How May Coexisting Frailty Influence Adherence to Treatment in Elderly Hypertensive Patients?

Abstract

Background Hypertension is considered to be the most common condition in the general population. It is the most important risk factor for premature deaths in the world. Treatment compliance at every stage is a condition for successful antihypertensive therapy, and improving the effectiveness of treatment is a major goal in preventing cardiovascular incidents. Treatment noncompliance and lack of cooperation stem from numerous problems of older age, including frailty syndrome. Objective To evaluate the effect of frailty syndrome on treatment compliance in older patients with hypertension. Methods The study sample consisted of 160 patients (91 women, 69 men) with hypertension aged 65 to 78 (mean = 72.09, SD = 7.98 years), hospitalized at the University Clinical Hospital due to exacerbation of disease symptoms. Standardised research tools were used: the Tilburg Frailty Indicator questionnaire and the questionnaire for the assessment of treatment compliance in patients with hypertension, the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Results Frailty syndrome was diagnosed in 65.62% of patients: 35.62% with mild, 29.38% with moderate, and 0.62% with severe frailty. The treatment compliance was 36.14%. The prevalence of the FS and its three components (physical, psychological, social) significantly affected (p <0.05) the global score of the Hill-Bone Compliance to High Blood Pressure Therapy Scale and all subscales: “reduced sodium intake”, “appointment keeping”, and “antihypertensive medication taking”. Conclusions The coexistence of frailty syndrome has a negative impact on the compliance of older patients with hypertension. Diagnosis of frailty and of the associated difficulties in adhering to treatment may allow for targeting the older patients with a poorer prognosis and at risk of complications from untreated or undertreated hypertension and for planning interventions to improve hypertension control.

Evaluation of Frailty Syndrome and Adherence to Recommendations in Elderly Patients with Hypertension

“…To date, studies have shown that the median therapeutic adherence to antihypertensive therapy is 55.3% [35]. In the present study, the mean Hill-Bone adherence score was 20.51, which coincides with the results by Uchmanowicz et al [33] and Chudiak et al [34]. However, among hypertension patients living in Palestine the average score on the Hill-Hill-Bone scale was 24.9, which implies a lower adherence rate in comparison with the above studies [36].…”

“…A meta-analysis by Vetrano et al [31] showed that among patients with hypertension, 14% also have frailty syndrome, while frailty syndrome occurs in 46.5% of people over 65 with hypertension [32]. In fact, the most significant component of frailty syndrome turned out to be the physical component [28], which is consistent with the recent findings by Uchmanowicz et al [33]. In contrast, the study by Chudiak et al [34] suggested that for older hypertensive patients the social component of frailty played the most significant role, more likely resulting from poor fitness and diminished everyday life independence.…”

“…In contrast, the study of Jankowska-Polańska et al [39] showed that frailty negatively affected adherence in elderly hypertensive patients, and lower adherence to the recommendations was diagnosed more often in frail patients than in nonfrail patients [40]. The study by Uchmanowicz et al [33] showed a correlation between the frailty domains (physical, psychological, and social) and adherence to therapeutic recommendations in the aspect of "reduced sodium intake," "appointment-keeping," and "medication-taking." In contrast, Chudiak et al [34] demonstrated that TFI scores correlated with the global HBCS score (r = 0.509, p < 0.001) and two subscales: "appointment-keeping" (r = 0.34, p < 0.001) and "medication-taking" (r = 0.537, p < 0.001).…”

Prevalence and associated factors for frailty among elder patients in China: a multicentre cross-sectional study

“…The prevalence of frailty in community samples ranges from 6 to 11.1% [8][9][10]. Inpatients have a higher prevalence of frailty, ranging from 25 to 65.62% [11,12].…”

Prevalence and Associated Factors for Frailty among Elder Patients in China: A multicenter cross-sectional study

“…The prevalence of frailty in community samples ranges from 6% to 11.1% [9][10][11]. Inpatients have a higher prevalence of frailty, ranging from 25% to 65.62% [12,13].…”