The asymptomatic nature of hypertension creates complexity when it comes to adhering to medication, especially in older people, where a high level of hypertension patients exist.

Anti-hypertensive medications are central to controlling blood pressure yet, as one study pointed out,“despite advances in management, poor adherence to antihypertensive medications is often reported as the major reason [that limits] treatment efficacy.“

As we will see, there are several reasons for medication non-adherence. Equally important, however, is what can be done to increase it. This, in our view, is where home health care measures can make a decisive difference.

Looking more closely at non-adherence to hypertension medication

In a 2016 study of older people with hypertension*, only 44% of participants were considered compliant with medication plans.

More than 50% reported forgetting to take such medication – yet only 11.3% perceived “problems in remembering” to take their meds. This may indicate that 1. Short term memory loss or dementia may interfere with adherence or 2. Older hypertension patients tend to marginalize or ignore the role of anti-hypertensive medication. Note: The complexity of multiple prescriptions certainly plays a role in non-adherence.

Another interesting aspect of this study was the role of patient satisfaction in medication adherence. “Satisfaction with quality of contact with healthcare professionals…during consultations may play a vital part in how they assimilate or make sense of professional advice and thus influence their medication adherence,” said the report. “Older adults who were satisfied with…the behavior of healthcare professionals might perceive adherence as an important self-care task.” In other words, engaging the patient - rather than simply managing him or her - may increase medication adherence.

Prescription Bottle

Hypertension diet compliance with and without counseling support

44 percentage

A 2016 Journal of Cardiovascular Nursing study of older people with hypertension indicated that only 44% of participants adhered to medication plans. Other data points showed that non-compliance was not related to change in their physical condition. In our experience, older patients need to be monitored for short term memory loss or the onset or escalation of dementia. In-home care to manage medications and support caregivers is an effective response.

Hypertension medication hazards: Anticipating side effects

A 2016 entry in Aging Research Reviews called “Hypertension and Aging” points out that “the use of antihypertensive drugs…has been commonly proposed as a risk factor for falls and fractures [and] can produce significant hypotension in older adults which may threaten cerebral perfusion thereby causing dizziness, syncope, and falls.”

Other medication side effects add more variables in getting hypertension patients to be medication-adherent. Weakness, dizziness, fainting and fatigue lead the list. They are joined by erectile dysfunction (beta blockers), leg swelling (from some calcium channel blockers), dry cough (ACE inhibitors), and frequent urination (diuretics).

Research continues to investigate other consequences of anti-hypertensive medications, including increased risk of stroke and fractures (due to bone loss).

Making it easier: 3 ways home healthcare services can help

Keeping meds organized and simplified.

The majority of hypertension patients require more than one medication. Since elevating the dose of a single medication may produce side effects, physicians often add 1-2 more medications to join the first at lower dosages. Patients tend to dislike pill splitters, so home healthcare providers can have a significant impact on patient health by managing, storing, and administering meds.

NOTE: Single-pill (aka fixed dose) solutions are being embraced by doctors, and this approach has been shown to boost medication adherence. But in 2017,fixed-dose combinations represented only 12% of all blood pressure medication prescriptions in the U.S.

MONITORING BP

“Nurse-led hypertension management has been demonstrated to result in greater rates of BP control than those achieved with standard care,” reports the Annals of Global health (2016). “These improved outcomes have resulted from nurses placing a greater number of patients on medications,” the study says, “altering drug regimens in response to inadequate BP control, and placing a higher proportion of patients on multiple drug regimens to achieve greater control.”

PATIENT ENGAGEMENT AND COACHING

The Annals of Global Health study referred to above, entitled “Expanding the Role of Nurses to Improve Hypertension Care and Control Globally,” adds that within the practice of BP monitoring, RNs and nurse practitioners also provide education and encouragement.

This is a common practice within SeniorBridge.

* Disclosure: The research stated: “There are some limitations to this study. First, the measurement of medication adherence was based solely on self-reported responses to questionnaires. The results may be subjected to recall bias and social desirability bias especially when it comes to sensitive questions such as medication adherence.”

The integrated care management model by SeniorBridge

Home care services vary widely in the services they provide.

SeniorBridge offers an integrated care management practice model that involves two components:

  1. Clinical care (under the direction of an RNCM/Registered Nurse Care Manager) supported by a Social Worker and a team of caregivers, based on patient’s needs and
  2. A portfolio of home care services and geriatric care management in such areas as nutrition, caregiver education, benefit coordination, transportation, and coordination with discharge planners, physicians, pharmacy, home health agencies, and care managers.

NOTE: We have full COVID-19 safety protocols in place to keep clients, families and associates safe.

For more information on hypertension home care support services, contact SeniorBridge.

Sources consulted:
National Library of Medicine /NIH/Dialogues in Clinical Neuroscience (2009)
Taylor Francis/

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