The Influence Of Depression On The Adherence Of Elderly Patients With Hypertension

Objective: to develop a comprehensive treatment adherence scale for hypertensive patients,which is suitable for the use of patients in China,providing reference for the establishment of a unified hypertension adherence scale.To explore whether there is a correlation between different depression states and treatment adherence of elderly hypertensive patients and its extent,providing a reference and basis for the proposal of intervention measures to improve patient compliance.Methods: original item pool was formulated through literature review and clinical experience of research group.After two rounds of selection and evaluation by 15 medical experts,a pretest scale was formed,which contains 23 items.A cross-sectional survey of 128 patients with hypertension was conducted using the pretest scale,using item analysis,exploratory factor analysis,internal consistency analysis and empirical validity to evaluate the reliability and validity of the pre-test scale,and 16 items were reserved to form a formal scale.The formal treatment adherence scale for hypertenison and PHQ-9 were performed in 215 elderly patients with hypertension.Correlation analysis and multiple stepwise regression were used to analyze the influence of different factors on treatment compliance of elderly patients with hypertension.Results:There were 16 items in the treatment adherence scale for hypertension,including five dimensions of medication behavior(3 items),medication noncompliance behavior(3 items),health-related Suggestions(4 items),health belief(4 items),and tobacco and alcohol control(2 items).The loading value of each item in the common factor was0.561?0.891;the total Cronbach's ? coefficient of the scale was 0.844 and the Cronbach's ? coefficient of each dimension was 0.638?0.894.Likert 5-grade scoring method was adopted for the answers of the scale.According to the options from "no/very little time" to "all time",the scale was assigned 1?5 points respectively,and the reverse question was assigned 5?1 points respectively,with an overall score of 16?80 points.The scale evaluate the adherence of hypertension treatment in the last 4 weeks,with higher score indicating better adherence.In the study of influencing factors of adherence,8 predictive variables were included in the regression model.In order of the impact on adherence,hypertension grade,reimbursement of special outpatient service,PHQ-9 score,education level,physical condition,gender,duration of hypertension,and variety of medication were listed.The standardized regression equation was: adherence score = 0.318×hypertension grade+0.198×education level+0.215×reimbursement of special outpatient service +0.178×physical condition+0.150×hypertension duration-0.208×PHQ-9 score-0.169× gender-0.117×medication variety.Conclusion:The treatment adherence scale for hypertenison showed good reliability and validity,which met the standards of adherence measurement tools for patients with hypertension.In addition to hypertension grade,education level,special outpatient reimbursement,health,gender,duration of hypertension and drug category,depression is also an important factor of adherence in elderly hypertensive patients,so the intervention of depression can be an important way to improve the adherence in elderly patients.