Health behaviors among older adults with hypertension, Brazil, 2006

Dietary guidelines for the elderly in Primary Health Care: development and validation of a protocol based on the Food Guide for the Brazilian Population

Abstract Objective Develop and validate a protocol for the use of the Food Guide for the Brazilian Population (FGBP) in the dietary guidelines for elderly people during individual clinic appointments in Primary Health Care (PHC). Methods The elaboration followed six methodological steps, namely: (1) protocol format definition; (2) definition of the instrument for assessing food consumption; (3) extracting applicable Food Guide recommendations for individual dietary guidelines; (4) evidence systematization on dietary and nutrition needs of the elderly; (5) development of nutritional guidelines messages for the elderly; (6) content and apparent validation and data analysis. Results As products of the steps, the protocol structure was defined and dietary guidelines were elaborated based on the nutritional and health needs of the elderly population, considering the functional capacity and physiological and social changes of this life cycle. The protocol was well assessed by experts and health professionals as to clarity, relevance (content validity index > 0.8) and applicability. In addition, the participants made some suggestions to improve the clarity of the messages and to expand the applicability of the instrument with elderly Brazilians. Conclusion The protocol can contribute to the qualification of dietary guidelines in PHC, dissemination of information from the Food Guide and promotion of comprehensive care and healthy aging of the population.

Orientação alimentar da pessoa idosa na Atenção Primária à Saúde: desenvolvimento e validação de um protocolo baseado no Guia Alimentar para a População Brasileira

Resumo Objetivo Desenvolver e validar um protocolo de uso do Guia Alimentar para a População Brasileira na orientação alimentar da pessoa idosa durante as consultas clínicas individuais na Atenção Primária à Saúde (APS). Métodos Esta construção seguiu seis etapas metodológicas, sendo elas: (1) definição do formato do protocolo; (2) definição do instrumento de avaliação do consumo alimentar dos indivíduos; (3) extração das recomendações do Guia Alimentar aplicáveis para orientação alimentar individual; (4) sistematização de evidências sobre necessidades de alimentação e nutrição da pessoa idosa; (5) desenvolvimento de mensagens de orientação alimentar para a pessoa idosa; (6) validação de conteúdo e aparente e análise dos dados. Resultados Como produtos das etapas, foi definida a estrutura do protocolo e construída as orientações alimentares baseadas nas necessidades nutricionais e de saúde da população idosa, considerando a capacidade funcional e alterações fisiológicas e sociais desse ciclo de vida. O protocolo foi bem avaliado por especialistas e profissionais de saúde nos critérios de clareza, pertinência (Índice de validade de conteúdo >0,8) e aplicabilidade. Além disso, os participantes deram sugestões para melhoria da clareza das mensagens e para ampliar a aplicabilidade do instrumento com pessoas idosas brasileiras. Conclusão O protocolo pode contribuir para qualificação da orientação alimentar na APS, disseminação das informações do Guia Alimentar e promoção do cuidado integral e envelhecimento saudável da população.

Factors associated with the most frequent multimorbidities in Brazilian older adults

This study aimed to identify an association between the most frequent multimorbidities in Brazilian older adults and socioeconomic and lifestyle variables. National Health Survey's data were used. The Chi-square test and the Poisson multiple regression were used to analyze data. A total of 5,575 older adults with multimorbidity and mean age of 70.3 years participated in the study. Most of them are female (66.3%), white (56.1%), are sedentary (75.3%), with low schooling (40%), no health plan (65.3%), did not consume alcohol (78.7%) and did not smoke (90.1%). The most prevalent multimorbidities were hypertension and high cholesterol (31.3%), hypertension and stroke (30.9%) and hypertension and diabetes (23.3%). There was an association of the first condition with females, younger adults and no tobacco use. On the other hand, the second condition was associated with females and low level of schooling. The third group was associated with low schooling, sedentary lifestyle and no tobacco use. We can conclude that multimorbidity in Brazilian older adults is a frequent condition in women, younger seniors and those socioeconomically disadvantaged. Also, socioeconomic conditions and lifestyle influenced the prevalence of primary multimorbidities.

