The Correlation between Self-efficacy and Quality of Life in Elderly

Who are Living with Hypertension

Maria Manungkalit and Linda Juwita

Faculty of Nursing, Widya Mandala Catholic University, Jl. Raya Kalisari Selatan 1, Pakuwon City, Surabaya, Indonesia

Keywords: Elderly, Hypertension, Quality of life, Self-efficacy.

Abstract: The prevalence of hypertension was found to be high in the elderly globally. Self-efficacy plays an

important role in the initiation and maintenance of health behavior, thus has an impact in determining

quality of life (QOL). This study aimed to analyze the correlation between self-efficacy and QOL in elderly

who are living with hypertension. This was a correlational study by using cross-sectional design approach.

The population was all elderly with hypertension live in nursing home of St. Yosef Surabaya, amounting to

70 people. Sample size was 45 selected by purposive sampling technique. The independent variable was

self-efficacy measured by General Perceived Self-Efficacy instrument (α=.785, r=.447-.745). Dependent

variable was QOL measured by WHOQOL-BREF instrument (α=.700, r=.419-.798). Data analysis used

Spearman Rank correlation test (α=.05). Result showed that majority was female (57.78%), 75-90 years old

(55.56%), primary school graduated (40%), and had a family history of hypertension (82.22%). Most

respondent had sufficient self-efficacy (82.22%) with no low self-efficacy was found, and had sufficient

QOL (73.33%) with no high QOL was found. Self-efficacy was not correlated with QOL in elderly who are

living with hypertension (p=.456). Various factors influenced the elderly’s QOL, such as independency

level, family support, socio-economic status, living standard, and culture.

1 BACKGROUND

Every individual will experience and face the aging

process in the course of his life and this is a natural

process that cannot be avoided. Being elderly is a

process that takes place in life means someone has

gone through the stages of life, namely neonatal,

toddler, pre-school, school, adolescent, adult, and

the elderly. This different stage of life begins both

biologically and psychologically (Padila, 2013).

Gradually, the elderly will experience changes in the

ability of various organs, functions, and body

systems that are natural / physiological. With many

changes that occur in the elderly, elderly faces many

problems, one of that is the increase of blood

pressure (hypertension). Epidemiological

investigations have shown that the occurrence of

hypertension is closely related to morbidity and

mortality of cardiovascular disease (Mutaqqin,

2009). Some studies concluded that age is also one

factor in the occurrence of hypertension because the

increased age of a person will increase the risk of

hypertension. Hypertension is an increase in systolic

blood pressure of at least 140 mmHg or diastolic

pressure of at least 90 mmHg (Price & Wilson,

2006).

According to the data of Ministry of Health

(MOH), Republic of Indonesia (RI) in 2014, there

was an increase in number of elderly who had

hypertension about 50%. The incidence of

hypertension in East Java in 2013 was 26.2%.

According to data of the Health Departement of

Surabaya, number of hypertension cases in 2014 as

much as 19.56% (Basic Health Research, 2013).

The incidence of elderly with hypertension is

caused by many factors that are closely related to the

natural aging process. In elderly, structural and

functional changes occur in the peripheral vessel

system resulted in changes in blood pressure. These

changes include atherosclerosis, loss of elasticity of

connective tissue, and a decrease in relaxation of

smooth muscle of blood vessels which in turn

decreases the ability of distention and tensile

strength of blood vessels (Brunner & Suddarth,

2002). Complications will also occur in people with

hypertension, such as coronary heart disease, heart

failure, brain blood vessel damage, and kidney

failure (Corwin, 2009).

Manungkalit, M. and Juwita, L.

The Correlation between Self-efﬁcacy and Quality of Life in Elderly Who are Living with Hypertension.

DOI: 10.5220/0008326004130417

In Proceedings of the 9th International Nursing Conference (INC 2018), pages 413-417

ISBN: 978-989-758-336-0

413

Along with the increasing number of prevalence

of hypertension incidence and complication of the

disease, these will also impact on the QOL where

the individual needs to make adjustments in order to

remain able to perform its function optimally.

Xavier, et al., (2003) concluded that elderly with

poor QOL was equivalent to low health status, and

good QOL was equivalent to good health status,

more variety of activities, social life and good family

relationships. Therefore health status is one of the

good indicators of QOL in elderly. QOL reflects

how one sees himself about his satisfaction of life

(Philips, et al., 2009).

The QOL of elderly can be influenced by level of

independence as well. The success of self-reliance is

not only related to health care, but also maximizing

the psychological resources, such as self-efficacy,

resilience, increased precautions, medical

management during sick and illness, lifestyle

changes by doing things that have a positive effect

on health.

