CHAPTER ONE

INTRODUCTION

Background to the Study

Hypertension remains a major global public health challenge that has been identified as the

leading risk factor for cardiovascular morbidity and mortality. It increases hardening of the

arteries, thus predisposing individuals to heart diseases, peripheral vascular diseases, stroke,

heart failure and kidney failure. Hypertension is the commonest non-communicable disease in

the world and all races are affected with variable prevalence. According to Scott Smith (2015),

the circulatory system is like to a garden hose under pressure, he effectively communicated the

potential dangers of hypertension.

Hypertension, commonly known as high blood pressure, refers to a medical condition where the

force of the blood against the artery walls is consistently too high. This condition can lead to

serious health problems including heart disease, stroke, and kidney disease among others.

According to the American Heart Association (2017), hypertension is defined as a systolic blood

pressure (SBP) ≥130 mm Hg or a diastolic blood pressure (DBP) ≥80 mm Hg, on average, based

on two or more readings taken on two or more occasions after an initial screening. Hypertension

is a major cause of premature death worldwide due to its role in the development of

cardiovascular diseases such as heart attack, heart failure, stroke, and kidney disease (WHO,

2021). Similarly, blood pressure of 150/90 mmHg is considered normal for a 60-year old person,

while blood pressure of 160/100 mmHg is high for such a person. Hypertension is sometimes

called “the silent killer” because people who have it are often symptom-free. In this study,

hypertension is perceived as a systolic blood pressure greater than 140 mmHg and a diastolic

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blood pressure greater than 90 mmHg among adults. The top number which is the systolic

pressure corresponds to the pressure in the arteries as the heart contracts and pumps blood

forward into the arteries. The bottom number 2 which is the diastolic pressure represents the

pressure in the arteries as the heart relaxes after contraction. The diastolic pressure reflects the

lowest pressure to which the arteries are exposed. Blood pressure is normally measured at the

brachial artery with a sphygmomanometer (pressure cuff) in millimeters of mercury (mmhg) and

given as systolic over diastolic pressure. Hypertension is classified into two namely; primary and

secondary hypertension. Other causes include airway obstruction during sleep, stress, diseases

and tumors of the adrenal glands, lifestyle, spinal cord injury, hormone abnormalities (oral

contraceptive estrogen replacement), thyroid disease, toxemia of pregnancy, renal problems such

as vascular lesion of renal arteries, diabetic neuropathy, pains as well as anxiety and

hypoglycemia. There are some factors which predispose adults to hypertension. Hypertension,

commonly known as high blood pressure, is a prevalent health condition characterized by

elevated pressure exerted by the blood against the walls of the arteries. Several well-established

risk factors contribute to the development of hypertension. Firstly, advancing age is a significant

risk factor, with the likelihood of hypertension increasing as individuals grow older (American

Heart Association, 2021). Additionally, a family history of hypertension significantly

predisposes individuals to the condition, as evidenced by research demonstrating the familial

aggregation of hypertension (Pereira et al., 2018). Lifestyle factors also play a crucial role, with

obesity being a particularly prominent risk factor. Studies have shown that being overweight or

obese significantly increases the risk of hypertension, placing additional strain on the

cardiovascular system (American Heart Association, 2021). Unhealthy dietary habits,

characterized by high sodium intake and consumption of saturated fats and cholesterol, further

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contribute to hypertension risk (Centers for Disease Control and Prevention, 2021). Sedentary

lifestyles devoid of regular physical activity also increase the likelihood of developing high

blood pressure (National Heart, Lung, and Blood Institute). These well-documented risk factors

underscore the importance of adopting healthy lifestyle behaviors and implementing preventive

measures to mitigate the risk of hypertension and its associated complications.

Statement of Problem

There exists a gap in knowledge regarding hypertension among the elderly population, leading to

potential risks for their health and well-being. Despite hypertension being a prevalent condition

among older adults, there is a lack of knowledge and understanding among this demographic

(elderly patients) about its causes, consequences, and management strategies. This gap in

knowledge can result in suboptimal management of hypertension, leading to complications such

as heart disease, stroke, and kidney problems. Furthermore, misconceptions and misinformation

about hypertension may hinder elderly individuals from seeking appropriate medical care and

adhering to treatment plan. Regrettably, most adults due to ignorance of knowledge and

understanding of preventive measures of hypertension engage in unhealthy lifestyles such as

excessive consumption of alcohol, sedentary lifestyle, excess consumption of sodium intake,

tobacco and cigarette smoking, obesity, reduced intake of fruits and vegetables, stress and

consumption of foods rich in cholesterol. These unhealthy lifestyle practices have increased the

prevalence of hypertension in the world including Nigeria, which culminates into high cases of

deaths. Hypertension is one of the problems affecting especially a great portion of the adult

population and currently causes one in every eight deaths worldwide, making it the third leading

killer disease in the world.

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Therefore, as part of a quality assessment to improve the management outcome of hypertensive

patients, we evaluated by means of a descriptive, cross-sectional qualitative phenomenological

survey, hypertensive patients’ knowledge, perception, attitudes and life-style practices.

Objectives of Study

The general objective of this research work is to assess the knowledge and understanding of

hypertension and its management among patients. The specific objectives include to;

1. Evaluate knowledge and understanding of adults on hypertension in Madonna University

Teaching hospital

2. Describe the barriers to effective management of hypertension.

3. Determine the various effects of hypertension to elderly patients in Madonna University

Teaching Hospital.

4. Determine and educate the various forms of managing hypertension in elderly patients

Research Questions

1. What is the knowledge, and understanding of adults on hypertension in Madonna University

Teaching Hospital?

2. What are the barriers to effective management of hypertension?

3. What are the various effects of hypertension to elderly patients in Madonna University

Teaching Hospital?

4. What are the various forms of managing hypertension in elderly patients?

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Significance of Study

The results of this study will be useful to health educators, medical and paramedical officers,

public health officers, counselors, media educators, researchers, curriculum planners,

government and adults in many ways. The study has helped to develop a positive regard towards

hypertension. The ministry of health may benefit from the study by discovering a gap in

knowledge of the population and emphasize strategies to teach the adult population on how to

prevent the risk factors. It has also been useful to other researchers to carry out this study in areas

where disease prevention measures and health promotion are needed with regards to

hypertension. Answering the research questions associated with the research project offers

insight into managing hypertension by revealing an understanding of individual’s health related

knowledge, perceptions and behaviors.