Factors associated with not adopting healthy behavior among hypertensive individuals: a population-based study in Brazil

Adoption of a healthy lifestyle is strongly recommended for the control of hypertension, but professional advice alone does not ensure uptake of healthy behavior. Therefore, this study aimed to investigate the factors-associated with non-adoption of healthy behaviors among individuals with a medical diagnosis of hypertension. It was a cross-sectional study using data from the National Health Survey (PNS) carried out in Brazil in 2013, based on interviews with adults (≥18 years) (n = 60,202). The outcome variable was the non-adoption-two or fewer-of healthy behaviors (regular physical activity, recommended consumption of fruit and vegetables, no excessive alcohol consumption, no smoking, and very low/low salt intake [self-perceived]). A logistic regression model was used to verify the factors-associated with non-adoption of healthy behaviors. Approximately 64% of the study sample did not adopt healthy behaviors, i.e., they adopted two or fewer healthy habits. The most frequently mentioned healthy behaviors were not drinking excessively (91.5%), followed by not smoking (86%). Short time since disease diagnosis (OR = 1.20, 95% CI: 1.01-1.43), not using antihypertensive medication (OR = 1.38, 95% CI: 1.13-1.68), not making regular doctor visits (OR = 1.43, 95% CI: 1.23-1.65), and good self-rated health (OR = 1.16, 95% CI: 1.01-1.36) increased the chance of individuals not adopting healthy behaviors compared with their respective reference categories, independently of gender, age, schooling, and economic status. Counseling strategies should consider patient particularities, and health professionals need to be aware of issues that can interfere with the adoption of healthy behaviors of hypertensive patients.

Health behaviors and hypertension control: the results of ELSI-BRASIL

This study aimed to measure the contribution of selected health behaviors to the prevalence of hypertension control in Brazilian adults 50 years or older, based on data from the ELSI-Brasil study. The study included 4,318 individuals 50 years or older who reported having received a medical diagnosis of hypertension and were taking antihypertensive medication. The selected health behaviors were: physical activity, healthy diet, not consuming excessive alcohol, and never having smoked. The contribution of each health behavior to prevalence of hypertension control was estimated by the attribution method, via adjustment of the binomial additive hazards model, stratified by sex. Prevalence of hypertension control was 50.7% (95%CI: 48.2; 53.1). Overall, health behaviors made a larger contribution to hypertension control in women (66.3%) than in men (36.2%). Moderate alcohol consumption made the largest contribution in both sexes, but particularly in women (52.7% in women versus 19% in men). Physical activity contributed 12.6% in women and 10.7% in men. The other behaviors were more relevant in men: never having smoked (3.4%) and regular consumption of vegetables, legumes, and fruits (3.1%). These results underline the need for measures to promote the adoption of healthy behaviors by hypertensive individuals to reduce blood pressure levels, improve the effectiveness of antihypertensive medication, and decrease their cardiovascular risk.

Prevalência simultânea de hipertensão e diabetes em idosos brasileiros: desigualdades individuais e contextuais

Resumo A prevalência da simultaneidade de doenças específicas nos idosos ainda é pouco descrita na literatura. O objetivo do estudo foi estimar a prevalência simultânea de hipertensão arterial e diabetes mellitus em idosos brasileiros, e os fatores contextuais e individuais a ela associados. Estudo transversal de base populacional com idosos (≥ 60 anos) entrevistados pelo Vigitel em 2012 (n = 10.991). As análises foram realizadas por meio de regressão de Poisson multinível no Stata 12. A média de idade dos idosos foi de 69,4 anos e a prevalência simultânea das doenças foi de 16,2% com variação nas capitais brasileiras. Em São Paulo e Curitiba as prevalências foram mais elevadas do que em Boa Vista e Manaus. Maiores prevalências foram observadas nas capitais das regiões Sul/Sudeste/Centro-Oeste, nos idosos de cor preta e parda, naqueles com escolaridade ≤ 8 anos de estudo, nos não fumantes e ex-fumantes, e com excesso de peso. Verificou-se o efeito da região geográfica na prevalência simultânea pela elevação de 23,5% na magnitude da razão de prevalencia, após ajuste para todas as variáveis individuais. Por meio do estudo, foi possível dimensionar o efeito do contexto onde estão inseridos os idosos (região de residência) sobre a prevalência das principais doenças que acometem e relacionam-se à mortalidade na população idosa na atualidade.

