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DOI: 10.32725/kont.2018.007

KONTAKT / Journal of nursing and social sciences related to health and illness

Original research article

Prevalence of hypertension and predictive factors
of self-efficacy among elderly people with
hypertension in institutional-based rehabilitation in
Indonesia
Tantut Susanto*, Hanny Rasny, Latifa Aini Susumaningrum, Rismawan Adi
Yunanto, Kholid Rosyidi Muhammad Nur
University of Jember, Faculty of Nursing, Department of Community, Family, and Gerontic Health Nursing, Jember, Indonesia

Abstract
Aim: Identification of hypertension factors among elderly people is expected to form appropriate nursing interventions to improve
the self-efficacy of patients by modifying factors affecting the blood pressure of elderly people with hypertension. The aim of this
study is to investigate the prevalence of hypertension and predictive factors of self-efficacy among elderly people with hypertension
in institution- based rehabilitation (IBR) in Indonesia.
Methods: An IBR cross-sectional study was conducted, involving 64 elderly people selected through random sampling. Research data
were collected using a structured questionnaire and standard protocol, employing a stethoscope and sphygmomanometer to measure
blood pressure. The data were then analysed using descriptive and comparative statistics, as well as multivariate linear regression
analyses.
Results: The prevalence of systolic and diastolic hypertension among elderly people who lived in the IBR were 31.30% and 45.30%,
respectively. The predictors of self-efficacy of the elderly with regard to systolic hypertension were spiritual activity, length of stay,
education, the occupation of the elderly before entering the rehabilitation, and dementia; while daily activities, risk of falling, pain,
and depression anxiety and stress become significant predictors of self-efficacy in elderly people with diastolic hypertension.
Conclusion: This study provides new evidence that signifies the current burden of hypertension and the critical factors of self-
efficacy for uncontrolled hypertension among the elderly in the IBR. The study suggests that health-promotion programs should be
developed to modify factors of hypertension among elders of IBR in Indonesia.

Keywords: Blood pressure; Elderly; Hypertension; Institution-based rehabilitation; Self-efficacy

Introduction Attitudes and views of hypertension (Elder et al., 2012)

impacts on complications, progression of illness, improper
Changes in the aging process will affect the body’s physical care, and premature death among elders (Yu et al., 2001).
functioning which is commonly associated with hypertension Self- care management is urgently needed for controlling the
problems (Son and Won, 2017). The prevalence of hyperten- blood pressure of elderly people (Friedberg et al., 2015).
TJPO JO *OEPOFTJB JT 4Z.9% JO UIF BHF HSPVQ PG ZZo64 Health be- havior management (Martin et al, 2008) and
ZFBST, health promotion (Li and Zhang, 2013) positively correlated
57.6% in the age group of 65–74 years, and 63.8% in the age with the elderly’s self-efficacy related to hypertension.
HSPVQ PG 5Z ZFBST BOE BCPWF (#BEBO 1FOFMJUJBO EBO 1FOHFN- Furthermore, self-effica- cy is an important factor in relation
to hypertension self-care behaviors (Warren-Findlow et al.,
bangan Kesehatan, 2013). As the age increases, the blood
2012). Therefore, self-effi- cacy is necessary for controlling
pressure increases and hypertension is generally considered a
or altering factors affecting blood pressure in elderly people
OPSNBM DPOEJUJPO JO UIF FMEFSMZ (-FF BOE 1BSL, h0ß5). 5P
with hypertension.
NBJO- UBJO UIF CMPPE QSFTTVSF PG FMEFSMZ QFPQMF BU ß40/90
1SFWJPVT SFTFBSDI IBT TIPXO UIBU NFOUPSJOH BOE USBJOJOH
NN)H JT
very difficult (Currie and Delles, 2018). This is associated programs with self-efficacy can improve the health behavior
and quality of life of hypertensive patients (Eom and Lee,
with various factors such as age, body weight (obese), lower
level of education, an unbalanced dietary pattern, regular 2017), while an intervention program in the community is
able to improve the self-efficacy and health behavior and to
drinking and non-comorbidities (Yang et al., 2017).
Therefore, behav- ior management (Douglas and Howard. reduce the modifiable cardiovascular risk factors of elderly
QFPQMF XJUI IZQFSUFOTJPO (:BOH FU BM., h0ß6). 1SFWJPVT TUVEJFT
2015) and self-efficacy (Sol et al., 2006) are needed for
have shown the role of self-efficacy in decreasing salt intake
maintaining blood pressure and its factors among the elderly
to keep the hypertension problem under control. (Irwan et al., 2016), reducing depression, encouraging
medica-