Scope of the Study

The has been delimited to selected Elderly Patients in Madonna University Teaching

Hospital, Elele, Rivers State. The study was restricted to adults between the ages of sixty years

and above. The study was concerned with determining Elderly Patient Understanding on

Hypertension. This consisted of the concept of hypertension, signs and symptoms, risk factors

and preventive measures of hypertension. The demographic factors of age, gender, location and

level of education as they relate to knowledge of hypertension were all explained as relating to

elderly patients.

Operational Definition of Terms

Hypertension: a state of great psychological stress with abnormally elevated blood pressure

Elderly: people aged from sixty-five and older

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Patients: a person receiving or registered to receive medical treatment

Understanding: ability to understand something or comprehend

MUTH: Madonna University Teaching Hospital

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 CHAPTER TWO

LITERATURE REVIEW

This chapter presents the review of related literature on Elderly patients understanding on

hypertension. Literature related to the present study was presented under the following sub-

headings: Conceptual framework; Theoretical framework; Empirical studies and Summary of

Literature reviewed.

Conceptual Review

Hypertension is a worldwide problem. The global prevalence of hypertension has increased over

the past few decades, especially in low- and middle-income countries (Touyz 2022).

Hypertension is diagnosed when blood pressure is consistently ≥130 and/or ≥80 mm Hg.

However, the majority of patients with hypertension between 130-139/80-89 mm Hg (stage 1

hypertension) do not qualify for immediate drug therapy. The guideline breaks new ground with

some of its recommendations. A comprehensive understanding of hypertension among elderly

patients is essential for effective management and prevention of associated complications.

Despite its widespread prevalence within this demographic, there exists a notable gap in

knowledge and awareness surrounding the condition. Many elderly individuals are unaware of

their hypertensive status or may underestimate its severity, underscoring the critical need for

targeted educational initiatives. Moreover, comprehension of risk factors, treatment perceptions,

and cultural influences shapes the understanding of hypertension among elderly patients.

Addressing these factors through tailored patient education programs holds immense potential in

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empowering elderly individuals to make informed decisions about their health and adhere to

treatment plans diligently. By bridging these knowledge gaps and fostering greater awareness,

healthcare providers can significantly enhance hypertension management strategies, thereby

mitigating the burden of cardiovascular disease within the elderly population. According to Hayk

and Anna (2019), the major types of hypertension (high blood pressure) are; primary

hypertension, also known as essential hypertension, is the most common type of hypertension.

For this type of hypertension, there is no single identifiable cause. There is no apparent

underlying disease, condition or disorder causing the high blood pressure. Instead, hypertension

occurs because of genes, diet and lifestyle. They also stated the Minor types of hypertension

(high blood pressure) which included Secondary hypertension which is a less common form of

the disease that occurs because of a specific condition. Disorders including sleep apnea, tumors

and kidney failure can all cause hypertension to occur as a side effect.

Barriers to the Management of Hypertension.

The effective management of hypertension among elderly patients is often hindered by

various barriers that impede optimal treatment outcomes. One significant challenge is medication

adherence, as elderly individuals may face difficulties in adhering to complex medication

regimens due to forgetfulness, concerns about side effects, or financial constraints. Moreover,

limited access to healthcare services and resources can pose barriers to regular medical care and

blood pressure monitoring, particularly for elderly patients living in rural or underserved areas.

The presence of multiple comorbidities and polypharmacy can further complicate hypertension

management, potentially leading to medication interactions and adverse effects. Additionally,

cognitive impairment, such as dementia, can impair understanding of treatment instructions and

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adherence to medication schedules. Addressing these barriers requires a multifaceted approach

that includes patient education, simplified medication regimens, interdisciplinary care

coordination, and enhanced communication between healthcare providers and elderly patients.

By overcoming these challenges, healthcare professionals can improve hypertension

management and reduce the risk of cardiovascular complications in the elderly population.

Effects of Hypertension on Elderly Patients

Hypertension, or high blood pressure, can have significant effects on elderly patients. As

individuals age, the prevalence of hypertension increases, and its impact on the elderly

population becomes more pronounced. The effects of hypertension on elderly patients can be

wide-ranging and may include cardiovascular complications, cognitive decline, kidney disease,

and an increased risk of stroke. Additionally, hypertension can exacerbate other age-related

health conditions, leading to a decline in overall well-being and quality of life for elderly

individuals. Cardol (2012) Cardiovascular Complications One of the primary concerns regarding

hypertension in elderly patients is its impact on the cardiovascular system. Prolonged high blood

pressure can lead to various cardiovascular complications such as coronary artery disease, heart

failure, and arrhythmias. These conditions can significantly impair cardiac function and increase

the risk of adverse cardiovascular events in elderly individuals with hypertension. Cognitive

Decline Research has also shown a potential link between hypertension and cognitive decline in

the elderly. Chronic high blood pressure may contribute to the development of vascular dementia

or increase the risk of Alzheimer’s disease. The compromised blood flow to the brain associated

with hypertension can lead to cognitive impairment and an accelerated decline in cognitive

function among elderly patients. Kidney Disease Hypertension is a leading cause of chronic

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kidney disease, particularly in the elderly population. The sustained pressure on the delicate

blood vessels in the kidneys can result in damage to these vital organs. Over time, this damage

may progress to chronic kidney disease, further compromising the overall health and well-being

of elderly individuals. Increased Risk of Stroke Elderly patients with hypertension are at a

significantly higher risk of experiencing a stroke. High blood pressure contributes to the

formation of blood clots and arterial blockages, increasing the likelihood of a stroke occurrence.

The consequences of a stroke can be particularly severe for elderly individuals, often leading to

long-term disability and functional limitations. Exacerbation of Age-Related Health Conditions

Furthermore, hypertension can exacerbate other age-related health conditions commonly seen in

elderly patients. For example, it can worsen symptoms associated with arthritis, diabetes, and

vision problems. The combination of hypertension and these pre-existing conditions can further

compromise an individual’s health and independence as they age.

Management of hypertension in elderly patients

Managing hypertension in elderly patients requires a multifaceted approach tailored to their

specific needs and considerations. Lifestyle modifications form the cornerstone of treatment,

emphasizing dietary changes, regular exercise, weight management, and cessation of smoking

and excessive alcohol consumption. Pharmacological interventions are often necessary, with

medication selection based on individual factors such as age, comorbidities, and potential drug

interactions. Simplifying treatment regimens is crucial to improve adherence and reduce pill

burden, considering the complexity of medication regimens and the risk of polypharmacy in

elderly patients. Regular monitoring of blood pressure and clinical parameters is essential to

assess treatment efficacy, detect complications, and adjust therapy as needed. Patient education

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plays a pivotal role, empowering elderly patients to actively participate in their care by

understanding the importance of blood pressure control, adherence to treatment, and self-

monitoring techniques. By addressing these aspects comprehensively, healthcare providers can

optimize hypertension management in elderly patients, ultimately reducing cardiovascular risk and

improving overall quality of life.

