The Relationship Between Health-Promoting Lifestyle and Cognitive Functions in Older Adults with Hypertension: The Mediating Role of Perceived Stress

One of the significant factors related to cognitive functions is a health-promoting lifestyle, alongside perceived stress. The consideration of the relationship between these factors, especially among older adults with hypertension, is of great importance. Therefore, this study aimed to model the structural relationships between a health-promoting lifestyle and cognitive functions, through the mediating role of perceived stress in older adults with hypertension. This descriptive research employed a correlational method using structural equation modeling (SEM). The statistical population consisted of older adults with hypertension from health centers in Urmia during the first six months of 2023, among whom a sample of 250 individuals (135 men and 115 women) were selected through convenience sampling. Data were collected using Wilson et al.’s cognitive functions questionnaire, Walker et al.’s health-promoting lifestyle profile and the Cohen’s perceived stress scale. Data were analyzed using Pearson’s correlation coefficients and SEM in SPSS-22 and AMOS software. The findings indicated a direct relationship between a health-promoting lifestyle and cognitive functions. Additionally, the bootstrap test showed that perceived stress mediates the relationship between a health-promoting lifestyle and cognitive functions. Specifically, 6% of the variance in cognitive functions was predicted by perceived stress, and 18% by a health-promoting lifestyle. Hence, it can be concluded that perceived stress mediates the relationship between a health-promoting lifestyle and cognitive functions. Therefore, psychologists and therapists in health centers, nursing homes, and psychological service clinics can focus on a health-promoting lifestyle and perceived stress to improve cognitive functions in older adults.
EXTENDED ABSTRACT
 Introduction
Hypertension is one of the most common chronic diseases affecting older adults. Approximately 70% of women and 65% of men over the age of 65 suffer from high blood pressure. One of the significant issues in older individuals with hypertension is their cognitive function. Studies have shown that psychological changes due to aging include a decline in cognitive functions, alertness and short-term memory, and these cognitive functions are further weakened by high blood pressure. Additionally, cognitive functions are related to a healthy lifestyle. One of the important factors associated with cognitive functions is a health-promoting lifestyle. According to research findings, perceived stress can mediate the relationship between a health-promoting lifestyle and cognitive functions. Cognitive function problems in older individuals with hypertension can negatively impact their lives. As examining the role of perceived stress in older adults can help interpret the relationship between cognitive functions and a health-promoting lifestyle, providing a comprehensive model of the cognitive status of older adults seems necessary. Therefore, given the lack of research in this area, the present study aimed to determine the mediating role of perceived stress in the relationship between a health-promoting lifestyle and cognitive functions in older individuals with hypertension.
Method
As a descriptive study, this research used a correlational method based on structural equation modeling (SEM). The statistical population of this study included older individuals aged 60 and above with hypertension from health centers in Urmia during the first six months of 2023. A sample of 250 individuals (135 men and 115 women) were selected through convenience sampling. Inclusion criteria included (1) being over 60 years old, (2) literacy, and (3) willingness to participate in the study and complete the questionnaires, while exclusion criteria included (1) use of psychotropic drugs and (2) the presence of physical and mental disabilities. Participants completed Wilson et al.’s cognitive functions questionnaire, Walker et al.’s health-promoting lifestyle profile and the Cohen’s perceived stress scale with the guidance of the researcher. Data from 250 individuals were analyzed as the final sample. Descriptive analyses, including mean, standard deviation, and Pearson’s correlation coefficient, were conducted using SPSS-22 and SEM was conducted using Amos version 22.
Results
Before data analysis, it was determined that the distribution of scores for all variables was normal, and the results indicated no correlation between errors and no multicollinearity between variables. SEM was used to evaluate the proposed model. The results of Pearson’s correlation test showed that There is a significant positive correlation (P≤.01) between cognitive functions in older adults with hypertension and the health-promoting lifestyle (including all its subscales). However, there was a significant negative correlation (P≤.01) between perceived stress and cognitive functions in older adults. Additionally, there was a significant negative correlation (P≤.01) between health-promoting lifestyle (including all subscales except interpersonal relations and spiritual growth) and perceived stress. The final model of the study can be seen in Figure 1. The standardized regression coefficients for the pathway from the health-promoting lifestyle to cognitive functions in older adults with hypertension were positive and significant (P≤.001, β=.36), and the pathway from perceived stress to cognitive functions in older individuals with hypertension was negative and significant (P≤.01, β=-.38). The pathway from the health-promoting lifestyle to perceived stress was negative and significant (P≤.01, β=-.24). The fit indices for the obtained model were as follows: X2/df=1.56, CFI=0.93 CFI=0.93, IFI=0.97IFI=0.97, NFI=0.94NFI=0.94, AGFI=0.98AGFI=0.98, and RMSEA=0.05RMSEA=0.05, indicating a good model fit. Considering the desirable range for these indices, it can be said that the data largely support the theoretical model of the research. Consequently, these indices indicate the acceptability of the model. The test results showed that perceived stress had a significant mediating role between a health-promoting lifestyle and cognitive functions. The lower and upper bounds and confidence interval for perceived stress as a mediating variable between a health-promoting lifestyle and cognitive functions in older adults with hypertension were (0.288) and (0.372) (P≤0.01), respectively, indicating a mediating role.
Conclusion
A health-promoting lifestyle is related to mental health and quality of life, thereby increasing the cognitive functions of older adults. Previous research has also consistently shown that lifestyle is an important factor in hypertension in older adults. Numerous pieces of evidence have shown that lifestyle, particularly psychosocial factors such as stress and tension, are risk factors for hypertension. Stress and turmoil are associated with high blood pressure. with reduced perceived stress, individuals may experience improved memory performance, judgment, problem-solving, decision-making, and cognitive functions. When perceived stress is higher in older adults with hypertension, their health-promoting lifestyle is also disrupted, and cognitive functions decrease. Individuals with high blood pressure may experience more problems in skills involving delayed recall and prefrontal cortex skills. Older adults with hypertension have weaker cognitive functions compared to other older adults. The results of this study showed a significant relationship between a health-promoting lifestyle and cognitive functions. The results also indicated the mediating role of perceived stress in the relationship between a health-promoting lifestyle and cognitive functions in older adults with hypertension. Therefore, the results of this study have practical implications for planners and specialists in older adults’ care homes and consultants. It is recommended that consultants and psychologists in older adults’ care homes or psychological service centers and clinics consider and use a health-promoting lifestyle alongside other methods to improve the cognitive functions of older adults.
Ethical Consideration
Ethical Code
This article is derived from a Master’s thesis in General Psychology at the Islamic Azad University, Tabriz Branch.
Financial Support
 This study had no financial support
Authors’ Contributions
S.S: Data Curation, Conceptualization, Methodology, Project Administration; S.N: Software, Validation, Formal Analyses, Writing-Review & Editing
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
We extend our gratitude to older adults for their cooperation and assistance in completing the questionnaires.
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