* Author for correspondence: Tantut Susanto, University of Jember, Faculty of Nursing, Department of Community,
Family, and Gerontic Health Nursing, Jl. Kalimantan 37, Jember, Jawa Timur, 68121 Indonesia; e-mail:
[email protected] http://doi.org/10.32725/kont.2018.007
4VCNJUUFE: h0ß8-05-03 t "DDFQUFE: h0ß8-ßß-0h t 1SFQVCMJTIFE POMJOF: h0ß9-0ß-ßß
,0/5",5 hß/ß: ß4ohß t &*44/ ß804-5ßhh t *44/ ßhßh-4ßß5 ª
h0ß9 5IF "VUIPST. 1VCMJTIFE CZ 6OJWFSTJUZ PG 4PVUI #PIFNJB JO ſFTLÏ #VEƩKPWJDF, 'BDVMUZ PG )FBMUI BOE 4PDJBM 4DJFODFT.
This is an open access article under the CC BY-NC-ND license.
 Susanto et al. / 15
KONTAKT

tion adherence (Son and Won, 2017), and improving the

We also measured the elderly measurement status, includ-
regu- larity of exercise (Jewpattanakul, 2012) and physical
ing Katz Index of Independence in Activities of Daily Living
activities (Martin et al., 2008). The health management of
the elderly hypertensive is determined by the existence of ("%-) (8BMMBDF BOE 4IFMLFZ, h000), 4IPSU 1PSUBCMF .FOUBM
self-efficacy in modifying any factor associated with blood 4UB- UVT 2VFTUJPOOBJSF (41.42) (1GFJêFS, ß95Z), ɥF .JOJ
pressure control. .FOUBM 4UBUF &YBNJOBUJPO (..4&) (3JEIB BOE #PTTPS, h00Z),
This study included self-efficacy among elderly patients "1("3 'BNJMZ (4NJMLTUFJO, ß958), #FDL’T %FQSFTTJPO
with hypertension in Indonesia. With the identification of 4DBMFT (#%4) (#FDL FU BM., ß96ß), .JOJ $PHOJUJWF (#PSTPO FU
these factors, it is expected that appropriate nursing inter- BM., h003), %BJMZ
ventions can be designed to improve the self-efficacy of pa- Spiritual Experience Scale (DSES) (Krebs et al., 2007),
tients by modifying factors which affect the blood pressure Depres- sion Anxiety Stress Scale 42 (DASS-42) (Lovibond
of elderly people with hypertension. Therefore, the and Lovi- CPOE, ß99Z), %FQSFTTJPO "OYJFUZ 4USFTT 4DBMF ß4
objective of the study was to investigate the prevalence of (%"44-ß4) (8JTF FU BM., h0ß5), 1BJO /VNFSJD 3BUJOH 4DBMF
hypertension and the predictive factors of self-efficacy (/34) (,SFCT FU BM., h005), .PSTF 'BMM 4DBMF (.PSTF FU BM.,
among the elderly with hypertension in institution-based ß989), BOE (FOFSBM 4FMG-FïDBDZ (4DIXBS[FS BOE +FSVTBMFN,
rehabilitation in Indo- nesia. ß99Z).
To measure blood pressure, we used a standard protocol
employing a stethoscope and sphygmomanometer. In this
study, we controlled blood pressure by maintaining systolic
blood pressure below 140 mmHg and diastolic blood pressure
CFMPX 90 NN)H ($VSSJF BOE %FMMFT, h0ß8). 6ODPOUSPMMFE IZ-
Materials and methods pertension was defined as systolic blood pressure ≥140
mmHg
Sample and setting PS EJBTUPMJD CMPPE QSFTTVSF ǘ90 NN)H CBTFE PO UIF NFBO WBM-
An institutional rehabilitation-based cross sectional study ue measured.
was conducted. After this, we used a convenience sampling.
Approximately, 64 elders participated in this study. The par- Analysed data
ticipants were selected using a simple random sampling "MM SFTFBSDI EBUB XFSF BOBMZTFE VTJOH UIF *#. 4UBUJTUJDBM 1BDL-
tech- nique. The criteria for the participants were as follows: age for Social Sciences software program, version 22.0.
(1) age Statis- tic descriptive was used to determine the
≥ 55 years (people aged over 55 years are classified as early characteristics of the participants with mean and standard
elderly in Indonesian context); (2) living in institutional care; deviation (for numeric data) and percentage (for categorical
(3) having the ability to communicate verbally with the re- data). Firstly, we tested the normality of the distribution of
searcher and understand all of the questions and (4) signing the data. Then, Chi-square tests and t-tests of independence
the consent form. We excluded elderly people with mental were used to compare cate- gorical and continuous variables
dis- orders (schizophrenia) and psychological dysfunction. in systolic and diastolic blood pressure. To determine factors
related to self-efficacy, a linear regression analysis was used
Data collection to examine the relationship be- tween several factors of
The data was collected for one month (in March 2018). We elderly people and the self-efficacy of elderly people with
measured the characteristics of the participants as follows: hypertension. A p-value < 0.05 was consid- ered statistically
significant.
age (years), gender (male vs. female), length of stay in insti-
tutional care (years), ethnicity (Jawa, Madura, or Mixed), ed-
ucation (not attending, elementary school, junior high Results
school, senior high school, and university/college),
occupation before entering the institution (public The prevalence of systolic and diastolic hypertension among
government, entrepreneur, farmer/seller), and marital status the elderly who lived in the institutional rehabilitation were
(single, married, divorced, widowed). 31.30% and 45.30% respectively (Table 1).

