Research Problem
It has been established by various researchers that older members of society are losing their lives due to issues relating to hypertension. This is much discouraging considering the efforts made by all relevant authorities especially the government is trying to curb the problem. The purpose of this research is to point out the various risk factors for elderly people developing hypertension.
As suggested by a report from a joint national committee on hypertension, currently about fifty million Americans are affected by hypertension while globally slightly above one billion people are suffering from the disorder (Wenyu et al, 2006: 2). This thus has been a health concern worldwide and more so, nationally, particularly for Americans.
Additionally, it has been predicted that as the human population grows, the problem of hypertension will be much worse. For instance, a study carried out by Wenyu et al 2006: 43 examined HT in American Indians established the chances of developing hypertension are tremendously rising especially in the elderly. Studies previously carried out have consistently depicted that, hypertension is closely linked to heart diseases or disorders (Ostchega et al., 2007: 1060).
If these hypertension risk factors for elderly individuals could be brought out clearly, then the nursing fraternity will be in a better position to adequately advise and treat members of society who are at risk of suffering from HT. Additionally, the findings will help affected individuals and those close to them to make a rational decision on how best to curb the problem in the future.
Research Purpose
The purpose of this research is to point out the various risk factors for the elderly developing hypertension. Similarly, the research will seek to find out how prevalent is the problem and the advantages associated with early and proper identification of the risk factors that make older members of the society develop hypertension. Additionally, establishing recommendations on how to address the risk factors is also part of the proposed study.
The importance of the study is first linked to pointing out the major risk factors for hypertension. This will help them to re-evaluate lifestyles and adopt the one that will foster their lives. Similarly, nurses will have a clue on the same factors hence be in a better position in advising patients. Similarly, better strategies will be developed to curb the problem associated with hypertension. Lastly and more importantly, the research will lay the ground for further related studies.
Literature Review
Hypertension has been considered as a cardiac medical condition in which the systematic arterial blood pressure ends up being elevated. It has been found that, when hypertension gets to a higher level, especially to those elderly individuals, it becomes a risk factor for stroke complications, myocardial infarctions, heart failures, as well as an arterial aneurysm.
It was found by Shailendra, et al. (2010: 42) that, hypertension plays a major role in the etiology of cardiovascular disease, ischemic heart problems as well as cardiac and renal failures in old aged and adult individuals. In addition, Mendoza, et al. (2006, p 173) found that it also negatively affects specific cognitive responsibilities, like resulting in an attention deficit, learning a long with memorization.
Rodrigues, & Borgatti (2010, p 624), added that hypertension, which has become a world disaster causes stroke, heart failure along kidney problems. This has been going hand in hand with its modifiable risk factors like obesity and sedentary lifestyle, (Fernandez, et al, 2001, p 864). The best way of preventing such risks caused by hypertension is to carry out studies that will help in the identification of its risk factors causing it
It was found by Shailendra, et al. (2010: 40) that, both lifestyle and anthropometric dimensions predict the prevalence of hypertension compared to ethnicity. In developing countries, a central and overall increase in obesity amongst the population has emerged as being a major cause of increased blood pressure, which eventually leads to hypertension.
Obesity has been thought to be caused by imbalances between caloric consumption and expenditure over a long period. In old age, overweight occurs as a result of decreased exercise and a high-fat diet. This in general increases cholesterol concentration in the body leading to heart failure, (Shailendra, et al, 2010: 40).
On the other hand, Rodrigues, & Borgatti, (2010: 625) stated that, elderly individuals suffer more from hypertension as compared to the youths and children. This has been due to smoking habits in old aged individuals. Despite the fact that smoking is not a direct cause of HT it is attributed to temporal higher level of blood pressure.
This occurs due to factors like injuries caused by smoking on blood vessels. In addition, elderly individuals have been already susceptible to other hypertension risk factors; research has shown that smoking increases the risk of secondary hypertension complications.
Mendoza, et al. (2006: 172) also connected plasma concentration with the body mass index, which is mostly present in patients having insulin resistance. This has been reported as being one of the factors leading to cardiovascular diseases like hypertension. Going with the point of body mass index, it has been found that, elderly individuals have higher body mass index, indicating the presence of high body fats. The cases of high body mass index is high in elderly individuals is due to lack of exercise.