Adequate control of hypertension among older adults: ELSI-Brazil

OBJECTIVE

To estimate the prevalence of adequate control of hypertension among older adults and to examine its association with predisposing and enabling factors and the need to use health services.

METHODS

The analysis was carried out with 4,148 participants (≥ 50 years) from the baseline of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), who reported being hypertensive and using antihypertensive medication. Adequate control of hypertension was defined as systolic and diastolic blood pressure below 140 mmHg and 90 mmHg, respectively. The following exploratory variables were included: age, sex, health behaviors, and body mass index (predisposing factors); region of residence, rural or urban residence, education level, socioeconomic status of the household, and coverage by private health plan (enabling factors); and medical diagnosis of diabetes (need). The multivariate analysis was performed using Poisson regression and binary logistic regression.

RESULTS

The prevalence of adequate control of hypertension was equal to 51.1% (95%CI 48.5-53.6). After adjusting for potential confounders, we observed statistically significant associations (p < 0.05) for education level > 4 years [prevalence ratio (PR) = 1.12 in relation to the lowest level], highest quintile of the socioeconomic status (PR = 1.22 in relation to the lowest quintile), coverage by private health plan (PR = 1.13), residence in the South (PR = 1.19) and Midwest regions (PR = 1.20) in relation to the Southeast region, and obesity (PR = 1.10).

CONCLUSIONS

Half of the population studied had adequate control of hypertension. The improvement of this control is an important challenge, which should consider overcoming social and regional inequalities associated with it.

Predictors of health-promoting behaviour among older adults with hypertension in Indonesia

OBJECTIVES

This study aimed to determine the predictors of health-promoting behaviour among older adults with hypertension in Bengkulu City, Bengkulu, Indonesia.

METHODS

A cross-sectional study was conducted in 333 older adults with hypertension, who were selected using multistage sampling method. Data were obtained by face-to-face interview with structured questionnaires. The questionnaires used in this study included the Health-Promoting Lifestyle Profile II (HPLP II), Hypertension Knowledge-Level Scale (HK-LS), Self-Rated Abilities for Health Practices Scale (SRAHP), Barriers to Health-promoting Behaviour Scales (BAS), Benefits to Health-Promoting Behaviour Scales (BES), Multidimensional Scale of Perceived Social Support (MSPSS) and Situational Influences Questionnaire (SIQ). Data were analysed by using multiple linear regressions.

RESULTS

The mean and standard deviation (Mean ± SD) of each questionnaire were as follows: HPLP II, 2.55 ± 0.19; HK-LS, 11.83 ± 3.00; SRAHP, 2.00 ± 5.87; BAS, 27.89 ± 2.70; BES, 34.29 ± 2.29; MSPSS, 60.35 ± 8.12; and SIQ, 47.71 ± 6.66. According to the multiple linear regression model, 36.9% of the variation in health-promoting behaviour among older adults with hypertension can be explained by six variables, namely, education, knowledge, self-efficacy, perceived barriers, social support and situational influences (adjusted R 2 = 0.369).

CONCLUSIONS

High and good-quality education will increase the level of health-promoting behaviour, whereas barriers, such as expense and time requirement, can decrease it. Situational influences and support from family and friends can also influence the older adult's attempts to change their health behaviour. Increased self-efficacy will clearly result in improved health-promoting behaviour of older adults with hypertension.

