Healthcare providers use assessment as a tool to inform population-focused health promotion. They select a vulnerable population, such as older adults, and assess risks and common health problems, prevalence, and possible treatment methods needed to address the issue

Hypertension among Hispanics in the Elderly Population

Introduction

Healthcare providers use assessment as a tool to inform population-focused health promotion. They select a vulnerable population, such as older adults, and assess risks and common health problems, prevalence, and possible treatment methods needed to address the issue. According to the Centers for Disease Control and Prevention (2022), assessing vulnerability determines a population at risk of a specific health problem. The information acquired through evaluation determines the previous interventions, their effectiveness, and existing gaps. The knowledge gained can be used in developing health policy to support response, such as establishing how resources will be allocated to the vulnerable population. The following paper will address hypertension assessment among Hispanics above 65 years in Miami-Dade County. The valuation will illustrate high blood pressure prevalence in the county, why the old Hispanics are vulnerable, interventions and policy to address the health problem. The paper will provide knowledge on how advanced nurse practitioners can collaborate to address the problem among the identified population.

Part 1: Population/Community Snapshot

Information Synthesis

The Behavioural Risk Factor Surveillance System (BRFSS) shows that hypertension prevalence in Miami-Dade County is very high (Florida Department of Health, 2023). Hypertension is among the leading causes of death in the region. 16.9 % of elderly above 65 were diagnosed with hypertension as of 2021. The diagnosis rates in the county have been going high from 2012 to 2021 (Miami Matters, 2023). The Centres for Medicare & Medicaid Services shows that as of 2021, the total number of people with high blood pressure in Miami-Dade was 32.7 %. By gender, increased cases of hypertension are seen among men, with 62 % in comparison to women, which is 60 %. In terms of age, people above 65 have the highest prevalence level of 60 %, followed by 45-64 at 34 % and 18-44 at 8 %. Regarding race/ethnicity, white non-Hispanics have high rates of 37 %, followed by black Americans at 33 % and Hispanics at 27% (Miami Matters, 2023). Low education, economic instability, and low health status are the key social determinants that led to increase in hypertension rates.

Analysis of the Assessment Findings

The assessment illustrates high prevalence rates among Hispanics 65 years and above. There are different hindrances to health access in hypertension treatment. The first challenge is the communication barrier and language discordance between elderly patients and physicians. Most healthcare providers are Hispanic white Americans and do not use the Spanish language. Most patients use Spanish instead of English. This hinders understanding diagnosis, treatment, and management of high blood pressure (Oliveros et al., 2020). The other barrier is low education among the patients, which creates adherence problems when taking medication. Discrimination against the minority is another challenge. Few resources are allocated to delivering healthcare services to the Hispanics in Miami-Dade County, and they face challenges such as long-waiting times and lack of access to hypertension drugs. The low economic state among most older adults in the county is another hindrance to effective services.

Priority Population Health Risk

Low education among older adults with hypertension increases risk in Miami-Dade County. The risk is associated with failure to take the prescription medication and managing the health problem effectively. As a result, the emergency rates are very high among older people over 65 are rushed to the hospital due to excessively high blood pressure. Vigue et al. (2022) assert that a population-focused solution to address this concern would be individualized education and training program. Each patient should be educated and trained individually on managing hypertension. The program will be personalized to precise requirements of a patient, such as education and economic status. For instance, the foods they can access that are effective in lowering blood pressure, physical activities such as gardening, swimming, walking the dog, and others. A nurse with cultural and language competence will oversee the intervention to ensure its effectiveness (Campos & Rodriguez, 2019).

Part 2: Vulnerable Population Assessment

Vulnerable Population

Hispanics above the age of 65 are at a high risk of getting high blood pressure. Several variables place the vulnerable population at risk. The first variable is age. As individual ages, the blood pressure tends to rise, increasing the chances of diagnosis if not managed properly. This is triggered by variations in the vascular system, including the heart and blood vessels, reducing tissue elasticity, leading to stiffness (Campos & Rodriguez, 2019). The second variable is low education which limits health knowledge associated with healthy living above 65 years. Most old Hispanic individuals lack education, which means they are unaware of the lifestyle changes they need to make as they grow old, which can promote their health status. When at risk of high blood pressure, the population is unaware of how the problem should be controlled. Failure to regulate increasing blood pressure results in diagnosis. The third variable is low economic status and lack of medical insurance (Oliveros et al., 2020). Most Hispanics above 65 live in poverty and lack knowledge on how to apply for Medicare. Therefore, most are uncovered, and it affects access to quality medical services such as assessments that may guide taking necessary steps to reduce diagnosis with chronic conditions. The lifestyle of Hispanic older adults, such as lack of physical activities and poor diet, increases the risks of diagnosis with conditions such as hypertension.