In that connection, an increase in body fats increases the risks of metabolic disease like diabetes, which might lead to hypertension and certain CVDs with more effects on the elderly individuals. In addition, higher body mass index in increases the chances of being obese, hence obese factors come into play. According to Mendoza, et al. (2006: 173), there are oxidative stresses as well as inflammations, which are casual variables that might lead to atherosclerosis and arterial hypertension. The results indicated that, the level of leptin in elderly people is mostly linked to the presence of SBP, which is as a result of high fat content.
It was found by (Ellis, et al, 2010: 806) that; pronounced alcohol usage in elderly individuals, leads to hypertension. Research as shown that consumption of increased alcohol increases water concentration in the body. This ultimately increases retention of salts. It has been established that when water is in excess in the veins as well as arteries the heart is overworked as space for fluid which are vital for flow of blood is constricted.
As a result, this leads to an increase in blood pressure to ensure enough blood transportation within the body. Alcohols in addition cause incidences of high blood pressure to individuals having, overactive nervous systems. Another effect of alcohol on blood pressure and hypertension is the presence of calories in alcoholic drinks; hence ends up increasing the amount of calories in the body that might either increase the body mass index and obesity. Generally, the proper reducing salt intake, usage of alcohol changing dietary habits, taking exercises along with taking blood pressure modifications, are the practices recommended for blood pressure improvement.
It was stated by Van der Niepen, & Dupont, (2010: 585) that, prevalence of concomitant cardiovascular risks include sub clinical organ damage. Some of these diseases, which render the kidney inefficient in absorbing in absorption salts from blood. Higher concentration of salt in blood results to high blood pressure since there is increased rate of absorption of water ultimately causing high blood pressure. In addition, “hypertension as a result of kidney diseases occurs due to renal artery stenosis is as a result of systematic vascular resistance as well as an increase in cardiac output” (Van der Niepen, & Dupont, 2010: 543).
It has been noticed from literature that, a very large number of elderly individuals are affected with hypertension risk factors like alcohol drinking and smoking, salt intake, obesity, sex, cholesterol and kidney problems. However, According to the study by Zhaoqing, et al. (2010: 5), hypertension risk factors can be identified in an urbanizing environment as well as diet westernization and heath practices. The differences in hypertension incidences between ethnic groups as shown in their results were explained as being due to genetic variations, (Shailendra, et al. 2010: 38).
In situations where one’s family members have suffered from hypertension, subsequent generations are also at risk of HP. This explains the genetic component that leads to the development of hypertension. In addition, in looking at obesity, there are some genes which cause obesity or weight gain, so due to the fact that most elderly individuals don’t participate in physical exercises, this factor ends up being another risk factor causing hypertension.
Zhaoqing, et al. (2010, p, 4) also confirmed that, types and levels of salt intake has an effect on hypertension incidences especially in elderly individuals. Though salt is one of the essential to individual’s body, however in elderly individuals, the kidney seem to be not effective in its function as compared to young individuals.
As an effect, high salt concentration in blood ends up increasing blood water absorption, which automatically increases blood volume in blood vessels. This effect of high blood volumes ends up hindering blood flow in vessel lumen; hence overworking the heart by making it constrained and this increases blood pressure which latter leads to hypertension.
In the analysis of hypertension risks in aged individuals, Wildman, et al. (2004: 54), found that high triglyceride as well as apolipoprotein B levels and lower HDL-C levels being a univariate factor of hypertension, hence supporting other studies that linked serum lipoprotein and hypertension. It has been found that higher levels of Triglyceride or cholesterol are far much risky in the development of cardiovascular diseases.
Food stuff rich in fat raises the cholesterol levels as well as triglyceride which ultimately affects both veins and arteries. This effect ends up reducing the arterial lumen hence increasing blood pressure with the aim of forcing blood through smaller blood lumens. This problem affects elderly individuals because; their body cells no longer required triglyceride. (Wildman, et al. 2004: 29)
According to Ostchega, et al. (2007: 1060), hypertension affects men and women in elderly individuals. But it has been indicated that, this occurs more in women as compared to men, irrespective of availability of health insurance or if proper measures are not put in place. This can be explained that, sex is also a risk factor causing hypertension in elderly individuals. Due to awareness in elderly men as compared to women, there have been some improvements in men as compared to women.
