Healthand Wellbeing in Older People: Hypertension among the elderly peoplein Singapore
Hypertensionis a chronic health issue involving the primary elevation of systemicblood pressure. Medical professionals also refer to it is high bloodpressure (BP). It is a major issue in the public health agenda ofmost states. Its prevalence in both the developed and developingcountries is high enough to trigger the concern of health promotionstakeholders to take steps in preventing and educating the public onthe way to manage it. According to the World Health Organization(WHO), about one billion people across the globe suffer fromhypertension. The condition is prevalent among the elderly, andaccording to WHO, its occurrence among individuals aged above 55years is between 60-80% (WHO, 2015). Also, the Framingham Heart Studydiscovered that the residual lifetime risks of developinghypertension for individuals edging 80 years for both men and womenis between 93% and 91% respectively (Seow et al., 2015). The highrate of hypertension is the primary contributing factor tocardiovascular diseases, including, stroke, myocardial infarction,health failure and chronic kidney diseases.
Objectivesof the Paper
Thereare gaps identified in addressing the challenge of hypertension. Thepaper aims at identifying the prevalence of hypertension among theelderly in Singapore. It will also identify the gaps in managing highblood pressure among the elderly by comparing it with Australia. Thecountry has a comprehensive health model approach to hypertension. Itwill also outline an intervention health strategy that is consistentwith the needs of this population.
Howthe Project was identified
Theprevious studies by the Ministry of Health have not been inclusive ofdata from all parts of the country. The latest health surveyconducted by the Singapore National Health Survey took place in 2004,and it assessed the prevalence of hypertension among adults aged 70years and below (Seow et al., 2015). The survey can be said to benon-inclusive because as observed by the Framingham Heart Study, therisk of hypertension for individuals edging towards 90 years is 93%in males and 91% in women (Seow et al., 2015). Excluding them fromthe study left a big gap in the conception of measures to address theproblem.
Accordingto the Singapore Ministry of Health, 16.1% of the elderly individualssmoke (Malhotra & Chan, 2010). It is identified by the ministryas one of the highest contributing factors to hypertension. Healthpromotion approach to discourage smoking can significantly reducecomplications for those who already suffer from hypertension. It canalso assist those with early symptoms to keep their condition at bay(Malhotra & Chan, 2010). The rationale for choosing this projectis that it is has worked well in Australia. The Australian HeartFoundation and the Medical Board of Australia attributed reducedsmoking to reduced burden of hypertension (Jafar et al., 2015).According to the Australian Heart Foundation, smoking reduces thecomplications related to hypertension by 2 to 6 times (Head et al.,2012). The discovery was included in the Smoking Cessation in theHypertension Lifestyle Modification Program rolled out in 2008 in thecountry.
Severalother bodies have identified the project as a necessity in Singapore.The Ministry of Health and the Health Promotion Board observe thatthe reduction of smoking among the elderly between 1998 and 2010 wasinsignificant, and it remained fairly constant (Yip et al., 2013).The Health Promotion Board of Singapore also alliterates that smokingcontributes up to 20% of all hypertension cases in old age.
Accordingto WHO, Singapore is an aging country. The population aged 60 yearsand above is currently about 10% (WHO, 2015). By 2030, the populationis expected to double. The big population demands the implementationof health promotion among the population to manage the condition.However, a comprehensive approach to managing hypertension inSingapore is lacking, and it is full of unfulfilled gaps.
Thetarget population is Singapore senior citizens aged 60 years andabove. The population will be identified using the national databasethat maintains the names and social demographic information of thecitizens. The database will assist in sorting out the targetindividuals and their locations. Also, to reach to them, the projectwill also exploit the community health information records to singleout individuals suffering from hypertension. Although smoking startsearly, its effects are more pronounced in individuals withhypertension.
Rationalefor choosing the Population
Therationale for singling out this population is that it endures thebiggest burden of hypertension in the country, and a big percentagedoes not have access to intervention measures (Basu & Millett,2013). According to the WHO, nearly three quarters (73.9%) ofcommunity-dwelling elderly individuals in Singapore suffer fromhypertension. Among this population, a third (30.8%) is unaware thatthey have the condition, and they only manage the symptoms throughself-prescribed methods. Additionally, 32 % of those withhypertension do not receive treatment while 75% live with sub-optimalhypertension (WHO, 2015).
Implementingand promoting hypertension intervention
Accordingto Seow, Subramaniam, Abdin, Vaingankar and Chong (2015), theSingapore Social Isolation, Health, and Lifestyle Survey (SIHLS)(2009) and the Well-being of the Singapore Elderly (WiSE) studiesprovide that 76% of the senior citizens in Singapore are aware thatthey suffer from high blood pressure. Furthermore, the treatmentprevalence for the target group is 95.8% – 98.1%. As such, the beststrategy for implementing the hypertension treatment scheme among theelderly would involve the intensive provision of knowledge regardingthe condition. An active campaign will encourage the old people totake the BP tests in large numbers.
Tai(2013) states that the elderly in Singapore suffer from the stigmaassociated with advanced age. Consequently, they fear seekingassistance concerning both potential health challenges as well asexisting health conditions. Given that, the elderly are unwilling toseek professional counseling to address their hypertension and otherhealth challenges they are vulnerable to, holding regular publictalks in the media can help to deliver the information to them. Tai(2013) cites Ms. Wang Jing, who is one of Tsao Foundation’s seniorcounselors, saying that she has noted a substantial change inattitude among the Singaporean senior citizens. They are presentlyseeking counseling assistance, but in the past, they could not shareabout their health challenges with strangers or people who are notclose to them. Given that some elderly patients, especially, in hardto access regions may still have the stereotype stigma of discussingtheir health challenges with professionals and other people who arenot close to them, increasing broadcasts centering on high bloodpressure control approaches will help in increasing the number ofpatients willing to receive medical assistance.
