The Relationship Between Indestructible Healthy Lifestyle Patterns, Levels of Sensation-Seeking and Perceived Stress with Cognitive Performance in Older Adults with Hypertension

Abstract
Hypertension and cognitive impairments are common conditions among older adults. This study aimed to investigate the relationship between the Indivisible Self Model of Wellness (IS-WEL), sensation-seeking levels, and perceived stress with cognitive performance in older adults with hypertension. This was a descriptive-correlational study. The study population included all older adults diagnosed with hypertension in Urmia, Iran, in 2023. A total of 215 older adults with hypertension were selected from healthcare centers in Urmia through convenience sampling. Data were collected using Nasreddine et al.’s Montreal Cognitive Assessment, Myers et al.’s Wellness Evaluation of Lifestyle, Zuckerman’s Sensation Seeking Scale, and Cohen’s Perceived Stress Scale. Data were analyzed using Pearson’s correlation coefficient and multiple regression analysis in SPSS version 22. The results showed significant relationships between cognitive performance and IS-WEL, sensation-seeking, and perceived stress. The predictor variables explained 33% of the variance in cognitive performance (p<.001). Executive functioning accounted for 15%, excitement for 11%, self-socialization for 3%, self-coping for 2%, and perceived stress for 2% of the variance (p<.001). These findings suggest that older adults with hypertension tend to have weak IS-WEL, and high levels of sensation-seeking and perceived stress. Emotional regulation and stress management training are recommended to improve cognitive performance in this population.
EXTENDED ABSTRACT
 Introduction
Studies have shown that with the onset of aging, blood pressure tends to increase while cognitive performance declines. In the research literature, various factors have been investigated in relation to cognitive performance among older adults with hypertension, with the Indivisible Self Model of Wellness (IS-WEL) emerging as one of the most significant predictors. IS-WEL is a holistic model of wellness that conceptualizes health as the integrated functioning of multiple life domains, including physical, emotional, social, and spiritual aspects. As individuals grow older and enter later stages of life, the relevance of IS-WEL becomes increasingly pronounced. Another important factor associated with cognitive functioning in older adults is sensation-seeking. Sensation-seeking is rooted in an individual's arousal capacity; those with high levels of sensation-seeking tend to prefer constant mental stimulation, experience boredom with repetitive tasks, and seek out novel and stimulating experiences to maintain arousal. In addition, perceived stress is a psychological factor that can negatively impact cognitive performance, health, and well-being in older adults. Despite the importance of stress, emotional regulation, and healthy lifestyle patterns in this population, these variables have received relatively limited attention in the context of hypertension-related cognitive decline. Accordingly, the present study aimed to examine the relationship of IS-WEL, sensation-seeking, and perceived stress with cognitive performance in older adults with hypertension.
Method
The present study was fundamental in its objective and descriptive in its methodology. The statistical population consisted of older adults with hypertension residing in Urmia, Iran. A total of 215 individuals (112 men and 103 women) were selected through visits to healthcare centers in Urmia using a convenience sampling method. Initial coordination was made by visiting relevant health centers in Urmia and obtaining permission from their administrators, including the Hamrah Elderly Day Center. In an introductory session, the researcher introduced themselves, explained the study’s purpose to the participants, and provided full instructions on how to complete the questionnaires to ensure honest and voluntary participation. Eligible participants were selected based on inclusion criteria, and efforts were made to establish trust and ensure sincere responses from the sample group. Inclusion criteria were: (1) age between 65 and 85 years, and (2) literacy. Exclusion criteria included: (1) the presence of physical illnesses or psychiatric disorders, (2) use of psychiatric medications within the past year, and (3) unwillingness to participate in the study. Data collection instruments included Nasreddine et al.’s Montreal Cognitive Assessment, Myers et al.’s Wellness Evaluation of Lifestyle, Zuckerman’s Sensation Seeking Scale, and Cohen’s Perceived Stress Scale. On average, each participant required approximately 40 to 60 minutes to complete the questionnaires. The questionnaires were distributed among participants, and instructions were provided to ensure accurate completion. Participants were informed about the anonymity and confidentiality of their responses, and written informed consent was obtained prior to participation. Incomplete or invalid questionnaires were excluded from the final analysis. Following data collection, responses were entered into SPSS version 22 for statistical analysis. Pearson’s correlation coefficient, and multiple regression analysis were employed to analyze the data.
Results
Prior to conducting data analysis, the distribution of scores for all variables was assessed and found to be normal, and the assumptions of multicollinearity were satisfied. The independence of errors was evaluated using the Durbin-Watson statistic, with a coefficient of 1.91 indicating no autocorrelation. Following confirmation of the necessary assumptions, the study’s conceptual model was tested using stepwise multiple regression to predict cognitive performance based on sensation-seeking, perceived stress, and self-destructive healthy lifestyle patterns. The results of the regression analysis are presented in Table 1. Based on the results presented in Table 1, the predictor variables collectively explained 33% of the variance in cognitive performance (R²=.33). Specifically, executive functioning accounted for 15%, excitement for 11%, self-socialization for 3%, self-coping for 2%, and perceived stress for 2% of the variance.
The F-statistic for the overall regression model was significant at the .001 level, indicating that the combination of these five variables significantly predicts cognitive performance.
Conclusion
The association between healthy lifestyle patterns and cognitive performance in older adults with hypertension highlights the importance of promoting health-enhancing behaviors and ensuring optimal blood pressure control. Such efforts can contribute to an improved quality of life and a reduction in the burden of cognitive disorders among older adults. There exists a complex relationship between sensation-seeking tendencies and cognitive performance in older adults, particularly those with hypertension. Some studies have suggested that moderate levels of sensation-seeking may support the maintenance of cognitive functioning in this population. Individuals with moderate sensation-seeking tendencies are more likely to engage in cognitively and physically stimulating activities, which, in turn, may help preserve or even enhance cognitive abilities. In contrast, elevated levels of perceived stress have been shown to negatively influence cognitive functioning. Among older adults with hypertension, higher stress levels may disrupt daily routines, reduce adherence to healthy behaviors, and ultimately impair cognitive performance. Unhealthy lifestyle patterns can exacerbate both stress and hypertension, thereby compounding their detrimental effects on cognition. Conversely, adherence to a healthy lifestyle, characterized by regular physical activity, proper nutrition, stress management, and adequate social engagement, can enhance cognitive function and mitigate the adverse effects of both hypertension and psychological stress in older individuals. These findings emphasize the need for integrated health interventions targeting lifestyle modification in hypertensive older adults to protect and sustain cognitive health.
Ethical Consideration
Ethics Code
 This study was approved by the Ethics Committee of Maragheh University with the ethics code 015 IR.UM.1402.
Financial Support
This research did not receive any financial support.
Authors’ Contributions
The author was responsible for all aspects of conducting the study.
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The author sincerely thanks all participants for their valuable cooperation, as well as the administrators and staff of the healthcare centers in Urmia for their support throughout the study.
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