Impact of the diagnosis of diabetes and/or hypertension on healthy food consumption indicators: a longitudinal study of elderly persons

Abstract Objective: to evaluate if the prevalence of healthy food consumption indicators among elderly persons with the self-reported diagnosis of diabetes mellitus and/or systemic arterial hypertension (DM and/or SAH) improved after diagnosis of these diseases, and to compare if the prevalence of such indicators was more frequent among elderly persons with DM and/or SAH than in elderly persons without these diseases. Method: a longitudinal study of 1,197 elderly persons aged 60-104 years, living in Florianopolis, Santa Catarina, Brazil, was performed, considering as an outcome the self-reported diagnosis of diabetes and/or hypertension. Healthy consumption indicators (exposures) were considered the maintenance and/or acquisition of the intake of fruit and vegetables ≥3 and ≥2 times/day, respectively, the consumption of fatty meat <2 times/week, and fried foods <2 times/week. Data was analyzed in terms of absolute and relative frequencies, and Poisson Regression was used to obtain the crude and adjusted prevalence of food consumption indicators. Values of p≤0.05 were considered statistically significant. Results: when comparing the prevalences of the indicators of healthy food consumption among elderly persons with DM and/or SAH with those without these diseases, it was observed that only the consumption of fried foods changed positively between the periods 2009-2010 and 2013-2014. This result was statistically significant only for women, with maintaining/acquiring the infrequent consumption of fried foods (<2 times/week) 8.2% higher among elderly women with DM and/or SAH, p=0.043. Conclusion: The prevalence of healthy food consumption indicators was low and there was almost no difference between older adults with and without DM and/or SAH.

Association of hypertension-related distress with lack of self-care among hypertensive patients

Research on factors associated with poor adherence to self-care focuses primarily on psychiatric emotional disorders such as depression and anxiety, whereas non-psychiatric chronic-disease-related emotional distress has received little attention in hypertensive patients. The objective of this study was to evaluate the association of hypertension-related distress with the lack of self-care including low adherence to pharmacological treatment, lack of regular physical activity, low intake of fruits and vegetables and frequent intake of high-salt foods. A cross-sectional survey was conducted in 2014 in two family medical units affiliated with the Mexican Institute of Social Security. The study included 487 hypertensive patients >19 years of age. The conceptual framework for the study was based on the Health Promotion Model. The analysis included multiple Poisson regression models. We found that 21.1% of participants had hypertension-related distress. Low adherence to pharmacological treatment was identified in 45.8% of patients, whereas 46.8% lacked regular physical activity, 30.8% reported a low consumption of fruits and vegetables, and 54.6% frequently consumed foods high in salt content. Hypertension-related distress was associated with lack of regular physical activity and low intake of fruits and vegetables. These findings highlight the importance of addressing distress in order to improve self-care of hypertensive patients.

Socio-demographic caracteristics and prevalence of risk factors in a hypertensive and diabetics population: a cross-sectional study in primary health care in Brazil

BACKGROUND

Systemic arterial hypertension and diabetes mellitus, and their related morbidity and mortality, are currently the most common public health problems and also a higher burden of disease in Brazil. They represent a real challenge for primary health care. This study describes the methodology and baseline data of an adult population with hypertension and diabetes attending in primary health care.

METHODS

It is a cross sectional study which presents data from a longitudinal research. 3784 adults were randomly selected from the registry of a health service in Porto Alegre, Brazil. The eligibility criteria were: confirmed diagnosis of hypertension and/or diabetes, consulted at least once in the prior 3 years and 18 years of age or older. Home data collection consisted of a questionnaire with information on demographic, medical history, life style and socio-economic factors.

RESULTS

A total of 2482 users were interviewed (response rate of 71 %). The median age was 64 (IQR = 55.7) and the majority were women (68 %), and married (52 %). Whereas 66.5 % (CI 95 % 64.5-68.3) of the sample had only hypertension, 6.5 % (CI 95 % 5.5-7.5) had diabetes and 27.1 % (CI 95 % 25.3-28.8) had both diseases. The prevalence of diseases increased with age and with fewer years of study (p < 0.05). Subjects with both diseases had significantly more associated comorbidities.

CONCLUSIONS

Hypertension and diabetes are more prevalent in older individuals, especially women, and less educated people. People suffering with both chronic conditions simultaneously are more likely to have additional comorbidities.