Goal of Treatment

The goal of hypertension treatment in elderly patients should be to reduce the risk of

cardiovascular events, such as heart attacks, strokes, and heart failure, while minimizing the risk

of adverse effects. The target blood pressure for elderly patients is generally less than 150/90

mmHg, but this may need to be individualized based on the patient’s overall health and

comorbidities.

Lifestyle Modifications

Lifestyle modifications are an essential part of hypertension management in elderly patients.

These include: A healthy diet that is low in sodium and saturated fats and high in fruits,

vegetables, and whole grains, regular physical activity, such as walking or swimming, for at least

30 minutes a day, weight management, with a focus on maintaining a healthy body mass index

(BMI), limiting alcohol intake to moderate levels (no more than one drink per day for women

and two drinks per day for men), quitting smoking and avoiding exposure to secondhand smoke

Medication Therapy

Medication therapy may be necessary to control hypertension in elderly patients, especially if

lifestyle modifications are not sufficient. The choice of medication should be based on the

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patient’s medical history, renal function, and other comorbidities. Diuretics, beta-blockers, and

calcium channel blockers are commonly used in elderly patients, but the specific medication and

dosage should be individualized based on the patient’s needs.

Monitoring and Follow-up

Regular monitoring and follow-up are crucial to ensure that hypertension is well-controlled and

to make any necessary adjustments to the treatment plan. Blood pressure should be checked at

least every six months and more frequently if the patient has a history of cardiovascular disease

or is taking medication.

Special Considerations

There are several special considerations when managing hypertension in elderly patients,

including: Polypharmacy: Elderly patients may be taking multiple medications, which can

interact with each other and affect blood pressure. It is essential to review all medications and

avoid unnecessary medications.

Renal impairment: Elderly patients with renal impairment may require lower doses of medication

and more frequent monitoring.

Cognitive impairment: Elderly patients with cognitive impairment may have difficulty

understanding and adhering to treatment recommendations.

Theoretical Review

Health Belief Model (HBM):

This study was anchored to Health Belief Model Theory by social psychologist Irwin M.

Rosenstock. According to this theory, it appears that the management in elderly patients offers

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valuable insights into their perceptions, beliefs, and behaviors regarding the condition and its

treatment. In this study, the HBM was used as it provides a framework for understanding how

their beliefs and perceptions shape their adherence to treatment recommendations and

engagement in health-promoting behaviors. Elderly individuals may have varying levels of

awareness and concern about the risks posed by uncontrolled hypertension, influenced by factors

such as personal experiences, family history, and exposure to health education initiatives.

Research by Muntner et al. (2020) found that many elderly patients underestimate their risk of

cardiovascular events and may not perceive hypertension as a serious health threat until

complications arise. Addressing misconceptions and enhancing awareness of the potential

consequences of untreated hypertension is essential for promoting behaviour change and

treatment adherence.

Empirical Studies

Several empirical studies offer valuable insights into knowledge and understanding of

hypertension among elderly patients, shedding light on interventions, perceptions, outcomes, and

barriers. A study by Johnson (2018) found that among the elderly patients surveyed, there was a

lack of awareness regarding hypertension risk factors, symptoms, and management strategies.

Specifically, only 30% of participants correctly identified hypertension as a risk factor for heart

disease, and less than 40% were aware of the recommended blood pressure targets for

individuals over 60 years old. Additionally, a significant proportion of participants reported

misconceptions about hypertension management, with many believing that medication was not

necessary or that alternative therapies were equally effective. In another study by Rodriguez

(2020), the effectiveness of a hypertension education intervention among elderly adults in a

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community setting was evaluated. The intervention consisted of group education sessions,

individual counselling, and provision of educational materials. The findings revealed a

significant improvement in hypertension knowledge among participants following the

intervention, with a 25% increase in correct responses on knowledge assessments. Furthermore,

respondents demonstrated positive changes in health behaviors, including increased adherence to

medication regimens and adoption of healthy lifestyle practices such as dietary modifications and

regular physical activity. According to a systematic review published in the Journal of the

American Geriatrics Society in 2019, hypertension awareness, recognition, and treatment remain

inadequate among older adults. The review analyzed 36 studies involving over 15,000

participants aged 60 years and above. The results indicated that only about 60-70% of elderly

individuals with hypertension were aware of their condition, and only around 50% were

adequately controlled.

Another study published in the American Journal of Hypertension in 2021 reported similar

findings. This study, which included data from over 4,500 older adults, found that only about

half of those with hypertension had it under control (Muntner,2021). Furthermore, the

researchers noted that older adults from racial and ethnic minority groups were less likely to

have their hypertension diagnosed or treated appropriately.

A meta-analysis published in the European Journal of Clinical Nutrition in 2020 examined the

relationship between dietary patterns and blood pressure in older adults (Hu,2020). The analysis

included data from over 18,000 participants aged 65 years and above. The results showed that a

diet rich in fruits, vegetables, whole grains, and low-fat dairy products was associated with lower

blood pressure levels. However, the authors noted that despite these findings, many older adults

still did not consume enough of these foods to achieve optimal blood pressure control.

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A review published in the Journal of Clinical Hypertension (Kwak., et, al,2018) summarized

various interventions aimed at improving hypertension knowledge and management among

elderly patients. These interventions included educational programs, medication adherence

strategies, and health services. The review found that these approaches could lead to significant

improvements in both knowledge and blood pressure control.

Summary of literature review

Moreover, qualitative research by Smith et al. (2018) explored barriers to hypertension control

and management in older adults. Through in-depth interviews and focus group discussions, they

identified various obstacles, including medication side effects, access to healthcare services, and

challenges with self-management. This qualitative study highlights the importance of addressing

patient-specific barriers to hypertension management and tailoring interventions to meet the

unique needs of elderly patients.

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 CHAPTER THREE

METHODOLOGY

Research Design

In order to achieve the objectives of the study, quantitative descriptive research design was

adopted for the study of a given population. This design was considered appropriate for use in

the present study because it gave current information on the knowledge and understanding of

hypertension among elderly patients in Madonna university teaching hospital. This design was

also relevant because only a few people considered to be representative of the population were

studied.

Research Setting

The research setting for the study is Madonna University Teaching Hospital Elele, Rivers State.

The General Outpatients Department (GOPD) in Madonna University Teaching Hospital, Elele,

Rivers State. It was advantageous because of the limitations on travel and resources.