Table 1. Correlation between the characteristics of participants, health status and blood pressure (n = 64)
Variable Total Systolic blood pressure Diastolic blood pressure
2
n (%) <150 mmHg >150 mmHg t/χ p-value ‹90 NN)H ›90 NN)H t/χ2 p-value
Age (year)
M ± SD 5ß.86 œ 9.94 5ß.ßß œ 8.9Z 53.Z0 œ ßß.9h o0.889 0.378 70.43 ± 10.28 53.Z9 œ 9.40 –1.271 0.208
Gender
Male 38 (Z9.40) h6 (Z9.ß0) 12 (60.00) 0.000 1.000 21 (60.00) 17 (58.60) 0.000 1.000
Female 26 (40.60) ß8 (40.90) 8 (40.00) 14 (40.00) 12 (41.40)
Length of stay (year)
M ± SD 3.70 ± 4.44 4.16 ± 5.17 2.70 ± 1.84 1.657 0.103 4.43 œ Z.Z9 2.83 ± 2.24 1.552 0.127
Ethnicity
Madura ß4 (hß.90) 9 (h0.Z0) 5 (25.00) 0.730 0.694 10 (28.60) 4 (13.80) 5.084 0.059
Jawa 44 (68.80) 30 (68.20) 14 (70.00) 20 (57.10) 24 (82.80)
Etc 6 (9.40) 5 (11.40) 1 (5.00) 5 (14.30) 1 (3.40)
Education
Did not attend 16 (25.00) 8 (18.20) 8 (40.00) 4.968 0.h9ß 9 (hZ.50) 7 (24.10) 0.771 0.94h
Elementary school 24 (37.50) ß8 (40.90) 6 (30.00) 14 (40.00) 10 (34.50)
Junior high school 8 (12.50) 5 (11.40) 3 (15.00) 4 (11.40) 4 (13.80)
Senior high school 13 (20.30) 10 (22.70) 3 (15.00) 7 (20.00) 6 (20.70)
University college 3 (4.70) 3 (6.80) 0 ß (h.90) h (6.90)
16 Susanto et al. / KONTAKT