Factors associated with hypertension prevalence, awareness, treatment and control among participants in the International Mobility in Aging Study (IMIAS)

The aim of this study is to assess the factors associated with hypertension prevalence, awareness, treatment, and control, in the elderly populations of the International Mobility in Aging Study (IMIAS). Approximately 200 men and 200 women aged 65-74 years were recruited at each site (n=1995) during IMIAS' 2012 baseline survey at five cities: Kingston (Canada), Saint-Hyacinthe (Canada), Tirana (Albania), Manizales (Colombia) and Natal (Brazil). Blood pressure and anthropometric measurements were taken at participants' homes. Hypertension prevalence ranged from 53.4% in Saint-Hyacinthe to 83.5% in Tirana. Diabetes and obesity were identified as risk factors in all cities. More than two-thirds of hypertensive participants were aware of their condition (from 67.3% in Saint-Hyacinthe to 85.4% in Tirana); women were more aware than men. Awareness was positively associated with diabetes in Kingston, Manizales and Natal. Though most of those aware of their hypertensive condition were being treated pharmacologically, associations between awareness and physical activity and refraining from smoking were weak. Control among treated hypertensive participants was low, especially in Tirana and Natal. Diabetes and physical inactivity were associated with poor hypertension control. Hypertension is common in the older populations of IMIAS. Diabetes is strongly associated with hypertension prevalence, awareness and lack of control of hypertension. The fact that awareness is not strongly associated with healthy behaviours suggests that antihypertensive medication is not accompanied by non-pharmacological therapies. Improved health behaviours could strengthen hypertension control. Efforts should be made to increase men's awareness of hypertension. Hypertension control in diabetic patients is a challenge.

Hypertension and associated factors in older adults in South Africa

BACKGROUND

Older adults are disproportionately affected by hypertension, which is an established risk factor for cardiovascular disease. Little attention has been focused on hypertension and associated factors among older adults in Africa. Therefore, this study aimed to investigate the prevalence and associated factors of hypertension in a national sample of older South Africans who participated in the Study of Global Ageing and Adults' Health (SAGE) in 2008.

METHODS

In 2008 we conducted a national, population-based, cross-sectional study of a sample of 3 840 subjects aged 50 years or older in South Africa. The questionnaire included socio-demographic characteristics, health variables, and anthropometric and blood pressure measurements.

RESULTS

The prevalence of hypertension in the sample population was 77.3% (male 74.4%, female 79.6%). The rates of awareness, treatment and control among the hypertensive participants were 38.1, 32.7 and 17.1%, respectively. The results of multivariate logistic regression analysis revealed that the prevalence of hypertension was associated with being in the Coloured population group, having had a stroke, being overweight or obese and having had five or more out-patients care visits in the past 12 months. Hypertension was inversely associated with current alcohol use.

CONCLUSION

This study revealed high rates of hypertension among older adults (50 years and more) in South Africa, which puts them at risk for cardiovascular disease. The percentages of hypertensive subjects who were aware, treated and controlled were very low. These data underscore the urgent need to strengthen the public health education and blood pressure-monitoring systems to better manage hypertension among older adults in South Africa.

Prevalência e fatores associados à hipertensão arterial em idosos de municípios da Amazônia Legal, MT

Este estudo teve como objetivo analisar as características epidemiológicas da hipertensão arterial e os fatores associados na população idosa residente nos municípios da Amazônia Legal no Estado de Mato Grosso - Alta Floresta, Sinop, Sorriso e Diamantino. Trata-se de estudo transversal, de base populacional, realizado por meio de inquérito domiciliar com 312 idosos. A amostra da pesquisa foi obtida por amostragem complexa. Consideraram-se hipertensos aqueles que apresentaram pressão arterial >140/90mmHg e/ou que referiram uso de medicação anti-hipertensiva. A análise de regressão de Poisson foi utilizada para testar a associação entre a hipertensão e as variáveis independentes. A prevalência da hipertensão foi de 67,4%. As variáveis associadas à hipertensão nos homens foram situação conjugal (p=0,012) e índice de massa corporal (p=0,025). Já entre as mulheres, foram faixa etária (p=0,026), tabagismo (p=0,030) e índice de massa corporal (p=0,034). Entre os idosos, observou-se que 78,3% tinham conhecimento de sua condição de hipertenso; destes, 97,7% estavam em tratamento. Entre os que estavam em tratamento, apenas 43,7% apresentavam sua pressão arterial controlada. A alta prevalência da hipertensão, a associação a fatores de risco cardiovascular, assim como o baixo percentual de idosos com pressão arterial controlada, reforçam a necessidade de implementar políticas públicas, visando a ações de prevenção, controle e promoção da saúde da população idosa.