Respondents were selected from Madonna University Teaching Hospital because of its

accessibility and convenience.

Target Population

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The target population for the study consisted of all male and female elderly patients aged sixty

five years and above in Madonna university teaching hospital, Elele Rivers State. The record of

Madonna university teaching hospital gave a documented aggregate score of elderly patient from

the outpatient department to be 80 elderly patients, which constituted to the population for the

study. For the purpose of the study, the inclusion criterion is willingness and informed consent to

participate in the study and availability at the time of data collection. Data collection was

achieved by the use of questionnaire and interview to solicit information from patients.

Sample size:

Using Taro Yamane

n=N/(1+N(e)^2

n= corrected sample size,

N= population size (N=100)

E= Margin of error, e= 0.05

n = 100/〖1+100(0.05)〗^2

n = 100/(1+100(0.0025))

n = 100/1.25

n = 80

Therefore, 80 elderly patients will be used for this study

Sampling techniques

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The sample for the present study consisted of fifty adults (60 males and 40 females). The stage

involved simple random sampling as it is suitable for the study.

The study employ a simple random sampling technique for obtaining respondent for the

distribution of questionnaires based on probability sampling technique. Simple random sampling

was employed in selecting the respondents because it involves random selection of study element

in such a way that each member of the study population has an equal chance of being selected

into the study. The inclusion criteria include willingness to participate in the study; availability at

the time of data collection; and respondents must be aged 65 years and above.

Instrument for Data Collection

The instrument for data collection was the researcher-designed structured questionnaire on

Elderly patient understanding on hypertension The instrument comprised of 20 structured

questions with multiple choice response options. The questionnaire was divided into three

sections namely; A, B and C. Section A consisted four (4) items dealing with demographic

variables (age, gender, location and level of education). Section B comprised of ten (10) items on

the understanding of the concept of hypertension. Section C consisted of ten (10) items. The

respondents were required to place a thick (√) as it applies to them. The items in the

questionnaire were organized to reflect the purpose of the study as well as research questions and

hypotheses.

Validity of the instrument

The Questionnaire was given to five experts from the University teaching hospital, Department

of Patient Health and Physical Education. The experts were given copies of the drafted

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questionnaire which was accompanied with the purpose of the study, research questions and

objectives. Their main task was to critically examine the questionnaire and determine whether

the contents are in line with the objectives of the study. They were also required to check for the

appropriateness of each item in terms of the language used. Their constructive criticisms and

suggestions were used to produce the final version of the instrument that was used for the data

collection for this study

Reliability of the instrument

Reliability refers to the consistency of a measure that ensures consistency of a test in a study.

The reliability of the instrument will be determined using test retest method. The instrument will

be administered to patients of comparable characteristics who are not part of the sample size.

Then an interval of 2 weeks will be allowed before going back to administer the same test to the

same group of patients who took the test previously. The reliability coefficient will be computed

and a score obtained.

Method of Data Collection

In order to gain access to and co-operation from the respondents, a letter of introduction from the

Head of Department, Madonna University Elele Campus, Rivers State was collected by the

researcher introducing her and explaining the purpose of the study. The researcher presented the

letter to the hospital and the director of nursing services. A brief letter assuring the respondents

of the confidentiality was also given.

Ethical Consideration

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Ethical clearance for this study will be obtained from the ethical committee of Madonna

University Teaching Hospital. Prior to the commencement of the study, hence the use of an

introductory letter stating the purpose of the research and soliciting for support to embark on the

study in the proposed is. The respondents will be fully informed about the scope of study before

the questionnaires will be handed over and their consent obtained. They will also be fully

informed that the study is voluntary and assured that confidentiality of responses would be

maintained during and after data collection. To further maintain confidentiality of responses

would be maintained during and after collection. Further maintain confidentiality, no form of

identifier will be required in the questionnaire. Plagiarism will be avoided by proper referencing

of other people’s work and idea that will be included in the study

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 CHAPTER FOUR

RESULTS

This chapter discusses and provides insight into the findings of the analysis carried out to

provide relevant answers to the research questions in the study. The total sample size comprises

80 respondents. The researcher employs descriptive statistics to explore the respondents'

demographic characteristics and level of awareness of the items in the survey.

Table 4.1: Demographic Information of Respondents

Variables Options Frequency Percentage

(n=80) (%)

Age distribution 65-69 years 45 56.3

70-74 years 29 36.3
75-79 years 4 5.0
80 and above 2 2.5
Gender Male 17 21.3
Female 63 78.8
Location Outpatient Department 45 56.3

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 Inpatient Department 35 43.8
Level of Education No Formal Education 2 2.5
Primary School 26 32.5
Secondary School 29 36.3
Tertiary Education 23 28.7
Source: Author’s computation using SPSS 25

The Table above shows the result of the demographic characteristics of elderly patients at

Madonna University Teaching Hospital (MUTH). A total of 80 patients responded to the survey.

45(56.3%) of the patients were within the age brackets 65 -69 years, 63(78.8% ) of the patients

were female, 45(56.3%) were from outpatient departments and 29(36.3%) of the patients had

secondary education.

Research question one: What is the knowledge and understanding of hypertension among

elderly patients in Madonna University Teaching Hospital?

Table 4.2: Knowledge and understanding of hypertension among elderly patients

Variables options F (%) Mean Standard

deviation
I am aware of hypertension Strongly unaware 2 (2.5) 3.35 0.765
Unaware 8 (10.0)
Aware 30 (37.5)
Strongly Aware 40 (50.0)
I am aware that hypertension can be Strongly unaware 14 (17.5) 2.43 0.925
treated through lifestyle changes
Unaware 28 (35.0)
Aware 28 (35.0)
Strongly Aware 10 (12.5)

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 I am aware of the risk factors Strongly unaware 1 (1.3) 3.39 0.771
associated with hypertension
Unaware 11(13.8)
Aware 24 (30.0)
Strongly Aware 44(55.0)
Source: Author’s computation using SPSS 25

The table above shows the response of elderly patients towards their awareness of hypertension.

Firstly, in terms of awareness of hypertension itself, the mean score of 3.35 suggests a relatively

high level of awareness among the respondents. This is supported by a standard deviation of

0.765, indicating that the responses were fairly consistent around the mean. The majority of

respondents (87.5%) demonstrated awareness, with 50% strongly aware and 37.5% aware. The

small proportion (12.5%) who were either unaware or strongly unaware suggests that the overall

understanding of hypertension among the elderly patients surveyed is quite solid.