In addition, with the availability of health insurance for both elderly sexes, women still have problems in treatment as well as control. It was found that, men having health insurance have higher chances of being treated unlike women. This is based on the fact that, health care providers approach the CVD in women much different as compared in men, this is because, most health care providers downgrade the risk factors associated with cardiovascular risk in women as compared men, hence are reluctant in the provision of preventive measures for women as they could do to men.
Research Question and Hypotheses
The research question for the study is, ‘What are the risk factors associated with hypertension in aging population?’
The hypothesis thus is; hypertension in elderly people in the United States is associated with risk factors such as smoking, obesity diet, lack or decrease exercise and family history.
The study approach that will be used is quantitative, non experimental research. Quantitative research will also be employed in the study. It is worth noting that the approach employs a step by step empirical examination of quantitative attributes as well as phenomenon and their links. Models are then developed with regards to the phenomenon in question.
This approach is the only one that can verify the hypotheses hat are true since the information generated in purely based on a given case study. Additionally, the approach usually generates numerical data. With this, analysis of data has been an easy task. It is the numerical values help researchers to accurately generalize.
The purpose of non-experimental study design is to explain and fully describe the present existing characteristics for this study the risk factors of hypertension. Quantitative study design is a flexible tool that can be easily manipulated o fit the study purpose. Additionally it yields quantitative data which are easy to analyze (Polit & Beck, 2007:242).
Variables and Definitions
The major variables are risk factors and hypertension. According to Ostchega et al., 2007: 23 risk factors have been thought of as variables that are closely linked with an increased risk of suffering from infections or diseases. Hypertension is a health condition in which the normal blood pressure in arteries is considered to be elevated. Hypertension is conceptually defined as a person with B/P > 140/90 and at least taking one hypertensive medication.
To measure this I will ask a question “Have you ever been informed by a doctor on more than two occasions that you have high blood pressure?” another additional question to be asked will be “Are you under medication to lower high blood pressure?” Individuals who will respond yes to these questions will then be considered to be suffering from HP.
The IVs are the risk factors which are increased weight or BMI, diet (high salt, and high fat or cholesterol diet), family history, decrease or lack of exercise, smoking, and alcohol. Body Mass Index has been thought of as “the measure of body fat typically based on height and weight of individuals who are adult” (Fernandez et al. 2008: 1868).
To calculate BMI the weight measured in kilograms is divided by height in m2. The classification of the finding will be by the criteria used by the National Institute of Health and include; less than normal (25.0 kg/m2), overweight (25.0-29.0 kg/m2), and obese (> 30 kg/m2). “Abdominal obesity was defined as a waist circumference >88cm for women and >102 cm for men according to the Adult Treatment Panel III definition” (Van der Niepen & Dupont, 2010:575).
The measurements (weight, waist circumference, and height) will be taken by a trained technician based on a standardized protocol. Additionally, they will be taken three times and an average computed. A portable GPM anthropometer will be used to measure height while weight will be measured using a weighing standard scale and weight circumference will be measured with nylon tape. It is the mean values that will be used in the analysis.
Smoking refers to “the process in which individuals inhale smoke from a burning tobacco that is either encased in pipes, cigarettes or cigar” (Zhaoqing et al., 2010: 6). To measure smoking, I will provide three sets of choices, current, never, and former; this will provide information regarding who are presently smoking, never smoked, and quieted smoking. It is worth noting that there are active and inactive/passive smokers.
The former is of interest since they indulge in smoking cigarettes. In addition to the state of smoking, the study will seek to establish the number of cigarettes one smokes or smoked per day as well as the time is taken to smoking. From such information, it will be possible to compute pack years of those who smoke.
By a pack, this means that one smokes 20 sticks of cigarettes in a day for 12 months. Family history is a situation where we are interested in establishing whether close family members are or have ever suffered from the medical condition being examined. This will be measured by digging in the history to find out the family members who ever suffered from HT (Fernandez et al. 2008: 1863). The question to be as will be “Has any of your family members known to you been told to be hypertensive?” a yes will be considered to a family history of having hypertension problems.