Adesão ao tratamento farmacológico e não farmacológico e fatores associados na atenção primária da hipertensão arterial

Com o objetivo de determinar a adesão aos tratamentos farmacológico e não farmacológico da hipertensão arterial na atenção primária e identificar fatores associados, realizou-se estudo transversal com 385 hipertensos de 20 a 79 anos cadastrados em uma unidade de saúde da família de Londrina, Paraná. A adesão ao tratamento farmacológico foi de 59,0%. A atividade física regular foi relatada por 68 (17,7%) hipertensos, enquanto 266 (69,1%) referiram mudanças da alimentação. Na análise de regressão múltipla, associaram-se à adesão ao tratamento farmacológico: maior idade (50 a 79 anos), ter recebido ao menos uma consulta ao ano, não ingestão regular de bebidas alcoólicas e infarto prévio. Hipertensos do sexo masculino, com escolaridade igual ou superior à 4ª série, que receberam pelo menos uma consulta ao ano, com diabetes e sem relato de colesterol elevado mostraram-se mais aderentes à atividade física regular. A realização de dieta associou-se à escolaridade inferior à 4ª série e ao fato de ter recebido no mínimo uma consulta ao ano. Tais resultados demonstram níveis variados de adesão ao tratamento e evidenciam a importância de ações integrais na atenção ao hipertenso.

Perfil dos hipertensos da Unidade de Saúde da Família Cidade Nova 8, município de Ananindeua-PA

A Hipertensão Arterial é um grave problema de saúde pública pela sua alta prevalência e morbimortalidade. Neste sentido, medidaspreventivas e corretivas são essenciais para o controle de agravos. Esta pesquisa teve como objetivo caracterizar o perfil clínicoepidemiológicodos hipertensos cadastrados em uma Unidade de Saúde da Família do município de Ananindeua, Pará. O estudo foi do tipoobservacional, transversal, descritivo e de natureza quantitativa. A coleta de dados foi realizada por meio da aplicação de um questionárioem visitas domiciliares. A amostra foi de 124 hipertensos, sendo 70,16% idosos (idade média de 64,9 anos); 66,13% mulheres; 54,84%casados; 77,42% pardos; 39,52% possuem o ensino fundamental incompleto; 34,68% pertencem à segmentação econômica C2,equivalente a R$ 933,00; 34,68% estavam com a pressão controlada. Entre os problemas de saúde relatados, destacam-se inchaço/dores nas pernas (41,13%); diabetes (33,06%); dislipidemia (33,06%). O IMC médio foi de 27,84, e observou-se associação significativaentre tabagismo e aumento dos níveis de pressão arterial. Os resultados sugerem a necessidade de se implementar ações de promoçãoà saúde, direcionadas para a educação na prevenção dos fatores de risco.

Energy expenditure through physical activity in a population of community-dwelling Brazilian elderly: cross-sectional evidences from the Bambuí cohort study of aging

The aim of this study was to estimate physical activity energy expenditure among older adults. The study comprised 1,585 residents in Bambuí, Minas Gerais State, Brazil, aged > 60 years (91% of the town's total elderly), and examined the frequency and duration of 23 types of physical activity among them. Median energy expenditure was 975 MET.min/week (1,195.8 among men and 803.1 among women), declining significantly with age in both sexes. The prevalence of sedentary lifestyles (< 450 MET.min/week) was 31.2%. Unhurried walking accounted for about 1/3 of total energy expenditure. Multivariate analysis based on ordinal logistic regression showed inverse associations between energy expenditure and age and hospitalizations in both sexes. Among men, inverse associations were observed with smoking, number of chronic diseases and number of medical appointments. These results emphasize the need for effective strategies to increase physical activity in older elderly, and underscore the high prevalence of walking in this group.