Psychosocial Support as Predictors of Mental Wellbeing Among Hypertensive Elderly Persons in Wuro-Sembe Area of Jalingo Local Government Area Taraba State
Chapter One
General objective
To assess the psychosocial support as predictors of mental wellbeing among hypertensive elderly persons in Wuro-sembe Area of Jalingo Local Government Area Taraba State in order to provide information that will help guide interventions to improve their health related quality of life.
Specific objectives
- To assess the relationship between socio-demographic characteristics, psychological well-being and blood pressure control among the participants.
- To compare the family support of the elderly with blood pressure control.
- To compare the psychological well-being of the elderly with blood pressure control.
- To evaluate the association between family support and psychological well-being amongst participants.
- To assess the association between morbidity pattern and blood pressure control.
CHAPTER TWO
LITERATURE REVIEW
Hypertension
Epidemiology
Hypertension is a chronic medical disease of immerse public health concern. The prevalence and morbidity of hypertension is greater among older adults who often have multiple comorbidities.5, 6 It is the leading cause of cardiovascular disease (CVD) world-wide. In the year 2000, 972 million people were living with hypertension. This number was predicted to increase by about 60% to a total of 1.56 billion by the year 2025.26 It is one of the most controllable chronic conditions and adults with it are more likely to have other chronic conditions. It was also ranked third as a cause of disability adjusted life years (DALYS) and in various studies on the average, blacks had higher blood pressure than non-blacks.26
World-wide data on the prevalence of hypertension varies from one region to another and has been on the increase over the past three decades according to WHO world health day report in 2013. The population of hypertensives globally rose from 600 million in 1980 to 1 billion in 2008.33 On the average in the African region it was 46%, 41% in Eastern Mediterranean region, 40% in Europe, 38% in Western pacific region, 37% in South East Asia and 35% in America.33 The increasing prevalence of hypertension was attributed to population growth, ageing and behavioural risk factors, such as unhealthy diet, harmful use of alcohol, lack of physical activity, excess weight and exposure to persistent stress.33
A systematic review of population based studies on hypertension in sub-Saharan Africa (SSA) published between 1975 and 2006 showed a rising prevalence that varied within urban and rural communities, with higher prevalence of hypertension in urban settings.34 The results were variable because the included studies that defined hypertension either with WHO criteria (≥160/95mmHg) or the seventh Joint National Committee on Prevention, Detection, Evaluation and Treatment of high blood pressure (JNC-7) criteria (≥ 140/90mmHg). The studies were also carried over a varied number of years (span was 31 years). Overall prevalence of hypertension in urban communities in Ghana was 29.4% (in 2004), Cameroon 24.6% (in 2003), Southern Africa 24.4% (in 1998), Gambia 18.4% (in 1997) and Nigeria was 18.2% (in 1999) using the JNC-7 criteria.34 In another systematic review, the overall prevalence of hypertension in sub-Saharan Africa was estimated at 16.2% with an estimated number of individuals with hypertension to be 74.7 million.35
In Nigeria, the overall prevalence of hypertension ranged from 8% – 46.4% over a five decade period (1970-2011). The variation in prevalence occurred because of differences in the study target population, type of measurement and cut-off value used for defining hypertension.36 A rising trend of the pooled prevalence was observed from 15% in 1990-1999 to 22.5% in 20002009. The prevalence also varied across the geopolitical zones in Nigeria with 20.8% in Southwest, 20.2% in the South-south, 30.0% in South-east, 27.1% in North-central, 40.0% in Northeast and 25.7% in North-west between 2008 and 2011. Nigerian geopolitical zones vary in cultural, dietary and lifestyle practices which have different effects on blood pressure levels. In all the studies, the prevalence of hypertension increased with age, and it was higher in males than in females.36
Patho-physiology and Pathogenesis of hypertension
Well documented factors in pathogenesis of hypertension are atherosclerosis, salt intake, obesity and insulin resistance, the renin-angiotensin system and the sympathetic nervous system.37 In the past few years, a number of other factors have been evaluated, including genetics, endothelial dysfunction, low birth weight, and neurovascular anomalies.37
Atherosclerosis
As an individual ages, so does the vascular system. Atherosclerosis begins in childhood with the development of fatty streaks. The advanced lesions of atherosclerosis occur with increasing frequency with aging. Due to vascular remodelling, there is alteration in structure, mechanical properties and function of small arteries and resultant narrowing of vessel lumen. The resultant arterial stiffness and high peripheral resistance plays a major role in hypertension as the individual ages.38 Some unique ageing changes in the nitric oxide and angiotensin II pathways are particularly important for vascular ageing.39
CHAPTER THREE
METHODOLOGY
Study site description
The study on the psychosocial support as predictors of mental wellbeing among hypertensive elderly persons was carried out in Wuro-sembe Area of Jalingo Local Government Area Taraba State. The study was conducted in the Specialist hospital Wuro-sembe.