National Population Health Goal

One of the principal goals of Healthy People 2030 is to eradicate health inequalities, realize health fairness and achieve health knowledge that will enhance the health and welfare of individuals (US Department of Health and Human Resources, n.d.). Hispanics are among the minority groups and thus face discrimination in healthcare delivery. The discrimination hinders access to quality services such as hypertensive medication and knowledge on managing the health problem effectively. This explains the high hypertension prevalence among Hispanics over 65 years, as they lack knowledge on managing the health problem effectively. The goal will address the causes of disparity and expand Medicare while reducing eligibility requirements for Hispanics.

Advanced nursing practitioners will work together at the local, state, and national levels to advocate for the population’s health by introducing a policy promoting access to necessary services. The policy will target Hispanics above 65 years, who will all be eligible for Medicare coverage. In addition, the insurance will cater to all medical requirements of Hispanic older adults. The nurse practitioners will promote the Health People goal by creating hypertension education programs for Hispanics (US Department of Health and Human Resources, n.d.). The program will consider the population’s values, beliefs, and practices. It will be designed based on the population’s education levels to ensure that they will understand the concepts and how they will conduct a lifestyle change to manage the condition effectively (Campos & Rodriguez, 2019).

Part 3: Population-Level Health Intervention Analysis

Population Health Intervention

The best intervention for Hispanics above 65 years in Miami-Dade County is designing a personalized healthy lifestyle change plan. The population lifestyle risks high blood pressure, such that even with treatment and failure to make necessary lifestyle changes, the high prevalence rates and emergency rates remain (Risica et al., 2021). An individualized healthy lifestyle plan will have several components. The first one will be the heart-healthy foods in the DASH eating plan. The next element will be limiting or avoiding alcohol intake. The patients will be introduced to an Alcohol Treatment Navigator from the National Institute on Alcohol Abuse and Alcoholism to support those struggling to quit. The other element will be regular physical activity. The plan will also include healthy weight as obesity increases the chances of high blood pressure. Those who smoke will be required to quit and will have access to resources such as Your Guide to a Healthy Heart and Smoking and Your Heart to guide them in stopping (Campos & Rodriguez, 2019). Stress management will be an essential component of the plan, where the older adults will learn coping and managing skills. The program will also include a guide to at least seven hours of good-quality sleep.

Accessibility, Levels of Prevention, And Social Determinants of Health

The personalized healthy lifestyle change plan will have high accessibility. The advanced nurses will develop a general plan, then adjust it to a specific patient’s needs. The modification will require removing some components based on the patient’s health status and social determinants of health (Risica et al., 2021). For example, a patient with no smoking history will not need the quitting component; this will be removed from the plan.

The plan will present primary, secondary, and tertiary levels of prevention. Once screening of a Hispanic individual shows that they are at risk of getting high blood pressure, they will be introduced to the plan immediately. It will control the blood from rising further, thus making the necessary prevention. The lifestyle change plan will work effectively with hypertension medication in secondary intervention (NIH, 2022). The program will effectively manage the rise in blood pressure, thus preventing emergency cases. Since the plan will be tailored to a specific patient’s needs, it will address social determinants such as education and gender elements.

Gap and Recommendation

The gap with the intervention is the lack of a health literacy plan. Most old Hispanics may not know why they need to make all the changes in their lives. Therefore, if they do not understand the essence of the various plan components, it will be hard to align with them. The gap can be bridged by creating hypertension education conferences for the older population in Miami-Dade County. In that way, once a patient is introduced to their plan, they will have basic information on why they need to make necessary changes (Smith et al., 2018).

Part 4: Health Policy Analysis

Health Policy

The Affordable Care Act Medicare expansion would effectively address the disparities in accessing hypertension treatment for Hispanics over 65 years. The policy will support medical coverage for more older individuals, thus covering the medical finances and ensuring they access the treatment every month as required (Angier et al., 2022). Most old Hispanics fail to access medical due to their medical limitations. However, with the policy, the problem will be addressed. In addition, disparities associated with failure of access to quality services will also be addressed. The ethical implication of the policy is promoting fair, just, and equitable services to all people in Miami-Dade County, including older people.

Policy Within National Population Health Initiative

The Affordable Care Act Medicare expansion has a high degree of congruence with the national population health goal as it promotes access to quality healthcare and addresses disparities associated with delivery (Cole et al., 2021). The policy will ensure that the older population has access to quality services and high blood drugs despite their ethnic background. The policy will support access to other services, such as health literacy associated with hypertension treatment and management. It will promote improved life quality among old Hispanics and reduce the development of other hypertension-related chronic illnesses (Risica et al., 2021).