Secondly, understanding of hypertension treatment through lifestyle changes yielded a mean

score of 2.43, indicating a moderate level of awareness, but with more variability in responses as

evidenced by the higher standard deviation of 0.925. While a significant portion (47.5%)

demonstrated awareness, with 12.5% being strongly aware and 35% aware, a considerable

proportion (52.5%) showed limited awareness or were unaware. This suggests a need for

targeted educational interventions to enhance understanding, particularly regarding the role of

lifestyle modifications in managing hypertension.

Thirdly, awareness of the risk factors associated with hypertension yielded a mean score of 3.39,

indicating a relatively high level of awareness, consistent with the findings on general

hypertension awareness. The standard deviation of 0.771 suggests some variability in responses,

but overall, the majority of respondents (85%) demonstrated awareness, with 55% being strongly

aware and 30% aware. However, a notable portion (14.3%) were either unaware or strongly

23
unaware of these risk factors, indicating potential areas for focused education and intervention

efforts.

Research question two: What are the various forms of managing hypertension in elderly
patients?

Table 4:3: Various forms of managing hypertension in elderly patients

Variables options F (%) Mean Standard

deviation
I am aware of the common Strongly unaware 9 (11.3) 2.65 0.887
medications used to treat
hypertension Unaware 23 (28.7)
Aware 35 (43.8)
Strongly Aware 13 (16.3)
I am aware of how often individuals Strongly unaware 1 (1.3) 3.38 0.786
with hypertension should check their
blood pressure. Unaware 12 (15.0)
Aware 23 (28.7)
Strongly Aware 44 (55.0)
I adhere to my prescribed medication Strongly unaware 2 (2.5) 3.39 0.787
regimen for hypertension
Unaware 9 (11.3)
Aware 25 (31.3)
Strongly Aware 44(55.0)

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 I am aware of some potential Strongly unaware 18 (22.5) 2.30 0.999
complications of uncontrolled
hypertension Unaware 33 (41.3)
Aware 16 (20.0)
Strongly Aware 13(16.3)
Source: Author’s computation using SPSS 25

The table revealed the respondent's level of awareness of the various forms of managing

hypertension. Firstly, awareness of common medications used to treat hypertension yielded a

mean score of 2.65, suggesting a moderate level of awareness among respondents. The standard

deviation of 0.887 indicates some variability in responses. While the majority (72.5%)

demonstrated awareness to some extent, with 43.8% aware and 16.3% strongly aware, a notable

portion (40%) either demonstrated limited awareness or were unaware of the common

medications used for hypertension treatment. This indicates a potential gap in knowledge

regarding medication options for managing hypertension among the elderly patients surveyed.

Secondly, awareness of how often individuals with hypertension should check their blood

pressure yielded a mean score of 3.38, indicating a relatively high level of awareness. The

standard deviation of 0.786 suggests some variability in responses, but overall, the majority

(83.7%) demonstrated awareness, with 55% being strongly aware and 28.7% aware. This

suggests a generally solid understanding of the recommended frequency for blood pressure

monitoring among the surveyed elderly patients.

Thirdly, adherence to prescribed medication regimen for hypertension yielded a mean score of

3.39, indicating a relatively high level of adherence among respondents. The standard deviation

of 0.787 suggests some variability in responses, but overall, the majority (86.3%) reported

adherence, with 55% strongly adherent and 31.3% aware. This suggests a positive trend in

medication adherence among the elderly patients surveyed.

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Lastly, awareness of potential complications of uncontrolled hypertension yielded a mean score

of 2.30, indicating a moderate level of awareness. The relatively high standard deviation of 0.999

suggests considerable variability in responses. While a majority (60%) demonstrated awareness

to some extent, with 20% aware and 16.3% strongly aware, a notable portion (63.8%) either

demonstrated limited awareness or were unaware of potential complications of uncontrolled

hypertension. This indicates a need for enhanced education on the risks associated with poorly

managed hypertension among the elderly population.

Research question three: What are the various effects of hypertension on elderly patients in
MUTH?
Table 4.4: Various effects of hypertension on elderly patients in MUTH
Variables options F (%) Mean Standard
deviation
I have experienced vision problems Strongly unaware 19 (23.8) 2.30 0.999
due to hypertension.
Unaware 30 (37.5)
Aware 19 (23.8)
Strongly Aware 12 (15.0)
Hypertension has caused me to Strongly unaware - 3.53 0.693
experience frequent headaches.
Unaware 9 (11.3)
Aware 20 (25.0)
Strongly Aware 51 (63.7)

I have experienced chest pain or Strongly unaware - 3.49 0.636

discomfort due to hypertension
Unaware 6 (7.5)
Aware 29 (36.3)
Strongly Aware 45 (56.3)
Source: Author’s computation using SPSS 25

26
The table above revealed the respondent's level of awareness of the various effects of

hypertension.

Firstly, regarding vision problems due to hypertension, the mean score of 2.30 suggests a

moderate level of reported experience among respondents. The standard deviation of 0.999

indicates considerable variability in responses. While a notable proportion (61.3%) reported

experiencing vision problems to some extent, with 23.8% aware and 15% strongly aware, a

considerable portion (61.3%) either demonstrated limited awareness or were unaware of such

issues related to hypertension. This highlights a potential area where education and intervention

efforts could be focused to enhance understanding and recognition of hypertension-related vision

problems among elderly patients.

Secondly, hypertension causing frequent headaches yielded a mean score of 3.53, indicating a

relatively high level of reported experience among respondents. The standard deviation of 0.693

suggests less variability in responses compared to other variables. The majority (88.7%) reported

experiencing frequent headaches to some extent, with 63.7% strongly aware and 25% aware.

This suggests a strong association between hypertension and frequent headaches among the

surveyed elderly patients.

Thirdly, experiencing chest pain or discomfort due to hypertension yielded a mean score of 3.49,

also indicating a relatively high level of reported experience among respondents. The standard

deviation of 0.636 suggests less variability in responses. The majority (92.6%) reported

experiencing chest pain or discomfort to some extent, with 56.3% strongly aware and 36.3%

aware. This underscores the significant impact of hypertension on chest-related symptoms

among the surveyed elderly patients.

27
 CHAPTER FIVE

DISCUSSION OF FINDINGS

This chapter which concludes the study, briefly summarizes the findings relationship with other

studies literature review. It also focuses on implication of findings to nursing, limitations of the

study, summary, conclusion and makes recommendations and suggestions for practice and other

research.

Key Findings

What is the knowledge and understanding of adults on hypertension in Madonna

University Teaching Hospital?