Study population
This consisted of elderly patients 60 years and older with established hypertension for at least one year duration irrespective of where treatment was being received before enrolment at Specialist hospital Wuro-sembe. The age of the respondents were determined by direct recall, age at marriage, age of first child and use of the table of historical events.137
Study design
The study was a cross sectional comparative survey over three months. The relationship between psychological well-being, perceived social support and blood pressure control was examined. Controlled blood pressure was taken as average of blood pressure readings of systolic < 140 mmHg and diastolic < 90 mmHg. Enrolment took place between 1st February and 30th April 2020.
Sample size estimation
The sample size was calculated using the formula for comparison of two groups at a single time point (two sided).138 The proportion of adults with controlled systolic and diastolic blood pressure in South-west Nigeria is 31.4%.139
N = [Z1-α/2 {2p (1-p)} + Z1- β {p1 (1-p1) + p2 (1-p2)}]2/ (p1- p2)2 N = sample size p1 = proportion with controlled blood pressure (31.4%).
CHAPTER FOUR
RESULTS
A total of 400 respondents were recruited for the study. The characteristics of the respondents, blood pressure control, family support and psychological well-being are presented in this chapter.
CHARACTERISTICS OF RESPONDENTS
Socio-demographic characteristics
Table 1a shows the socio-demographic characteristics of the study respondents. The majority of participants in this study were females (65.8%) and there is a male: female ratio of 1:2. The age range of the participants was 60 to 95 years, with a mean age of 70.5 ± 6.8 years. Majority of the respondents (75.8%) were within the young-old age group while only (4.2%) were in the oldest old group. Majority of the participants (67.5%) had formal education. Majority were
Christians (65.7%) and Yoruba (93.7%). Most of the respondents were currently married (56.0%) followed by those widowed (37.5%) as at the time of study.
Majority of the participants (66.0%) were not actively engaged in any job. Most of the respondents were in the unskilled social class (24.0%) followed by skilled (6.8%) as at time of study.
CHAPTER FIVE
DISCUSSION, CONCLUSION AND RECOMMENDATIONS
This study showed the Psychosocial support as predictors of mental wellbeing among hypertensive elderly person’s in Wuro-sembe Area of Jalingo Local Government Area Taraba State. Majority of the elderly hypertensive elderly persons had strong/good perceived family support (95.8%) and good psychological wellbeing (84.5%), but both were not statistically related to blood pressure control.
This study also highlighted co-morbidities and clinical profile of the respondents, and their association with blood pressure control.
Socio-demographic characteristics of respondents
The ages of the respondents in the study ranged between 60 – 92 years and the mean age was 70.5 ± 6.8 years. The majority of them (75.8%) were in the young-old age group (60 -74 years) of the elderly. This finding is similar to an average group of 67.8 ± 7.1 years and 70.8 ± 8.1 years found by Adebusoye and Abegunde in South-western Nigeria._ENREF_1125, 7 Similar average age of elderly ranging from 60 to 80 years was found in studies from other parts of Nigeria and West Africa.150, 151 This age group constitute a higher proportion of the elderly in the population record in Nigeria.136
There was a female preponderance in this study (65.8%). This was consistent with findings in other studies on the elderly in Nigeria that had shown 65.2% female preponderance.31, 150 The higher number of female respondents in the study may be a reflection of higher health seeking behaviour and increase in clinic attendance of females than males in this environment.5 Also higher life expectancy has been found in women than men.152 This female preponderance could be associated with possible early deaths in men as a result of risky lifestyle behaviours, cardiovascular diseases and stroke.152 _ENREF_118
Literacy level was low in the study respondents. About three quarters of the respondents (72.7%) had less than tertiary level of education. The National Population Commission of Nigeria (2006 census) also recorded high illiteracy levels in the elderly as well as a female preponderance of illiteracy.153 This is consistent with other studies in this age group in Nigeria, and West Africa.105, 115 _ENREF_82This high illiteracy rate may be due to the low priority given to formal education in the emerging phase of westernization during the early decades of this generation.115
Majority of the respondents in this study were currently married (56.0%), which was similar to the findings of Ibitoye et al. in a study of the psychological well-being of elderly in Nigeria.150 This may be as a result of the cultural and societal value attached to marital status in this environment. It is worthy of note that 37.5% were widows and widowers, similar to 34% reported by Adebusoye et al. on elderly in Nigeria.5
CONCLUSIONS
In this study, majority of the elderly attending the C.T.A.G.C, U.C.H were young-olds and unemployed (dependent). Majority of the elderly hypertensive elderly persons attending the
C.T.A.G.C, U.C.H have strong perceived family support and good psychological well-being. However, the perceived social support and psychological well-being of the respondents were not found to directly affect the blood pressure control.