Table 1 (Continued)
Variable Total Systolic blood pressure Diastolic blood pressure
n (%) <150 mmHg >150 mmHg t/χ2 p-value ‹90 NN)H ›90 NN)H t/χ2 p-value
Occupation before entrance
1VCMJD HPWFSONFOU 3 (4.70) 3 (6.80) 0 3.5Z9 0.153 0 3 (10.30) 4.736 0.094
Enterpreneurship 13 (20.30) 11 (25.00) 2 (10.00) 9 (hZ.50) 4 (13.80)
Others 48 (75.00) 30 (68.20) ß8 (90.00) 26 (74.30) hh (5Z.90)
Marital status
Single 5 (ß0.90) 5 (ßZ.90) 0 4.9Z6 0.175 6 (17.10) 1 (3.40) 4.213 0.h39
Married 24 (37.50) 16 (36.40) 8 (40.00) 13 (37.10) ßß (35.90)
Divorced 6 (9.40) 5 (11.40) 1 (5.00) 4 (11.40) h (6.90)
Widowed 27 (42.20) 16 (36.40) 11 (55.00) 12 (34.30) 15 (51.70)
KATZ
0 Z8 (90.60) 40 (90.90) ß8 (90.00) h.5h9 0.435 3h (9ß.40) h6 (89.50) 2.076 0.557
1 4 (6.30) 3 (6.80) 1 (5.00) 2 (5.70) h (6.90)
2 1 (1.60) 0 1 (5.00) 0 1 (3.40)
4 1 (1.60) 1 (2.30) 0 ß (h.90) 0
41.42
1 28 (43.80) ß9 (43.h0) 9 (4Z.00) ß.988 0.575 16 (45.70) 12 (41.40) 4.646 0.200
2 17 (26.60) 11 (25.00) 6 (30.00) 7 (20.00) 10 (34.50)
3 15 (23.40) 10 (22.70) 5 (25.00) 8 (hh.90) 7 (24.10)
4 4 (6.30) 40 (9.ß0) 0 4 (11.40) 0
MMSE
1 15 (23.40) 10 (22.70) 5 (25.00) 0.388 0.824 7 (20.00) 8 (27.60) 1.800 0.407
2 16 (25.00) 12 (27.30) 4 (20.00) 11 (31.40) 5 (17.20)
3 33 (51.60) 22 (50.00) 11 (55.00) 17 (48.60) 16 (55.20)
"1("3 'BNJMZ
1 10 (15.60) 5 (ßZ.90) 3 (15.00) 0.063 0.969 6 (17.10) 4 (13.80) 0.h99 0.861
2 21 (32.80) 14 (31.80) 7 (35.00) 12 (34.30) 9 (3ß.00)
3 33 (51.60) 23 (52.30) 10 (50.00) 17 (48.60) 16 (55.20)
BDS
1 ß9 (h9.50) ß3 (h9.Z0) 6 (30.00) 3.710 0.h94 11 (31.40) 8 (27.60) 0.642 0.887
2 22 (34.40) ßh (h9.Z0) 9 (4Z.00) 11 (31.40) ßß (35.90)
3 17 (26.60) 12 (27.30) 5 (25.00) 9 (hZ.50) 8 (27.60)
4 6 (9.40) 6 (13.60) 0 4 (11.40) h (6.90)
Mini cognitive
0 5 (7.80) 5 (11.40) 0 h.9ZZ 0.228 32 (8.60) h (6.90) 0.331 0.847
1 15 (23.40) 11 (25.00) 4 (20.00) 9 (hZ.50) 6 (20.70)
2 44 (68.80) 28 (63.60) 16 (80.00) 23 (65.70) 21 (72.40)
DSES
1 5 (ß0.90) 5 (ßZ.90) 0 4.Z93 0.101 5 (14.30) h (6.90) 3.756 0.153
2 ß9 (h9.50) 14 (31.80) 5 (25.00) 13 (37.10) 6 (20.70)
3 38 (Z9.40) 23 (52.30) 15 (75.00) 17 (48.60) 21 (72.40)
Self-efficacy
M ± SD h5.88 œ 6.Z9 27.34 ± 6.42 h9.0Z œ 6.96 o0.96h 0.340 h5.ßß œ 6.ß9 h8.59 œ 5.03 –1.015 0.314
DASS 42
M ± SD hZ.98 œ h0.0Z h6.36 œ ß9.33 25.15 ± 22.05 0.223 0.824 hZ.49 œ ß9.83 h6.Z9 œ h0.64 –0.217 0.8h9
DASS 14
M ± SD 9.08 œ 8.08 ß0.h3 œ 8.98 6.ZZ œ 4.9Z 2.104 0.040a 9.69 œ 9.ßh 8.34 ± 6.70 0.658 0.513
NRS
0 27 (42.20) ß9 (43.h0) 8 (40.00) 1.142 0.767 14 (40.00) 13 (44.80) 0.983 0.805
1 24 (37.50) 17 (38.60) 7 (35.00) 13 (37.10) ßß (35.90)
2 12 (18.80) 5 (ßZ.90) 5 (25.00) 7 (20.00) 5 (17.20)
3 1 (1.60) 1 (2.30) 0 ß (h.90) 0
MORSE
1 26 (40.60) ß8 (40.90) 8 (40.00) ß.9Z8 0.376 12 (34.30) 14 (48.30) 8.348 0.015b
2 hZ (39.ß) ß9 (43.h0) 6 (30.00) ß9 (Z4.30) 6 (20.70)
3 13 (20.30) 5 (ßZ.90) 6 (30.00) 4 (11.40) 9 (3ß.00)