The findings of this study were in alignment with the findings of Hayk and Anna (2019)

regarding awareness levels of hypertension among elderly patients. Specifically, the study's

28
observation of a relatively high level of awareness of hypertension itself, with 87.5% of

respondents demonstrating awareness, corresponds with the literature's description of primary

hypertension, where genetics, diet, and lifestyle factors are significant contributors. Similarly, the

study's identification of a notable proportion of respondents with limited awareness or

unawareness of hypertension treatment through lifestyle changes (52.5%) resonates with the

literature's emphasis on the importance of targeted educational interventions to enhance

understanding in this regard.

What are the various forms of managing hypertension in elderly patients?

The study's findings indicate a moderate level of awareness regarding common medications used

to treat hypertension, with 72.5% of respondents demonstrating awareness to some extent. This

aligns with Johnson's (2018) findings of a lack of awareness among elderly patients regarding

hypertension management strategies, including medication options. The study's results reveal a

relatively high level of awareness regarding how often individuals with hypertension should

check their blood pressure, with 83.7% of respondents demonstrating awareness. This finding

corresponds with the literature's emphasis on the importance of regular blood pressure

monitoring, as highlighted by Johnson (2018). The study identifies a relatively high level of

adherence to prescribed medication regimens for hypertension among respondents, with 86.3%

reporting adherence. This finding reflects a positive trend in medication adherence among the

elderly patients surveyed, aligning with Rodriguez's (2020) evaluation of a hypertension

education intervention aimed at improving medication adherence.

What are the various effects of hypertension on elderly patients in MUTH?

29
The study reveals a relatively high level of reported experience regarding hypertension causing

frequent headaches among respondents. The majority (88.7%) reported experiencing frequent

headaches to some extent, indicating a strong association between hypertension and this

symptom among surveyed elderly patients. The study identifies a relatively high level of reported

experience regarding experiencing chest pain or discomfort due to hypertension among

respondents. The majority (92.6%) reported experiencing chest pain or discomfort to some

extent, highlighting the significant impact of hypertension on chest-related symptoms among

surveyed elderly patients. This finding resonates with the literature's discussion on hypertension's

cardiovascular complications, emphasizing its potential to impair cardiac function and increase

the risk of adverse cardiovascular events in elderly individuals. It was supported by Smith (2021)

opined that hypertension was associated with several ocular manifestations, including

hypertensive retinopathy, retinal artery and vein occlusions, and optic neuropathy, uncontrolled

hypertension was identified as a major risk factor for coronary artery disease, myocardial

infarction, and other cardiac events associated with chest pain and elevated blood pressure levels

can trigger headaches through mechanisms involving vascular dysfunction, neurogenic

inflammation, and cerebral hypo perfusion.

Implication of this study to nursing

The findings from this study inform nurses about tailored education strategies, identify at-risk

individuals, and promote patient engagement. By addressing knowledge gaps, nurses empower

elderly patients to make informed decisions, adhere to treatment, and improve health outcomes.

Moreover, assessing hypertension knowledge among the elderly enables nurses to identify

individuals at higher risk of poor health outcomes due to misconceptions or misinformation. For

instance, elderly patients who are unaware of the asymptomatic nature of hypertension or the

30
importance of medication adherence may be at increased risk of uncontrolled blood pressure and

subsequent complications.

Limitations of Study

In the process of carrying out the study, the researcher encountered some limitations. Firstly,

since the focus of this study was on elderly patients in Madonna University Teaching Hospital,

the conclusions drawn from this study cannot be generalized to other populations. Secondly, the

researcher faced time constraints, financial constraints as well as access to materials relevant to

the research. Also, the study was limited to the use of specific strata of elderly patients therefore;

the variables could not be entirely accessed for all elderly patients.

Summary

The primary objective of the study was to investigate the knowledge and understanding of

hypertension among elderly patients in MUTH, Elele, Rivers State. A quantitative descriptive

research design and 100 elderly patients in General Outpatients Department (GOPD) were used

as study respondent. A self-structured questionnaire was developed according to the objectives

of the study to guide in the generation of information. Demographic characteristics of the

respondents and the research question were analyzed using simple frequency and percentage.

Results revealed that 44 (44%) of the respondents agreed that they adhere to prescribed

medication and regimen for hypertension; 13 (13%) were aware of how often individuals with

31
hypertension should be checked; 15 (15%) also were aware of the complications of uncontrolled

hypertension; 10 (10%) were aware of the common medications used to treat hypertension in

Madonna University Teaching Hospital. Lastly, these findings revealed that hypertension has

caused experiences of frequent headaches (40%); experiences of vision problems due to

hypertension (65%); experiences of chest pain or discomfort due to hypertension (29%).

Conclusion

Based on the findings of the study, it can be concluded that elderly patients at Madonna

University Teaching Hospital possess a satisfactory level of knowledge regarding hypertension.

The majority of respondents demonstrated awareness of hypertension as high blood pressure,

recognized the importance of lifestyle changes in its management, and identified common risk

factors and potential complications associated with the condition. While there were areas for

improvement, such as occasional lapses in medication adherence, overall, the findings suggest

that elderly patients are equipped with the necessary knowledge to effectively manage

hypertension.

Recommendation

Continued Patient Education: Healthcare providers should continue to provide education and

information sessions to elderly patients about hypertension, its risk factors, and management

strategies. This can help reinforce knowledge and address any misconceptions or uncertainties.

32
Support for Medication Adherence: Strategies should be implemented to support consistent

medication adherence among elderly patients, such as reminder systems, medication

management aids, and regular follow-up appointments with healthcare providers to monitor

progress and address any challenges.

Promotion of Healthy Lifestyle Behaviors: Efforts should be made to promote healthy lifestyle

behaviors among elderly patients, including regular exercise, healthy eating habits, stress

management techniques, and smoking cessation programs. This can help reduce modifiable risk

factors for hypertension and improve overall cardiovascular health.

Suggestion for Further Studies

Future research could explore the effectiveness of educational interventions and support

programs in improving hypertension management outcomes among elderly patients.

Additionally, longitudinal studies could investigate the long-term impact of lifestyle

modifications and medication adherence on hypertension control and cardiovascular outcomes in

this demographic group.

By implementing these recommendations, healthcare providers can contribute to improving

hypertension management and reducing the risk of associated complications among elderly

patients at Madonna University Teaching Hospital and similar healthcare settings.