Predictors of good psychological well-being are being married in monogamous family, with less than 40 years of marriage, having small household size, formal education, receiving financial support and cumulative monthly income above poverty line.
Majority of the elderly hypertensive elderly persons have a mean of two additional comorbidities. Osteoarthritis was more in respondents with uncontrolled blood pressure, while refractive error was more in respondents with controlled blood pressure.
Majority of the patients were using two or more antihypertensive medications to achieve their target blood pressure. A quarter of their median cumulative monthly income was spent on medications. The predictors of blood pressure control in this study were spending over N2,500.00 on medications monthly, body weight and refractive error.
RECOMMENDATIONS
- Further studies need to be conducted in this environment to find the association between various types of family support received by the elderly and their quality of life. The substantial burden of hypertension in the elderly and on the health care system calls for more review.
- The provision of poverty alleviation programs for the elderly would help to reduce financial strain on their family care providers and ultimately improvement in elderly quality of care. A substantial amount of the monthly income of the elderly patient is spent on antihypertensive medications monthly. Therefore, subsidization of cost of hypertension drugs in the country will reduce the burden on the elderly lean economic pocket.
LIMITATIONS OF THE STUDY
This was a cross-sectional study and as such inferences on the observed associations cannot be strongly drawn. It was a clinic-based urban study; the study sample is only representative of elderly hypertensive elderly persons attending a Geriatric clinic which may not necessarily be a complete reflection of the real picture in the general populace. The family support scale used had minimal variable options for the elderly and may have over-estimated their response when viewed based on social desirability bias.
STRENGTHS OF THE STUDY
This study has added the following to the existing body of knowledge:
It described the perceived family support and psychological well-being of elderly hypertensive elderly persons attending a primary care setting in Jalingo South-western Nigeria. The literature on psychological well-being of the elderly is scarce in Jalingo, Nigeria.
This study also adds to the existing body of knowledge of hypertension and medication adherence of hypertensive elderly persons attending a geriatric care centre.
This study adds to the body of knowledge of the effects of co-morbidities in elderly hypertensive elderly persons.
REFERENCES
- United Nations. World Population Aging 2013 [Accessed 24-04-2013]. Available from:http://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulatio nAgeing2013.pdf.
- World Health Organization. Definition of an older or elderly person: Proposed working definition of an older person in Africa for the MDS project 2012 [Accessed 10-02-2013]. Available from: http://www.who.int/healthinfo/survey/ageingdefnolder/en/.
- Isiugo-Abanihe UC. The Demography and Sociology of Ageing: Implications for Nigeria. Nig J Sociol and Anthropol. 2020;12(1):1-8.
- United Nations, division P. World population prospect: the 2002 revision;World urbanization prospects: the 2001 revision. 10 February, 2005.
- Adebusoye LA, Ladipo MM, Owoaje ET, Ogunbode AM. Morbidity pattern amongst elderly patients presenting at a primary care clinic in Nigeria. Afri J Pri Health Care & Fam Med. 2011;3(1):11-5.
- Hajjar I, Kotchen JM, Kotchen TA. Hypertension: Trends in Prevalence, Incidence, and Control. Annual Review of Public Health. 2006;27(1):465-90.
- Abegunde KA, Owoaje ET. Health problems and associated risk factors in selected urban and rural elderly population groups of South-West Nigeria. Ann Afr Med. 2013;12(2):90-7.
- World Health Organization, International Society of Hypertension writing group. 2003 World Health Organization (WHO)/ International Society of Hypertension (ISH) statement on management of hypertension. J Hypertens. 2003. 21(11):1983-92.