and other causes of psychological distress. Although drug treatments are available, dietary and lifestyle precautions give the most effective first line treatment.