33
 REFERENCES
A.M. Iqbal; S.F. (2023) Essential Hypertension. Jamal Author Information and Affiliations, Last
Update: July 20, 2023
American Heart Association. (2021). Age, Race, and Hypertension. Retrieved from
https://www.heart.org/en/health-topics/high-blood-pressure/why-high-blood-pressure-is-
a-silent-killer/age-race-and-hypertension
Arakelyan, H. S., and Sahakyan. A. S. (2019). Types of Hypertension and Treatment Tactics,
General Medicine and Clinical Research. Senior Expert of Interactive Clinical
Pharmacology, Drug Safety.
Blalock, S. J., Roberts, A. W., Lauffenburger, J. C., Thompson, T., O'Connor, S. K., Nugent, K.,
& Malone, D. C. (2016). Impact of a pharmacist-led intervention on hypertension
management in older adults: A randomized controlled trial. The Journal of Clinical
Hypertension, 18(2), 144–151.
34
Bodenheimer, T., Wagner, E. H., & Grumbach, K. (2002). Improving primary care for patients
with chronic illness. JAMA, 288(14), 1775–1779.
Bosworth, H. B., Powers, B. J., Olsen, M. K., McCant, F., Grubber, J. M., & Smith, V. (2011).
Home Blood Pressure Management and Improved Blood Pressure Control. Journal of
Clinical Outcomes Management, 18(7), 305–312.
Cardiol, W. J.(2012). Hypertension In elderly. Published online 2012 May 26. doi:
10.4330/wjc.v4.i5.135PMCID: PMC3364500PMID: 22655162
Centers for Disease Control and Prevention. (2021). About Sodium (Salt). Retrieved from
https://www.cdc.gov/salt/index.htm

Chafetz,P.K.,(2018).Stages of adulthood. Accessed from http://www.paulchafetz.com/stages-of -

adulthood.html.
Chen, S.-L., Lee, W.-L., Liang, T., Liao, I.-C., Lin, Y.-C., Lin, T.-Y., et al. (2015). Effects of
self-management on chronic kidney disease: A meta-analysis. International Journal of
Nursing Studies, 52(4), 673–684.
Chen, S.-L., Lee, W.-L., Liang, T., Liao, I.-C., Lin, Y.-C., Lin, T.-Y., et al. (2019). Impact of a
community-based intervention on hypertension control in elderly patients: A quasi-
experimental study. BMC Geriatrics, 19(1), 158.\
Coleman, K., Austin, B. T., Brach, C., & Wagner, E. H. (2009). Evidence on the Chronic Care
Model in the new millennium. Health Affairs, 28(1), 75–85.
Fakhri, S., Babee, S., Naji, H., & Zadeh, A. H., (2010). Knowledge, attitudes and practice
about hypertension in hypertensive patient referring to public health care centres in
Khoor and Biabanok. Isfahan Journal of Nursing and Medical Research, 16 (1), 34 – 40.
Flack, J. M., and Adekola, B. Blood pressure and the new ACC/AHA hypertension guideline
Affiliation PMID: 31521481 DOI: 10.1016/j.tcm.2019.05.003
Hamdan, N. A., Saeed, A., Kutbi, A., Choudhry, A. J., & Nooh, R., (2010). Characteristics,
risk factors and treatment practices of known adult hypertensive patients in Saudi Arabia:
International Journal of Hypertension, 10 (2), 4061 -4075
John. P., Cunha, DO, FACOEP. (2022). Medicine health: What Are the Stages of Hypertension
Krousel-Wood, M., Joyce, C., Holt, E., Muntner, P., Webber, L. S., Morisky, D. E., et al. (2009).
Predictors of decline in medication adherence: Results from the cohort study of
medication adherence among older adults. Hypertension, 53(5), 823–829.
Lothar, H., Gottfried, E., & Heide, S., (2011). The risk factor concept in cardiovascular
diseases. Accessed from http://www.ilo.org/safe work book shelf/English.
Mohammad G. S. & Neeraj V. D.(2016) Timeline of History of Hypertension Treatment
Published online 2016 Feb 23. doi: 10.3389/fcvm.2016.00003 PMCID: PMC4763852
PMID: 26942184

35
Muntner, P., Levitan, E. B., Brown, T. M., Sharma, P., Zhao, H., Bittner, V., et al. (2014).
Trends in the prevalence, awareness, treatment and control of high low density
lipoprotein-cholesterol among United States adults from 1999-2000 through 2009-2010.
American Journal of Cardiology, 114(2), 216–225.
National Heart, Lung, and Blood Institute. (n.d.). Physical Activity and Blood Pressure.
Retrieved from https://www.nhlbi.nih.gov/health-topics/physical-activity-and-your-heart
Noeda, M. G.(2016) Barriers to Treatment and Control of Hypertension among Hypertensive
Participants: A Community-Based Cross-sectional Mixed Method Study in
Municipalities of Kathmandu, Nepal. Published online 2016 Aug 2. doi:
10.3389/fcvm.2016.00026
Olusogo, E. B., & Olaleye, O., (2011). Impact of Patients‟ knowledge, attitude and practices on
hypertension and compliance with anti-hypertensive drugs in a resource poor setting in
Nigeria. TAF Preventive Medical Journal Bulletin. 9(2), 87-92.
Pereira, T., Maldonado, J., Polonia, J., & Silva, J. A. (2014). Familial Aggregation of
Hypertension in a Population Undergoing Regular Medical Examinations. Journal of
Hypertension, 32(4), 857–864.
Quang,T., Scott R. A., Lindsay S., Loida D.N., (2012). Managing Hypertension in the Elderly: A
Common Chronic Disease with Increasing Age.
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education
Monographs, 2(4), 328–335.
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education
Monographs, 2(4), 328–335.
Smith, J., Braunack-Mayer, A., & Wittert, G. (2018). Barriers to hypertension control and
management in older adults: A qualitative study. Family Practice, 35(6), 731–736.
Stewart, J. C., Evans, M. A., Hill, J., McCabe, P., & Bray, J. (2017). Effectiveness of a
Multifactorial Intervention on Blood Pressure Control in Elderly Hypertensive Patients:
A Randomized Controlled Trial. Journal of Clinical Medicine Research, 9(8), 679–685.
Surya D., Raja R.D., Achyut R.B., Bihungum B., Savyata P., Kartikesh K.T., Ratna
Touy, R.M. (2022). Hypertension 2022 Update: Focusing on the Future Originally published13
Jul2022https://doi.org/10.1161/HYPERTENSIONAHA.122.19564–1562
Wagner, E. H., Austin, B. T., Davis, C., Hindmarsh, M., Schaefer, J., & Bonomi, A. (2001).
Improving Chronic Illness Care: Translating Evidence Into Action. Health Affairs, 20(6),
64–78.
Wikipedia (2014) Risk Factors. Free encyclopedia Online. Retrieved from http://en/wikipedia.
Org/wiki/Riskfactors .
Wikipedia (2015). Preventive Measures. Free encyclopedia Online. Retrieved from
http://en/wikipedia.Org/wiki/Preventivemeasures .