Thecampaign will also print brochures that will be distributed randomly– in the streets, residential areas and workplaces. Consideringthat old age stigma is a common problem in Singapore, several elderlypatients are still shy to share their personal health information. The social stigma explains the reason 25% of the older people, whoare aware they suffer from hypertension, do not seek medicalassistance (Tai, 2013). Distributing leaflets with information oneffective methods of controlling the disease, as well as, potentialclinics the sick can visit to receive confidential treatment willboost the turnout of patients seeking treatment assistance.
Anothereffective intervention method of providing the elderly withhypertension information is through providing close family memberswith education regarding the disease. Approximately 70% of theelderly people, who could be living in the government welfare homes,or other institutions for the elderly, have lived in anintergenerational home for some time (Leng & Lim, 2012). Thismeans that many family members, whom the elderly can trust with theirconfidential information concerning advanced age, have close contactswith their loved ones at some point. Educating the youths can alsohelp to relay the hypertension knowledge to the elderly living intheir homesteads conveniently. The sessions for educating familiesthat have elderly people should be delivered in local social halls.However, the hypertension therapists will also be visiting theinstitutions for the elderly, where the old are housed, to providethem with education regarding efficient methods of controlling the BPcondition.
Choosingthe meeting rendezvous
Sincea majority of the elderly patients is vulnerable to high bloodpressure, the education regarding the condition will target all theelderly people and public volunteers who are willing to participatein taking care of the senior citizens (Allen, 2008). The campaignerswill also lobby the government and other Non-GovernmentalOrganizations (NGOs) to provide them with test kits that willfacilitate extensive testing for the people who have not yet beentested. Moreover, the campaign will lobby for mobile clinics thatwill make it possible to reach older people living in remote areaswhere they cannot readily access proper medical care.
Liaisingwith other health professionals
Giventhat over 70% of the elderly people, either suffering fromhypertension or are vulnerable to the condition live in proximity totheir relatives, the campaign will invite the public with suchindividuals to attend open forum education (Duke-NUS Medical School,n.d). The public forums will allow health professionals from otherfields to join in the effort to suppress hypertension among theelderly in Singapore. The primary target will be the people who havefirst-hand information with taking care of the old. In return forparticipating in the voluntary programs, the campaign will giveselected participants certificates and employment recommendation inhomecare health institutions involved in providing care to theelderly Singaporeans suffering from high blood pressure.
Theinstructor shall obtain the details of the participants to theworkshop, including, their location. The setting details shall beused to select the most convenient meeting point for the attendants.The instructor shall assess the accessibility of the site to allparticipants. Specifically, the location of the workshop shall be ina clear and accessible locality so that everyone can get at therendezvous conveniently. The instructor shall take into considerationthe availability of electricity, road connectivity as well as thetelecommunication infrastructure. Besides, there is the need toconduct an evaluation of several characteristics of the venueconcerning heating, lighting, electricity, kitchen, and toilets.Besides, the number of parking spaces shall be evaluated to identifysufficiency (Powers, 2013). Theworkshop shall take a maximum of two days for full time attendantswhile part time learners will take a week of intensive education. Routine follow up on the trainee will be conducted through skilledcommunity nurses. Consequently, the instructor shall require twoassistant personnel to help in conducting demonstrations. Besides,the representatives shall perform general administrative work such assetting up the material and equipment for the workshop as well asdistributing the study guides to the participants (Powers, 2013).Therequired equipment for the workshop shall entail writing materialsfor the participants. There is a need to have comfortable chairs anda demonstration table for the instructor. Besides, the presentationrequires a computer, a projector and an LCD screen that will be usedto display the instructor’s notes to the participants. Theinstructor shall also need a flip chart or a black board with markeror chalk (Powers, 2013).Toimprove the level of learning, the instructor shall use dietdemonstrations with real food samples. As a result, displaying foodsamples such as fruits, proteins- beef, bacon beans and cabbages.Besides, heating equipment shall be required to demonstrate the mostappropriate ways to prepare foods for people diagnosed withhypertension (Powers, 2013). Thetraining shall require the course instructor to demonstrate easyphysical exercises to control hypertension. Consequently, there isthe need for a ground mat for the assistants to show the physicalactivities to the participants (Powers, 2013).
Thisproject aims at creating a big network of informed individualsconcerning the hypertension condition. The knowledgeable individualswill help in training the elderly people under their care or thosewho can confide in them, suitable methods for addressing the issue.The primary value of the work will be eliminating the social stigmaabout the old age facing the elderly individuals in Singapore. Secondly, the project intends to increase the number of professionalswith skills for both preventing occurrences for the healthyindividuals, as well as, taking care of the sick. The increasedknowledge will help to expand the knowledge even in remote regionswhere patients have a hard time accessing professional care andpreventative information for blood pressure related problems.
Theproject will establish its efficiency through determining thebehavior change of the targeted population. The goal will beaccomplished through conducting biannual ‘follow up’ survey onthe trained professionals. Each of the recruits will requirecompiling a report of the number of the patients attended, theirattitude towards the service and the willingness to share abouthypertension with strangers.
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