Abstract: Hypertension is both a health problem and a financial one globally. It affects nearly 30 % of the general population. Elderly people, aged ≥65 years, are a special group of hypertensive patients. In this group, the overall prevalence of the disease reaches 60 %, rising to 70 % in those aged ≥80 years. In the elderly population, isolated systolic hypertension is quite common. High systolic blood pressure is associated with an increased risk of cardiovascular disease, cerebrovascular disease, peripheral artery disease, cognitive impairment and kidney disease. Considering the physiological changes resulting from ageing alongside multiple comorbidities, treatment of hypertension in elderly patients poses a significant challenge to treatment teams. Progressive disability with regard to the activities of daily life, more frequent hospitalisations and low quality of life are often seen in elderly patients. There is discussion in the literature regarding frailty syndrome associated with old age. Frailty is understood to involve decreased resistance to stressors, depleted adaptive and physiological reserves of a number of organs, endocrine dysregulation and immune dysfunction. The primary dilemma concerning frailty is whether it should only be defined on the basis of physical factors, or whether psychological and social factors should also be included. Proper nutrition and motor rehabilitation should be prioritised in care for frail patients. The risk of orthostatic hypotension is a significant issue in elderly patients. It results from an autonomic nervous system dysfunction and involves maladjustment of the cardiovascular system to sudden changes in the position of the body. Other significant issues in elderly patients include polypharmacy, increased risk of falls and cognitive impairment. Chronic diseases, including hypertension, deteriorate baroreceptor function and result in irreversible changes in cerebral and coronary circulation. Concurrent frailty or other components of geriatric syndrome in elderly patients are associated with a worse perception of health, an increased number of comorbidities and social isolation of the patient. It may also interfere with treatment adherence. Identifying causes of non-adherence to pharmaceutical treatment is a key factor in planning therapeutic interventions aimed at increasing control, preventing complications, and improving long-term outcomes and any adverse effects of treatment. Diagnosis of frailty and awareness of the associated difficulties in adhering to treatment may allow targeting of those elderly patients who have a poorer prognosis or may be at risk of complications from untreated or undertreated hypertension, and for the planning of interventions to improve hypertension control.
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Despite ample research on depression after stroke, the debate continues regarding whether symptoms such as sleep disturbances, loss of energy, changes in appetite and diminished concentration should be considered to be consequences of stroke or general symptoms of depression. By comparing symptoms in depressed and non-depressed stroke patients with patients in general practice and patients with symptomatic atherosclerotic diseases, we aim to further clarify similarities and distinctions of depression after stroke and depression in other patient populations. Based on this, it is possible to determine if somatic symptoms should be evaluated in stroke patients in diagnosing depression after stroke. An observational multicenter study is conducted in three hospitals and seven general prac- tices including 382 stroke patients admitted to hospital with a clinical diagnosis of intracere- bral hemorrhage or ischemic infarction, 1160 patients in general practice (PREDICT-NL), and 530 patients with symptomatic atherosclerotic diseases (SMART-Medea).
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Background: Up to one third of all stroke patients suffer fromone or more psychosocial impairments. Recognition and treatment of these impairments are essential in improving psychosocial well-being after stroke. Although nurses are ideally positioned to address psychosocial well-being, they often feel insecure about providing the needed psychosocial care. Therefore, we expect that providing nurses with better knowledge to deliver this care could lead to an improvement in psychosocialwell-being after stroke. Currently it is not knownwhich interventions are effective and what aspects of these interventions are most effective to improve psychosocial wellbeing after stroke. Objective: To identify potentially effective interventions – and intervention components – which can be delivered by nurses to improve patients' psychosocial well-being after stroke. Methods: A systematic review and data synthesis of randomized controlled trials and quasi experimental studies was conducted. Papers were included according to the following criteria: 1) before-after design, 2) all types of stroke patients, 3) interventions that can be delivered by nurses, 4) the primary outcome(s) were psychosocial. PubMed, Embase, PsychInfo, CINAHL and Cochrane library were searched (August 2019–April 2022). Articles were selected based on title, abstract, full text and quality. Quality was assessed by using Joanna Briggs Institute checklists and a standardized data extraction form developed by Joanna Brigss Institute was used to extract the data. Results: In total 60 studies were included, of which 52 randomized controlled trials, three non-randomized controlled trials, four quasi-experimental studies, and one randomized cross-over study. Nineteen studies had a clear psychosocial content, twenty-nine a partly psychosocial content, and twelve no psychosocial content. Thirty-nine interventions that showed positive effects on psychosocial well-being after stroke were identified. Effective intervention topics were found to be mood, recovery, coping, emotions, consequences/problems after stroke, values and needs, risk factors and secondary prevention, self-management, andmedicationmanagement. Active information and physical exercise were identified as effective methods of delivery. Discussion: The results suggest that interventions to improve psychosocial well-being should include the intervention topics and methods of delivery that were identified as effective. Since effectiveness of the intervention can depend on the interaction of intervention components, these interactions should be studied. Nurses and patients should be involved in the development of such interventions to ensure it can be used by nurses and will help improve patients' psychosocial well-being.
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