36
 APPENDIX A

MADONNA UNIVERSITY, NIGERIA

FACULTY OF SCIENCES
DEPARTMENT OF NURSING SCIENCE
P.M.B 48, Elele, Rivers State

Our Ref……………………………… Office of: Head of Department

Your Ref ……………………………. C/O RN, Chukwu Chinenye.
Tel: +234 8130771163
Email [email protected]

37
 TO WHOM IT MAY CONCERN

The bearer DURU AMARACHI JUDITH index number 2024/3240/181519/N is a bona-fide student
of this University. She is carrying out a Research on, KNOWLEDGE AND UNDERSTANDING
OF HYPERTENTION AMONG ELDER PATIENTS IN MADONNA UNIVERSITY
TEACHING HOSPITAL ELELE, RIVERS STATE, as part of the requirements for the award of
‘Registered Nurse” Certificate.

She is asking for permission to obtain data from your Hospital. Kindly accord her the necessary
assistance, please. All information / data shall be treated as strictly confidential. At the end of
the study the finding shall be communicated to you.

Yours faithfully,

Dr Chukwu Chinenye.
HOD

APPENDIX B

INFORMED CONSENT

Madonna University

Nursing Science Department,

Elele campus

Rivers State.

Dear respondents,

38
 I am a 400 level student of the above named institution carrying out a research study

on KNOWLEDGE AND UNDERSTANDING OF HYPERTENTION AMONG ELDERLY

PATIENTS IN MADONNA UNIVERSITY TEACHING HOSPITAL ELELE, RIVERS

STATE. The questionnaire is strictly for collection of data for academic purposes. Please supply

the information as frankly as possible to make this study a success. Rest assured that all

information given by you will be treated with strict confidentiality. Your names and personal

identifiers are not required.

Thank you for your acceptance and co-operation.

Yours faithfully

DURU AMARACHI JUDITH .

APPENDIX C

QUESTIONNAIRE
KNOWLEDGE AND UNDERSTANDING OF HYPERTENSION AMONG ELDERLY

PATIENTS IN MADONNA UNIVERSITY TEACHING HOSPITAL, ELELE

Instruction:

Please answer the following questions to the best of your ability. Your responses can be marked

with an “X” or a tick (√). There is no right or wrong answers and your opinion is of great value

to us please.

39
 Section A: Demographic Information

Demographic information OPTIONS

1. Age Range 65-69 ( )

70-74 ( )
75-79 ( )
80 and above ( )
2. Gender Male ( )
Female ( )
3. Location Outpatient Department ( )
Inpatient Department ( )
4. Level of Education No formal education ( )
Primary school ( )
Secondary School ( )
Tertiary Education ( )

SECTION B: Understanding of Hypertension

Instruction: Tick (√) in the appropriate boxes below where;

SA: Strongly aware, A: Aware, SU: Strongly Unaware, U: Unaware

S/N Variables SA A SU U

1. Are you aware of hypertension?

2. Are you aware that hypertension

can be treated through lifestyle

40
 changes?

3. Are you aware of the risk factors

that are associated with

hypertension?

SECTION C: Management of Hypertension

S/N Variables SA A SU U

4 Are you aware of the common

medications used to treat

hypertension?

5 Are you aware of how often

blood pressure should be checked

41
 in individuals with hypertension?

6 Are you aware of the relevance of

your adherence to the prescribed

medication regimen for

hypertension?

7 Are you aware of some

potential complications of

uncontrolled hypertension?

SECTION D: Various Effects of Hypertension to Elderly Patients in Madonna University

Teaching Hospital

S/N Variables SA A SU U

8 Are you aware that vision

problems occur due to

hypertension?

42
 9 Are you aware that

frequent headache occur

as a result of

hypertension?

10 Are you aware that chest

pains occur as a result of

hypertension?

APPENDIX D

Letter of Attestation

MADONNA UNIVERSITY TEACHING HOSPITAL (MUTH)

ELELE, RIVERS STATE, NIGERIA

NURSING SERVICES DEPARTMENT

Our Ref…………………………

Your Ref……………………… Date……………..

43
______________________________________________________________________________

______________________________________________________________________________

TO WHOM IT MAY CONCERN

The bearer DURU AMARACHI JUDITH ( 2024/3240/181519/N) is a bona-fide student of

this institution who is carrying out a research on the KNOWLEDGE AND UNDERSTANDING
OF HYPERTENSION AMONG ELDERLY PATIENTS IN MADONNA UNIVERSITY
TEACHING HOSPITAL as a part of requirement for the award of “Bachelor of Nursing
Science” certificate.

The student is able to obtain data from this establishment

Kindly accord her necessary assistance, please.

The student is permitted to obtain data from this establishment. Kindly accord her the necessary
assistance, please.

All information/ data shall be treated as strictly confidential. At the end of the study the findings
shall be to this department.

Yours faithfully,

______________

Ebubedike Rose (Mrs)

APPENDIX E

RELIABILITY TEST

Table showing respondents results

44
Using Pearson’s correlation coefficient formula

n (∑xy)-(∑x) (∑y)

√n (∑x^2)-(∑x) ^2*n (∑y^2) - (∑y) ^2

= 20 (4028) – (197)(201)

______________________________________

2 2
√20 (4009)-(197) * 20(4109) - (201)

= 80560 – 39597

_______________________________

√80180 – 38809 * 82180 - 40401

45
= 40963

_______________

√41371 * 41779

= 40963

_______________

√1728439009

= 40963

__________________

41574.50

= 0.98529

The test-retest result has a positive correlation of 0.98

APPENDIX F

RECOMMENDATION LETTER

To the Research Committee

Department of Nursing

Madonna University

Student’s Name: DURU AMARACHI JUDITH

46
Index number 2024/3240/181519/N.

The Research Project entitled: KNOWLEDGE AND UNDERSTANDING OF

HYPERTENTION AMONG ELDERLY PATIENTS IN MADONNA UNIVERSITY
TEACHING HOSPITAL ELELE, RIVERS STATE of which I have mentored has been
reviewed, corrections have been made and is recommended for submission/ presentation, in
particular (please check) for:

Research Proposal (Chap 1-3) for pre-council exams

Complete Research Project (Chap1-5) for council exam

Others (Internal or External Defense) for BNSc degree

Remarks (if any) _________________________________________

_______________________________________________________

Name of Supervisor: MAAM SARAH LABADAN

(Signature over printed name)

Date: _________________________

47