Note: a t = t-independent test; b χ2 = Chi-Square.

 Susanto et al. / 17
KONTAKT

The characteristics of the participants (Table 1) showed

also a correlation between Morse risk fall and diastolic
UIBU UIF NFBO BHF PG UIF FMEFSMZ XBT 5ß.86 œ 9.94 ZFBST,
hyper- tension (χ2 = 8.348; p = 0.015).
BOE Z9.40% XFSF NBMF. ɥF MFOHUI PG TUBZ PG UIF FMEFSMZ JO
Multiple linear regression using the stepwise method de-
JOTUJUV-
termined the explanatory variables predictive of the elderly’s
tional rehabilitation was 3.70 ± 4.44 years. The elderly in in-
self-efficacy with systolic hypertension. The last model (Ta-
stitutional rehabilitation still had functional family based on
ble 2) shows spiritual activity, length of stay, education, oc-
"1("3 TDPSFT (Zß.60%) BOE NJME EFQSFTTJPO (34.40%).
cupation before entering the institutional rehabilitation, and
"MNPTU 68.80% PG UIF FMEFSMZ QFPQMF IBE EFNFOUJB, XIJMF
dementia as significant predictors of self-efficacy of the
Z9.40% PG
elderly people with systolic hypertension (p < 0.05).
them had regularly experienced spiritual activities. Table 1
shows that there was a correlation between DASS-14 and
sys- tolic hypertension (t = 2.104; p = 0.040). Meanwhile,
there was

Table 2. Factors which influenced self-efficacy of the elderly people with systolic hypertension in a nursing home (n = 20)
Variable Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Model 7 Model 8 .PEFM 9
Marital status –
MORSE 0.099
"1("3 0.773 0.59ß
MMSE –0.606 o0.609 –0.461
DASS 14 –0.080 –0.076 –0.110 –0.118
Gender –4.048 –4.087 –4.201 –4.264 o3.89h
DASS 42 –0.075 –0.075 –13.437 –0.065 –0.084 –0.044
Ethnicity –7.014 –7.042 o5.ßß9 –7.048 –6.607 –5.657 –5.877
BDS 5.603 5.623 Z.Z90 5.484 6.070 5.657 5.168 3.272
KATZ ß6.Z09 16.644 16.172 15.700 16.226 11.668 10.072 5.728 6.110
Age 0.h69 0.272 0.241 0.234 0.248 0.ß9ß 0.202 0.241 0.217
NRS oß3.890 oß3.9ß5 –13.437 –13.108 –13.466a oß0.Z93a oß0.495a –7.012 oZ.950
41.42 –13.461 –13.563 oß3.098 –13.060 –12.686 o9.h83a o9.ßZ4a –7.018 –6.677
DESS 5.099 7.163 7.386 7.245 6.661 4.876 4.810 4.881 6.430a
Length of stay 1.452 1.455 ß.449 1.431 1.348 1.741 ß.95Za h.039a 2.354a
Education oß0.49Z –10.547 –10.234 –10.144a o9.9ßßa –10.336b –10.341b –10.217b –11.070b
Occupation before entrance –20.714 oh0.569 –10.234 oh0.h39a oß9.4Z0a –18.881b oß9.5h9b –20.130b –21.162b
Mini Cog oßh.539 oßh.569 –12.704 –12.658 –12.474 oß8.h90b oß9.804b –17.415b –18.211b
R Square 0.89ß 0.89ß 0.89ß 0.890 0.889 0.875 0.869 0.823 0.59Z
Constant 76.016 76.154 55.Z59 77.554 73.532 67.415 66.856 Zß.594 56.407