Strategy to Further Address the Health Risk

Hypertension can be addressed by supporting the economic growth of the Hispanic people. Hypertension develops slowly due to stress associated with life and struggles. This would require Miami-Dade County to intervene in Hispanic lives and create opportunities to address poverty and structural racism (Cole et al., 2021). Interprofessional collaboration can be done by including different groups in Miami-Dade County to assess high blood pressure and determine the best ways to address the problem. This will effectively pull financial, knowledge, and human resources needed in practices such as educative programs.

Conclusion

Population health assessment is critical in risk identification, thus guiding practitioners on how to respond. For instance, assessing hypertension among Hispanic older adults provides knowledge on contributing factors and gaps in intervention. Developing a lifestyle change plan will address primary, secondary, and tertiary response levels, thus reducing diagnosis rates and promoting effective management. Social determinants determine the risk factors and vulnerability to specific health problems (Risica et al., 2021). Therefore, when developing an intervention. MSN-prepared nurses should understand the social aspects and develop an intervention based on these elements. Advocacy should include developing policies to ensure access to quality medical care for people from different backgrounds without discrimination.

References

Angier, H., Huguet, N., Ezekiel-Herrera, D., Marino, M., Schmidt, T., Green, B. B., & DeVoe, J. E. (2020). New hypertension and diabetes diagnoses following the Affordable Care Act Medicaid expansion.  Family Medicine and Community Health,  8(4). https://fmch.bmj.com/content/fmch/8/4/e000607.full.pdf

Campos, C. L., & Rodriguez, C. J. (2019). High blood pressure in Hispanics in the United States: a review.  Current opinion in cardiology,  34(4), 350-358. https://doi.org/10.1097/HCO.0000000000000636

Centers for Disease Control and Prevention. (2022, October 25). CDC community health improvement navigator. https://www.cdc.gov/chinav/

Cole, M. B., Kim, J. H., Levengood, T. W., & Trivedi, A. N. (2021, September). Association of Medicaid expansion with 5-year changes in hypertension and diabetes outcomes at federally qualified health centers. In  JAMA Health Forum (Vol. 2, No. 9, pp. e212375-e212375). American Medical Association. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2784103

Florida Department of Health. (2023, April 3). Behavioral risk factor surveillance system (BRFSS) | Florida Department of Health. https://www.floridahealth.gov/statistics-and-data/survey-data/behavioral-risk-factor-surveillance-system/index.html

Miami Matters. (2023). Miami-Dade matters: Indicators: High blood pressure prevalence: County: Miami-Dade. Miami-Dade Matters. https://www.miamidadematters.org/indicators/index/view?indicatorId=253&localeId=414&localeChartIdxs=1%7C2%7C4

Miami Matters. (2023). Miami-Dade matters: Indicators: Hypertension: Medicare population: County: Miami-Dade. Miami-Dade Matters. https://www.miamidadematters.org/indicators/index/view?indicatorId=2063&localeId=414

NIH. (2022, March 4). High Blood Pressure Treatment. NHLBI. https://www.nhlbi.nih.gov/health/high-blood-pressure/treatment

Oliveros, E., Patel, H., Kyung, S., Fugar, S., Goldberg, A., Madan, N., & Williams, K. A. (2020). Hypertension in older adults: Assessment, management, and challenges.  Clinical cardiology,  43(2), 99-107. https://doi.org/10.1002/clc.23303m

Risica, P. M., McCarthy, M. L., Barry, K. L., Oliverio, S. P., Gans, K. M., & De Groot, A. S. (2021). Clinical outcomes of a community clinic-based lifestyle change program for prevention and management of metabolic syndrome: Results of the ‘Vida Sana/Healthy Life’program.  PloS one,  16(4), e0248473. https://doi.org/10.1371/journal.pone.0248473

Smith, S. M., McAuliffe, K., Hall, J. M., McDonough, C. W., Gurka, M. J., Robinson, T. O., … & Cooper-DeHoff, R. M. (2018). Peer reviewed: Hypertension in florida: Data from the oneflorida clinical data research network.  Preventing chronic disease,  15. https://www.cdc.gov/pcd/issues/2018/17_0332.htm

US Department of Health and Human Resources. (n.d.). Healthy people 2030 framework. Home of the Office of Disease Prevention and Health Promotion – health.gov. https://health.gov/healthypeople/about/healthy-people-2030-framework

Vigue, R., Hernandez, W. E., Ramirez, A. L., Castro, G., Barengo, N. C., Brown, D. R., & Ruiz-Pelaez, J. (2022). Factors Associated With Control of Diabetes and Hypertension Among Patients Seen as Part of a Longitudinal Medical School Service-Learning Program From 2018-2019: An Exploratory Analysis.  Cureus,  14(8). https://doi.org/10.7759%2Fcureus.28225

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