UMD Develops a DASH-Plus community-based hypertension management program for older adults

IMAGE: Fruits and vegetables, part of a health DASH diet view more 

Credit: Edwin Remsberg, University of Maryland

To address the significant health burden of hypertension (characterized by consistently high blood pressure), the University of Maryland (UMD) was recently awarded a grant from the United States Department of Agriculture National Institute of Food and Agriculture (USDA-NIFA) to develop, test, and deliver an integrated hypertension management program for older adults. The program takes the existing DASH (Dietary Approaches to Stop Hypertension) diet and tailors it to those aged 55 and older through a virtual education program (due to the pandemic) ongoing this summer, with an in-person program coming next summer. The DASH-Plus intervention developed by UMD faculty incorporates diet, simple chair exercises, access to fresh fruits and vegetables through the Imperfect Foods produce delivery service, and blood pressure self-monitoring. Working with dietetics students to develop and test recipes, this program brings together research, academics, and Extension to adapt and deliver strong hypertension management education to the older adults who need it most.

"Heart disease is the number one killer in our country, and high blood pressure is a primary risk factor," says Hee-Jung Song, associate professor in Nutrition and Food Science and UMD Extension (UME) specialist leading this grant. "Hypertension is particularly prevalent among older adults, but many are unfamiliar with how to manage it. If blood pressure is not managed properly, it takes enormous resources and huge healthcare costs to deal with the complications. We hope this grant can help reduce that burden and improve quality of life for our aging population."

According to the most recent data from the Centers for Disease Control and Prevention (CDC), 29% of U.S. adults suffer from hypertension. But this proportion increases substantially with increasing age, with 63% of adults aged 60 and over having hypertension. According to Song, it is estimated that by 2030, one in five people in the U.S. will be an older adult.

With this new grant, Song saw the opportunity to help this growing demographic, leveraging partnerships across research, academics, and UME. The DASH-Plus (featuring the DASH diet plus physical activity and self-management) hypertension education and management program being developed and tested consists of eight weeks of education, meeting once a week for one hour. The program starts with older-adult-appropriate chair exercises, followed by an educational module, and finishes with a DASH-friendly recipe video teaching proper food prep and safety.

"One of the very well studied approaches to manage hypertension is the DASH diet," says Song. "DASH is not only for someone with hypertension, it is a healthy eating pattern for everyone along with the current Dietary Guidelines for Americans and a Mediterrean heart healthy diet. But in addition to DASH, we wanted to integrate the exercise program with older adult tailored exercise, and recipes that are easy to prepare and enjoy."

To develop the DASH-Plus program and recipes presented, Song partnered with Margaret Udahogora, Dietetics Program director and lecturer in Nutrition and Food Science. "I worked in hospital and long-term care settings, and the DASH diet is something I applied one-on-one with older adults managing chronic diseases," says Udahogora. "To see it being incorporated into a community approach is something I was very interested in and gave a unique experience to my students."

As a part of Udahogora's Food Service Operation course, her students developed and tested recipes, created full nutrition labels for them, and even produced educational videos as an example of what can be done for the program to show off the recipe and how it can help manage hypertension.

"This came at a great time for our dietetics students who couldn't get work experience because of the pandemic," explains Udahogora. "Students are learning about what changes in the body as you age, what you can eat and digest, and considering all the practical components of a recipe that their grandparents can make and will want to eat. This gave them a different perspective on what needs to be considered for an older population, and it allowed them to apply it from the individual to the community level."

Song is working with Jinhee Kim and UME educators in Family and Consumer Sciences to test and disseminate the program throughout the state of Maryland. Because of the pandemic, the program will be initially tested virtually, and is ongoing this summer. The team will then use this information to adapt, improve, and deliver the program more broadly in-person next summer.

"UME educators are key players because they are actually implementing this program virtually, or in person later on," emphasizes Song. "They have extensive experience and established partnerships with senior centers, churches, and departments of aging, so we were able to leverage those existing resources and community relationships. That's why we are able to offer the program this summer."

In addition to the educational components of the program, Song hopes to address access issues to fresh fruits and vegetables in older adults by working with Imperfect Foods, a subscription service that delivers "ugly" produce at discounted rates. Song found in her initial needs assessment that even if older adults were provided with coupons or discounts at local farmers markets, getting to the farmers market to use the voucher was still a major barrier to eating more fruits and vegetables.

Similarly, she is hoping to remove some barriers to blood pressure self-monitoring, an important part of managing hypertension. Participants in her program will be asked to take their blood pressure regularly and share the information with their healthcare providers. With this combination of education, access, and monitoring, Song and Udahogora hope to make a difference in the quality of life of older adults with a program that can be used across the country.

"Managing blood pressure is very important for quality of life in older adults, because so many things worsen with high blood pressure," says Udahogora. "Fatigue, depression, kidney problems - you can remove some unnecessary suffering and prevent these issues from worsening. It is a silent killer, and it takes a toll on the person, the healthcare system, and their families when grandparents can no longer play with their grandkids. We want to prevent that as much as we can."

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The virtual DASH-Plus program launched this month and is open for registration! If you are interested in participating or learning more, please visit: https:/ / extension. umd. edu/ resource/ dash-plus-sessions

This work is funded by the United States Department of Agriculture National Institute of Food and Agriculture (USDA-NIFA), Award # 2021-68015-33435.