Note: a p < 0.05; b p < 0.01.

pertensive outcomes among the elderly people may be due to

Multiple linear regression using the stepwise method de- differences in the setting of the study site and the character-
termined the explanatory variables predictive of the elderly’s
self-efficacy with diastolic hypertension. The last model (Ta-
ble 3) shows daily activities, risk of falling, pain, depression,
anxiety and stress as significant predictors of elderly people’s
self-efficacy with diastolic hypertension (p < 0.05).

Discussion
Prevalence of hypertension among the elderly
in institution-based rehabilitation
The current study found that the prevalence of systolic and di-
astolic hypertension among the elderly is low compared to the
hypertension of elderly people in Shanghai (Yang et al., 2017),
although the prevalence of elders with hypertension is higher
UIBO JO UIF *OEPOFTJBO CBTJD IFBMUI TVSWFZ (#BEBO 1FOFMJUJBO
EBO 1FOHFNCBOHBO ,FTFIBUBO, h0ß3). ɥF EJêFSFODF JO
IZ-
istics of the elderly people. The current research setting was
an institution-based rehabilitation centre in Indonesia; it is a
unit owned by the Social Service and Social Welfare, which
is limited in health service management because the main
focus of the activity is the daily social activities of the
elderly people. This will affect the health problems of the
elderly people. The results of this study are also consistent
with previous research, suggesting that institutionalization
of the elderly contributes to various problems of those
living in nursing homes (Som- bateyotha et al., 2016).
Therefore, modification of the form of nursing action of
the institutionalized elderly persons should focus on
enhancing their self-efficacy to control blood pres- sure, so
that hypertension among the elders can be compre-
hensively and holistically managed.

Factors related to the self-efficacy of elderly

people with systolic hypertension
There are five factors related to the self-efficacy of elderly
peo- ple with systolic hypertension, including education,
occupa- tion before entering institutional rehabilitation,
spiritual ac-
Table 3. Factors which influenced self-efficacy of the elderly people with diastolic hypertension in a nursing home (n = 29) 18
Variable Model 1 Model 2 Model 3 Model 4 Model 5 Model 6 Model 7 Model 8 .PEFM 9 Model 10 Model 11 Model 12 Model 13
Marital status 0.013
MORSE 0.040 0.041
"1("3 –0.406 –0.412 –0.314
MMSE 1.015 1.005 0.893 0.852
DASS 14 –1.017 –1.036 –0.757 –0.825 –0.678
Gender h.ß95 h.h39 ß.988 2.023 2.014 1.783
DASS 42 –2.064 –2.071 oß.9hh oß.998 oh.ß95 oh.399 oh.09Z
Ethnicity –2.575 –2.561 –2.412 –2.376 –2.266 –2.173 –2.278 oß.9ß8
BDS –2.444 –2.423 –2.178 –2.172 –2.365 –2.583 –3.308 –2.837 –2.877
KATZ oh.Z94 –2.611 –2.441 –2.463 –2.430 –2.650 –2.550 –2.221 –2.417 –1.854
Age –7.257 –7.348 o5.4h9 o5.669 –7.883 –7.206 –5.363 –6.782 o6.395 –8.062 –6.621
NRS 3.h93 3.h9ß 3.136 3.034 h.9ZZ 2.882 3.009 3.347 3.h9h 2.384 h.49Z ß.93h
41.42 4.420 4.444 4.246 4.210 4.401 4.260 4.630 3.520 3.346 3.501 3.498 3.076 h.696
DESS 0.h59 0.280 0.265 0.265 0.264 0.256 0.204 0.185 0.ß98 0.174 0.ßZ9 0.140 0.136 Su
sa
Length of stay 9.84ß 9.836 9.4ß8 9.h84 9.503 ß0.094 10.770 9.444 9.0ß6 8.ß90 8.123 8.640 8.809a nto
et
Education 7.023 7.018 5.09ß 7.055 6.963 6.662 6.256 6.731 6.475 7.260 7.553 7.257a 5.6Z9a al.
Occupation before entrance o9.969 o9.954 o9.66ß o9.480 o9.54Z o9.Z5Z 9.400 –8.581 –8.468 –8.210 –8.435 –8.551a –8.447a /
K
Mini Cog –0.220 –0.221 –0.214 –0.215 –0.212 –0.210 –0.204 –0.204 o0.ß89 –0.221 –0.213 –0.211b –0.208b O
N
R Square 0.536 0.536 0.536 0.536 0.535 0.534 0.527 0.517 0.505 0.49ß 0.482 0.455 0.438 T

