The Influence of Living Arrangement on the Management and Control of Hypertension: A Mixed-Method Study

Tuesday, 31 July 2012: 1:55 PM

Hae-Ra Han, RN, PhD, FAAN
School of Nursing, The Johns Hopkins University, Baltimore, MD
Miyong T. Kim, PhD
Health Systems and Outcomes, Johns Hopkins University, Baltimore, MD

Learning Objective 1: The learner will be able to describe the influence of living arrangement on elderly health outcomes.

Learning Objective 2: The learner will be able to identify factors that influence hypertension control among Korean American elders, with a focus on system-level variables.

Purpose: Recent studies have found that elders living alone may experience worse health outcomes than those living with spouse and/or children, yet none of these studies specifically looked at the relationship in relation to chronic disease management outcomes. The purpose of this study was to examine the relationship between living arrangement and HBP control status.

Methods: We used baseline survey data obtained from 440 Korean American elders (60 yrs or older) who participated in a randomized trial to promote high blood pressure (HBP) control. In addition, individual telephone interviews were done with a sub-sample (n=12) to better understand the pattern of social interactions by living arrangement and its influence on their health behaviors.

Results: The sample were mostly female (70%) in their early 70s (mean=71 years). The most frequent type of living arrangement was “living with spouse (52%),” followed by “living with child(ren) (28%)” and “living alone (20%).” Those who reported “living alone” were more likely to be female and older, and tended to reside in senior group housing (p< 0.01 for all tests). Shorter length of stay in the United States (OR=0.97; 95% CI 0.94-0.99), shorter years of having HBP (OR=1.00; 95% CI 0.99-1.00) and living alone (OR=2.02; 95% CI 1.06-3.84) were significantly associated with BP control. Based on the individual interviews, those in senior group housing tended to have more frequent social interactions which often involved casual conversations around health topics and positive encouragements about HBP medication taking and health information sharing.

Conclusion: Korean American elders living independently are neither socially-isolated nor at increased risk for poor BP control when compared with peers in alternate living arrangements. The findings also point to the need for research at broadening our knowledge and understanding about the benefits of social support-based system approach to better improve community health systems.