Additionally, consumption of alcohol has been deemed to be a risk factor associated with HT. It will be measured by establishing weekly consumption of alcohol. The choices that will be used to measure this include 0, 1 day a week, 2 days a week, 3 days a week more than 4 days a week. Additionally, the type of drinks will be sought after.
Lack of exercise in this research is defined as not engaging in any physical exercise or vigorous activities at least three times a week in the past year. The question posed for this will be “For the past one year, how many times a week have you participated in a vigorous physical activity?” the choices will be 0, 1, and 2 more than 3.
Consumption of fast food for sake of the project will be considered as a diet with high salt concentration as well as a high level of cholesterol. To measure this independent variable, the respondent will be asked the number of times per week they consume fast food. 0, 1, 2, 3, and more than 4 will be the options to be chosen. Similarly, I will try to estimate the amount of salt taken in foods. “The number of pinches added will be multiplied by 0.37g” (Shailendra et al., 2010: 28)
Additionally, it is worth noting that attributes relating to gender, level of education, marital status, race, income, employment as well as health status will be considered as covariates.
Methodology
Research method
The research methods that will be employed will be quantitative research, nonexperimental. This will play a major role in helping me fully describe present as well as existing events or issues about hypertension. The quantitative approach will ensure that numerical data is collected and can be easily analyzed for inferences to be made (Polit & Beck, 2007:142).
Research design
The research design that will be employed in my study is retrospective and correlational. With the correlational design, it will be possible for the study to establish the relationship between the risks factors and hypertension.
It is worth noting that a retrogressive study aims at looking back at what happened previously. It is a fast method of studying events that could otherwise take a decade. Additionally, the design is cheap as one needs to acquire existing data and work on it; similarly, such data can be supplemented by asking the subjects about the topic one is investigating.
Because the risk factors being studied take long before their effects are felt, it will be rational to use existing data and probably support the findings with interviews or any other method. The retrospective is looking backward in time to find from the subjects who are elderly with HT as a disease already and finding out the risk factors that lead to the development of such hypertension as a disease. The only problem with the design is that it might be challenging to find out certain information.
Sample
For my study the target population is all elderly; however, the accessible population is the elders from different ethnic groups. Therefore the sample will be a random selection of elderly individuals of a population size of 300 each from African Americans, whites, Latinos, and Caucasians origin.
The main reason for selecting this group of individuals is that they are in a better position to help be me answer the question since they are capable of providing relevant data. Additionally, this will help give a general picture of hypertension in elderly people in America. Individuals of age 60 -85 yrs and above with no clinically diagnosed history of cardiovascular disease (CVD), diabetes, or renal problems will constitute the sample.
Individuals, less than 60 years and over 85 years will be excluded. Additionally, persons with a clinical history of CVD, diabetes, and renal disease will also be excluded.
The sampling strategy used is the quota sampling method. It entails choosing a population, segmenting it into distinct mutual sub-sections. It is worth noting that the segments to be used will be the ethnic grouping; i.e. African Americans, whites, Latinos, and Caucasians origin. The strategy was chosen because the time for the research is limited, a sampling frame is not available and the budget for the research is tight.
Setting
The study will be carried out in two major American states; Texas and New York. The major reason for choosing these two states is due to higher rates of diversity/cosmopolitans. Healthcare facilities that are known to treat heart-related diseases will be targeted to provide the relevant information.
Data collection
Data collection is via survey data collection. It will entail calling doctors and getting a random list of elderly people with Hypertension from different ethnic groups stated above bearing in mind the inclusion and exclusion criteria. Similarly, independent variables such as smoking alcoholism lack of exercise family history diet, increase weight, or BMI. I will measure smoking, alcohol, lack of exercise, and diet by ordinal method, weight, and height by ratio measurements. The dependent variable in the study was hypertension (nominal)
Data Analysis
I will use ANOVA to analyze the collected data. The reason solemnly rests on the fact that there will be four major groups that need to be compared. Additionally, correlation analysis will be carried out to establish the relationship between the risk factors and hypertension. Cross tabulation will be employed to test the most significant risk factor. The significance level is set at p=0.005. With this alpha level, the accuracy level is higher. Data presentation will be done by use of descriptive statistics such as tables, graphs, and figures such as charts (Polit & Beck, 2007: 121).