Constant hß.469 21.517 22.620 23.020 h4.9ß4 25.310 27.423 27.718 24.216 27.510 23.414 ß9.h08 22.150

Note: a p < 0.05; b p < 0.01.

 Susanto et al. / 19
KONTAKT

tivities, length of stay, and dementia. In this study, education

maintain the functional status of independence in meeting
is related to the self-efficacy of the elderly people with
ba- sic needs. So, the elderly can establish self-efficacy to
systolic hypertension, which is consistent with previous
control blood pressure.
studies indi- cating that lower education is linked with
Our findings showed that the risk of falling among the el-
uncontrolled hyper- tension among elderly people (Yang et
derly is associated with self-efficacy on diastolic
al., 2017). These results suggest that education contributes to
hypertension. Similar to previous research, fall-risk is
the understanding of health information and the health
related to self-efficacy in daily activities (Hellström et al.,
literacy of the elderly.
2013). This can be because self-efficacy has a large influence
The findings illustrate that the occupation of the elderly
on the physical activities of the elderly (McAuley et al.,
people before entering the institution-based rehabilitation
2013). The results of this study sug- gest that there is a need
correlated with the self-efficacy of the elders with systolic hy-
to provide adequate physical activities to the elderly to
pertension. The results of this study are similar to those of pre-
prevent the risk of falling, so that the elders can achieve the
vious studies, indicating that the occupations will affect their
self-efficacy to control their blood pressure.
health literacy, self-efficacy and their attitude to hypertension
In this study, elderly people with pain condition are
USFBUNFOU QSPHSBN ("O BOE 1BSL, h0ß6). ɥJT SFTVMU NBZ JOEJ-
related to self-efficacy of diastolic hypertension, which is
cate, that there is a correlation between elderly people’s pre-
consistent with previous research suggesting that extensive
vious occupation and subsequent physiological condition.
pain was cor- related with low self-efficacy (Rahman et al.,
The physiological concept of wear and tear during their life
2008). This could be because the intensity of physical and
experi- ences are related to type of work; each type will
psychological pain af- fects comfort, which simultaneously
have a differ- ent impact on the health status of the elderly
affects the health status of the elderly people. Therefore,
people, especially their blood pressure. Therefore, the
good pain management dur- ing the aging process is needed
severity of hypertension will depend on the type of work
so that the elderly can increase the value of self-efficacy in
prior to retirement and living in institution-based
blood pressure control.
rehabilitation.
The findings of the current study indicate that depressive
Spiritual activities regarding DESS measurement corre-
anxiety and stress in the elderly are correlated with self-effica-
lated with the self-efficacy of systolic hypertension of the el-
cy of diastolic hypertension. These results are consistent with
derly people. This finding is consistent with previous
previous research; the depressed status of elderly people is as-
research indicating that religious programs based on Islam or
sociated with adherence of medication hypertension (Son and
spiritual wellbeing in elderly patients with hypertension
Won, 2017). This finding may be explained by the fact, that hy-
(Moeini et al., 2016) influenced the quality of their life
pertension is a chronic disease which affects the mental health
(Susanto and Widaya- ti, 2018). These results suggest that a
PG FMEFST BOE DBO MFBE UP EFQSFTTJPO (3VFEB BOE 1ÏSF[-(BSDÓB,
spiritual activity program should be developed in institution-
2006). To solve bad mental health of elders, group therapy
based rehabilitation based on the health beliefs of elderly
in IRB and nursing intervention should be initiated.
people to improve self-efficacy. Our findings show that the
Our research results also indicate the prevalence of hy-
length of stay in institu- tion-based rehabilitation correlates
pertension and factors affecting self-efficacy in elderly
with the self-efficacy of the elderly people with systolic
people with hypertension living in institution-based
hypertension. This is similar to previous research results
rehabilitation in Indonesia. The result of this research is the
that suggest hypertension was associated with
best study in older nursing in Indonesia, because to our
hospitalization. Therefore, community-based rehabilitation
knowledge of identifi- cation of self-efficacy hypertension in