Self-efficacy theory was developed by Albert

Bandura as a cognitive social theory in 1977. He

defined self-efficacy as a decisive belief in how one

thinks, motivates himself and how one ultimately

decides to conduct a behavior to achieve the desired

goal. A study of Luszczynska's & Dona (2005) about

general self-efficacy suggested that self-efficacy can

predict compliance in treatment regimens, health

behaviors, physical activity, effective pain

management, and disease management.

This study aimed to analyze the correlation

between self-efficacy and QOL in elderly who are

living with hypertension.

2 METHODS

This study utilized cross-sectional design. The

population was all elderly with hypertension in St.

Yosef elderly home of Surabaya which amounted to

70 people. Sample size was 45, selected by

purposive sampling. Sample criteria were medical

diagnosis was confirmed by a physician, duration of

hypertension at least one month, willing to

participate, and cooperative. Independent variable

was is self-efficacy measured by instrument of

General Perceived Self-efficacy developed by

Bandura (1986) (α=.785, r=.447-.745). It consisted

of 10 items examined by 1-4 Likert scale. The

category of self-efficacy was low (score of 10-20),

sufficient (score of 21-30), and high (score > 30).

While the dependent variable was QOL measured by

WHOQOL-BREF developed by World Health

Ofrganization (WHO, 2004) (α=.700, r=.419-.798).

It consisted of 4 items assessing 4 domains of QOL,

such as, physical, psychological, social, and

environmental. Raw score in each domain was

transformed into 0-100 range. The category of QOL

was low (score of 0-40), sufficient (score of 41-69),

and high (score of 70-100). All data was in ordinal

scale, so that Spearman Rank correlation test was

used for data analysis (α < .05). Ehical aspect was

assured by principal of anonimity, beneficence, non-

maleficence, fidelity, and confidentialty

implemented in this study. Informed consent was

signed by all respondents.

3 RESULTS

There were 45 elderly with hypertension who are

living in an elderly home of St. Yosef of Surabaya

participated in this study. Age range was 66 – 97

years old. Most respondents were female (57.78%),

75-90 years old (55.56%), primary school graduated

(40%), and had a family history of hypertension

(82.22%). Table 1 explains demography

characteristic of study respondents.

Most respondents had sufficient self-efficacy

(82.22%) and sufficient QOL (73.33%). Self-

efficacy was uncorrelated with QOL in elderly with

hypertension (p = .456). Table 2 explains the result

of descriptive statistical analysis.

Table 1: Demography characteristic.

Characteristic n %

1. Sex

a. Male

. Female

42.22

57.78

2. Age (years old)

a. 60-74

b. 75-90

c. >90

40.00

55.56

4.44

3. Family history with

hypertension

a. Yes

. No

82.22

17.78

4. Educational background

a. Primary school

b. Secondary school

c. High school

d. Diploma

e. Bachelor degree

40.00

31.11

15.56

8.89

4.44

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

414

4 DISCUSSION

Self-efficacy in elderly who are living with

hypertension defined as self-confidence and

competency for doing some tasks, such as diet

management, physical exercise, drugs

administration, stress management, socialize with

others, occupational therapy, etc., to achieve the goal

of normal blood pressure. Most respondents had

sufficient self-efficacy. This potentially influenced

by cognitive function, affective, and selection

process in elderly’s state of mind (Bandura, 1997 in

Guffron & Risnawati, 2014).

Cognitive function is a conscious mental activity,

such as thinking, remembering, learning and using

language. Cognitive function is also the ability of

paying attention, memory, consideration, problem

solving, and the ability of executive competency

such as planning, assessing, monitoring and

evaluating (Strub, et al., 2000). In elderly people, we

found decreased cognitive function generally.

Memory is one of the earliest cognitive function

which decline. Long-term memory is less likely to

change, while short-term memory is instantly

changes in 0-10 minutes. For declining intellectual

functions, the fluid intelligent such as list recall,

geometric memory, word finding speed, problem

solving, responsiveness, and attention quickly

diverted (Kusumoputro, 2004). The ability to

understand or grasp the understanding of the elderly

has decreased. This is influenced by the decreased in

concentration and hearing function. In the elderly,

the problems faced more and more by time. Many

things can easily be solved in ancient times, but are

now hampered by the decline in cognitive function.

Other obstacles are derived from memory loss,

comprehension, and others that result in more

problem-solving difficulties (Azizah, 2011).

In performing individual tasks, we need to set the

goals and objectives of behavior so that individuals

can formulate appropriate actions to achieve those

goals. The setting of personal goals is influenced by

the individual's assessment of his cognitive abilities.

Cognitive function allows individuals to predict the

daily events that will result in the future. The

assumption that arises on this cognitive aspect is the

more effective the individual's ability in analyzing

and in practicing to express his personal ideas. It

will support the individual to act appropriately to

achieve the expected goal. Individuals will foresee

events and develop ways to control events that affect

their lives. This expertise requires an effective

cognitive process of various kinds of information

(Bandura, 1997 in Guffron & Risnawati, 2014).

