Keep on Track: A Volunteer‐Run Community‐Based Intervention to Lower Blood Pressure in Older Adults

Abstract

Uncontrolled hypertension in older adults is a common yet preventable threat to healthy aging. Improvements in blood pressure (BP) control and related health outcomes require innovative approaches that reach beyond the clinical environment. Keep on Track (KOT), a volunteer-run, community-based BP-monitoring program that aims to lower BP of community-dwelling older adults through senior center programming, is described and evaluated. KOT is based on a New York City (NYC) Department for the Aging program that has been in existence for more than 20 years and is evaluated in six senior centers in low- to middle-income neighborhoods in NYC. Program design includes monitoring sessions every other week to measure and record participant BP. BP education is provided using low-literacy materials, and medication adherence is encouraged. Over 6 months of observation, 244 participants enrolled (mean age 73). Of the 181 (74%) with hypertension at baseline, 92% were previously aware of their condition, 78% were treated, and 31% were controlled. BP control among the treated was 42%. Forty-three percent of enrollees (n=105) were multiple-visit participants who experienced on average a 3.9-mmHg reduction in systolic BP (SBP) between the first and last program visit (95% confidence interval (CI)=-7.6 to -0.1, P=.04). Participants with an initial SBP greater than 160 mmHg (n=20) experienced on average a 20.9-mmHg reduction in SBP (95% CI=-32.4 to -9.4, P<.001). Areas for program improvement include greater attention to peer counseling and timely communication with participants' healthcare providers. Volunteer-run, community-based BP monitoring in senior centers may provide an effective, replicable model for reducing BP in older adults.

Seniors centre‐based health intervention programmes in the United States and South Korea: A systematic review

“…The sample sizes of most studies ranged from 10 to 50 for each group. Only 5 studies (Campbell & Aday, ; Krieger, Castorina, Walls, Weaver, & Ciske, ; Leville et al, ; Truncali, Dumanovsky, Stollman, & Angell, ; West et al, ) had a group sample size over 100.…”

“…Most interventions in this domain were educational and used behavioural and clinical outcome measurements. Two studies (Resnick, Ilagan, Kaylor, Mehling, & Alwan, ; Truncali et al, ) focused on monitoring blood pressure. Use of technology, such as CD‐ROMs to present instructions (Sweeney & Chiriboga, ) and a distance‐based information‐transmitting system (Resnick et al, ), was also observed among these studies.…”

“…In 5 safety domain studies, 4 study interventions were provided by nurses (Schoenfelder & Van Why, ; Shin et al, ; Sohng, Moon, Song, Lee, & Kim, ; Sweeney & Chiriboga, ) and by a multidisciplinary team (Reinsch, MacRae, Lachenbruch, & Tobis, ). In 6 chronic disease management domain studies, three included nurses as providers (Park et al, ; Resnick et al, ; Song et al, ), two included lay volunteers (Truncali et al, ; West et al, ), and one featured an interdisciplinary team (Taylor et al, ). In the comprehensive wellness domain, interventions in all 3 studies were delivered by nurses.…”

“…In the chronic disease management domain, some interventions were effective in improving self‐management behaviours and/or the clinical indices. Blood pressure–related interventions resulted in positive changes (Park et al, ; Resnick et al, ; Truncali et al, ). An obesity intervention programme (West et al, ) resulted in significantly reduced weight.…”

“…Health fitness (medical) assessment or physician approval before exercise interventions (Park et al, ; Reinsch et al, ; Song et al, ; Wallace et al, ) and gradual increase of exercise strength and longer warm‐up and cool‐down times (Yoon & Ahn, ) were used to minimize the exercise health risks of the older adults. Low‐literacy handout materials were commonly used (Park et al, ; Song et al, ; Truncali et al, ), because older adults have many ageing‐related changes that affect learning. In addition, many have lower levels of basic education compared to younger adults.…”