Mean will be used to describe the age; of the elderly, that hypertension is more pronounced. With mode, I can be able to identify the ethnic group that is more affected by hypertension. Additionally, the range will be used to clearly describe the highest and lowest age of elder people suffering from hypertension.
Limitation of the study
They’re a few limitations in my study with the fact that the research is highly reliable and valid since the sample size, random sample selection among other suggestions were all put in place. Because the research will have factored in the issue of race, history, among others, and that reliability, as well as validity, will be greatly checked, the finding will be able to help bring out a generalized picture of hypertension and associated risk factors not only in America but also in the entire world.
Ethical Considerations
Because the research involves human subjects, there was a need for a high level of ethical consideration to be upheld. Some of the ethical consideration includes the following; the accessible sample populations that will be involved in the study to provide relevant information are to be informed. The reasons for carrying out the survey as well as how they stand to gain from the study will also be brought out clearly.
It is important to note here that the rights and welfare of the participants involved in the study must be protected and guaranteed. To do this, their identities will be kept confidential. Moreover, the information collected while soliciting for data is to be kept confidential and opt not to be used for any other purpose apart from what was initially intended for. Additionally, the information to be provided will be voluntary.
Implication for practice
As previously stated, the research will of paramount importance to nurses, patients among other relevant groups in society. The importance of the study is first linked to pointing out the major risk factors for hypertension. This will help them to re-evaluate lifestyles and adopt the one that will foster their lives.
Similarly, nurses will have a clue on the same factors hence be in a better position in advising patients. Similarly, better strategies will be developed to curb the problem associated with hypertension. Additionally, with the identification of the major risk factors associated with HT, family members of the affected individuals will be in a better position to help the individual overcome certain habits such as smoking, alcoholism, engage in exercise among others.
Additionally, the government through the ministry of health will be able to carry out a public campaign to educate the public about HT risk factors. Lastly and more importantly, the research will lay the ground for further related studies.
References
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Fernandez, S. et al. (2008). “A Senior Center–Based Pilot Trial of the Effect of Lifestyle Intervention on Blood Pressure in Minority Elderly People with Hypertension.” JAGS, 56(1):1860–1866.
Mendoza, M. et al. (2006). “Hyperleptinemia as a Risk Factor for High Blood Pressure in the Elderly.” Arch Pathol Lab Med, 130(1): 170-175.
Ostchega, Y. et al. (2007). “Trends in Hypertension Prevalence, Awareness, Treatment, and Control in Older U.S. Adults: Data from the National Health and Nutrition Examination Survey 1988 to 2004.” JAGS,55(1):1056–1065.
Polit, F. & Beck, C. (2007). Essentials of Nursing Research. 6th edition. Baltimore: Lippincot.
Rodrigues, B. & Borgatto, F. (2010). “Arterial Hypertension in the Elderly of Bridgetown, Barbados: Prevalence and Associated Factors” Journal of Aging and Health22(5): 611–630.
Shailendra, K. et al. (2010). “Hypertension and its correlates in two communities of dissimilar genetic ancestry in Sikkim, India.” Annals of Human Biology, 37(1): 23–43.
Van der Niepen, P. & Dupont, A. (2010). “Improved Blood Pressure Control in Elderly Hypertensive Patients Results of the PAPY-65 Survey.” Drugs Aging,27 (7): 574-588.
Wenyu, et al. (2006). “A longitudinal study of hypertension risk factors and their relation to cardiovascular diseases.” Hypertension, 47(1): 403-409
Wildman, P. et al. (2004). “Lipoprotein Levels Are Associated with Incident Hypertension in Older Adults.” JAGS,52(6): 917-921.
Zhaoqing, S. et al. (2010). “Incidence and Predictors of Hypertension Among Rural Chinese Adults: Results From Liaoning Province.” Annals of Family Medicine, 8(1): 4-7.