Affection occurs naturally within the individual

and plays a role in determining the intensity of the

emotional experience. Affection is directed by

controlling anxiety and depressive feelings that

hinder the right mind set to achieve goals. The

process of affection is related to the ability to cope

with emotions that arise in self to achieve the

expected goals. The individual's belief in his ability

to influence the level of stress and depression

experienced when faced with difficult or threatening

tasks. Individuals who believe they are capable of

controlling a threat will not arouse an intrusive mind

set. Individuals who do not believe in their abilities

will experience the anxiety of not being able to

manage the threat (Bandura, 1997 in Guffron &

Riisnawati, 2014).

The selection process relates to the individual's

ability to select appropriate behavior and

environment, so as to achieve the expected

objectives. Individual inability to perform behavioral

selection makes individuals unconfident, confused,

and easily give up when faced with difficult

problems or situations. Self-efficacy can shape the

lives of individuals through the selection of activity

and environment types. Individuals will be able to

carry out challenging activities and choose situations

that are believed to be capable of handling.

Individuals will maintain competence, interests, and

social relationships over the prescribed choice. It can

be concluded that the process of self-efficacy

includes cognitive, affection, and selection processes

(Bandura, 1997 in Guffron & Risnawati, 2014).

Study result showed that there was no correlation

between self-efficacy and quality of life (QOL) in

elderly who are living with hypertension. QOL has

been used as an indicator of how well a society

meets the needs of its elderly. There are various

potential variables mediate the relationship between

self-efficacy and QOL or possibly affecting QOL

stronger than self-efficacy alone in this study

context. Generally, QOL is influenced by living

standard. Reasonable standard of living has changed

with time and cultural settings. In a society with

Table 2: Table of frequency and descriptive statistic.

Category Self-efficacy QOL

n % n %

Low 0 0 12 26.67

Sufficient 37 82.22 33 73.33

h 8 17.78 0 0

Mean 28.27 46.09

Std. Deviation 3.39 9.30

The Correlation between Self-efﬁcacy and Quality of Life in Elderly Who are Living with Hypertension

415

inequalities in living standard, there is elevated

stress level, especially in the lowest socio-economic

status, leading to poorer health and even lower life

satisfaction (Marmot & Richard, 2006). Low socio-

economic status possibly affects QOL because

financial insecurity or problems has led to high

stress level among elderly in general, especially

related to retirement and family neglect.

Although QOL scores tends to decreased with

increasing age, a support of physical functions

optimization in older adults can be important for

increasing QOL and functional independence

(Bozkurt & Yilmaz, 2016). In elderly with

hypertension, some vascular risk factors are

associated with functional impairment due to clinical

and subclinical vascular disease (Canavan, et al,

014). Age-related physiological changes also bring a

reduction in functional capabilities resulted in

problems with self-care, activities of daily life, and

psychosocial problems. It has been identified that

intense exercise was not an obligatory condition for

optimal QOL in elderly people. Active part in

moderate intensity daily activities associated with

higher QOL (Pavlova, et al., 2015).

Other factor that possibly affects QOL in elderly

who are living with hypertension is social support,

especially from family subgroup. Elderly living with

their spouse and children had better social support

family subgroup scores compared to ones living

alone. A positive correlation was found between

social support and QOL (Unsar, et al, 2016). A study

in Korea towards 1,056 elderly showed that the

elderly who give and receive family support had

higher QOL than the one who only receive support.

Elderly and the younger generation put more value

on two-way intergenerational relation based on

mutual care and assistance (Kim & Cheong-Seok,

2003). Family and friend support are different across

ethnic because culture also influence the support

pattern in our society (Poulin et al, 2012).

Cultural factor could also be a potential factor

influencing QOL Social and cultural norms,

informed by religious principles that prescribe

familial elder care, impact how QOL is described by

elderly. It is also possible that religious faith or

traditions might provide a different account of how

individual’s own religious faith impacts expectations

of care and QoL in old age (Shreshta & Zarit, 2012).

A study in Singapore towards elderly showed that

QOL was more likely to be determined by socio-

cultural context rather than along racial lines (Wong,

2003).

5 CONCLUSIONS

There was no correlation between self-efficacy and

QOL in elderly who are living with hypertension.

Self-efficacy was potentially influenced by cognitive

function, affective, and selection process in elderly’s

state of mind. Independency level, family support,

socio-economic status, living standard, and culture

were potentilly influenced QOL in elderly who are

living with hypertension stronger than self-efficacy.

ACKNOWLEDGEMENTS

This study and publication were funded by Faculty

of Nursing, Widya Mandala Catholic University

Surabaya (WMCUS).

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