is the best practice for elderly people to improve their
elderly in institutional rehabilitation in Indonesia is rarely.
activity, daily living and cognitive functions (Moeini et al.,
This study provides new evidence that signifies the current
2016). This suggests that involving the elderly in family
burden of hypertension and the critical factors of self-
and/or community-based rehabilitation is an option for im-
efficacy for uncontrolled hyperten- sion among the elderly
proving their self-efficacy in controlling blood pressure.
people in institution-based rehabilita- tion.
Others results showed that dementia is correlated with
the self-efficacy of the elderly people with systolic hyperten-
Limitations
sion. This is consistent with previous studies on self-efficacy,
dementia and hypertension in elderly people (Crellin et al., The limitations of this study include the cross-sectional
2014; Harmell et al., 2011). These findings could indicate nature of the study design, which resulted in associations
that the cognitive function of elderly people with dementia being found among the variables, rather than causal
will in- fluence their perception in modifying their health conclusions. There is a further limitation regarding the
behavior in achieving self-efficacy in controlling blood measured prevalence of the elderly people with hypertension
pressure. Therefore, attention should be paid to the and factors of self-efficacy, which may be different from
management of dementia in order to improve self-efficacy in that identified in other studies based on sample size and the
the quality of life of the elderly people with hypertension. kind of management of health care in the institution-based
rehabilitation. However, regard- ing this research, we
suggest family or community based reha- bilitation, which is
Factors related to self-efficacy of elderly people better for maintaining the self-efficacy of elderly people in
with diastolic hypertension terms of maintaining their blood pressure.
In this study, daily activities, risk of falling, pain, depression,
anxiety and stress were found to be associated with self-effi-
cacy of the elderly people with diastolic hypertension. This re- of independence of the elderly in performing basic daily ac-
search has shown that the daily activities of elderly people may tivities. The results of this study suggest that the elderly still
correlate with self-efficacy on diastolic hypertension. Consist-
ent with previous research, this self-efficacy, along with func-
tional daily activities are correlated to achieving successful
BHJOH (4FFNBO FU BM., ß999). ɥJT NBZ CF FYQMBJOFE CZ UIF
MFWFM
Conclusions
Factors related to self-efficacy among elderly people with
systolic hypertension include: education, occupation before
entering institution-based rehabilitation, spiritual activity,
length of stay, and dementia. Meanwhile, the self-efficacy
of elderly people with diastolic hypertension is associated
with daily activities, risk of falling, pain, depression,
anxiety and
20 Susanto et al. / KONTAKT

stress. The study results suggest that health-promotion pro-

Conflict of interests
grams on the management of the health behavior of elderly
that is based on the characteristics of institution-based reha- The authors have no conflict of interests to disclose.
bilitation in Indonesia is needed to modify factors of hyper-
tension among elderly people. The health promotion Acknowledgements
program should be developed to keep blood pressure in The authors would like to thank the Faculty of Nursing and
order. This pro- gram should concern the self-efficacy of the Department of Research and Community Engagement of
elderly people to pre- vent hypertension among elderly the University of Jember for the funding of Research Group
people. Meanwhile, family or community based Health and Wellness for Elderly. They would also like to
rehabilitation for the elderly could become an alternative thank the intership students from the subject of Gerontic
solution for the improvement of the health sta- tus of the Nursing for collecting the data, who practiced in Elderly
elderly based on the Indonesian context. Rehabilitation of Bondowoso.

Ethical clearance
The study has been approved by the Ethical Committee
Review Board of Indonesia of the Faculty of Nursing,
University of Jember.

Prevalence hypertenze a prediktivní faktory sebeúčinnosti u starších lidí s

hypertenzí v institucionální rehabilitaci v Indonésii

Souhrn
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WS, Gilbert KL, et al. (2012). Trust, medication adherence,

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