44 MANAGING HYPERTENSION IN PEOPLE WITH FRAILTY: AN EXPLORATION OF A PATIENT LED APPROACH

Background: Nine out of ten 90 year olds have hypertension. Evidence for treatment, particularly in context of frailty and developing dependence, remains uncertain. National guidelines recommend personalising treatment but it is unclear how best to achieve this.

Methods: Participants with hypertension were recruited from the Community Ageing Research (CARE75+) cohort study using purposive sampling to include a range of ages and degrees of frailty. Qualitative interviews took place during two 45 minute sessions in the participant’s home. Interviews were semi-structured, based on a topic guide developed together with a participant representative who later was also involved in analysis. Narrative analysis was inductive and focused both on what and how stories were told. Emerging themes were identified from an individual’s stories and social context. Hypotheses were developed iteratively and tested against the data, to consolidate key themes.

Results: Between March and May 2018, we interviewed ten people, with a mean age 84, moderate/severe frailty, half were women, and three had family present. Hypertension treatment was not described as a priority. Frailty as a word was never voluntarily used, was better recognised in others, and described in negative and value laden terms. Decision making was depicted as better done by doctors who understood a patient’s values through knowing them over time, or through knowing their families. Few were aware of any uncertainties in blood pressure treatment. Stories championed survivorship, inter-relatedness and community. Priorities focused on day-to-day practicalities, and doing things that maintained identity.

Discussion: Shared decision making in the management of hypertension in people with frailty should acknowledge uncertainty and be framed by issues of greatest relevance and importance for the person. What is important to a person can be elicited from a person’s story, their identity ahead of frailty, and in the presence of a trusted family member or carer.