Holistic Assessment and Family-Centered Management of Hypertension in an Older Adult

Abstract

Hypertension is a major contributor to cardiovascular and renal morbidity, particularly among older adults. Effective long-term management requires not only pharmacological treatment but also lifestyle modification, medication adherence, and family involvement. A holistic, family-centered approach may help identify individual barriers to disease management and support patient-centered care. This case report describes the clinical assessment and family-oriented management of hypertension in an older adult attending a primary healthcare facility in Bandar Lampung, Indonesia. An 82-year-old male with hypertension diagnosed in 2010 and a reported history of declining kidney function since 2020 underwent a family medicine assessment at a primary healthcare facility in Bandar Lampung. Clinical examination documented a blood pressure of 118/79 mmHg, heart rate of 80 beats/min, respiratory rate of 20 breaths/min, and body temperature of 36.6°C. The patient reported regular antihypertensive medication use and routine healthcare attendance. Lifestyle assessment identified frequent consumption of high-salt and high-fat foods, inadequate fruit and vegetable intake, and insufficient physical activity. Family functioning was evaluated using the Family APGAR instrument, yielding a score of 10, indicating highly functional family relationships. A SCREEM assessment identified generally supportive family and socioeconomic circumstances. A family-centered intervention was implemented through patient education, counseling on dietary sodium reduction, recommendations for regular physical activity, medication adherence reinforcement, and family involvement in long-term hypertension management. Counseling incorporated behavioral change principles based on the 5A–5R framework, with particular emphasis on recognizing lifestyle barriers, strengthening motivation, and encouraging regular blood pressure monitoring. The patient's spouse was involved in supporting dietary modifications, treatment adherence, and routine healthcare follow-up.The documented blood pressure was within a controlled range at the reported assessment. The patient demonstrated favorable family support and reported regular medication adherence. However, the available case documentation did not provide serial blood pressure measurements or standardized pre- and post-intervention assessments to establish the effectiveness of the counseling intervention. This case illustrates the application of holistic family medicine assessment in identifying lifestyle-related challenges and supporting the long-term management of hypertension in an older adult. Family functioning assessments and individualized counseling may provide useful information for patient-centered care. Nevertheless, structured follow-up and objective outcome measurements are necessary to determine the impact of family-centered interventions on sustained blood pressure control.