Increasing Independence in Hypertension at the Jannati Home for the Elderly, Gorontalo City

Hypertension can be defined as persistent blood pressure where the systolic pressure is above 140 mmHg and the diastolic pressure is above 90 mmHg. In the elderly population, the elderly here are a group of people or people who are old, they carry out religious activities carried out by themselves and others. Independence in the elderly includes the ability of the elderly to carry out daily activities such as: bathing, dressing neatly, going to the toilet, changing places, can control urination and defecation, and can eat alone. Independence refers to psychosocial abilities which include freedom to act, not depending on other people's abilities, not being influenced by the environment, and free to regulate their own needs.


INTRODUCTION
Elderly Old people are people who are elderly, namely people who are sixty years old and above. Elderly people are also called late adulthood, which begins in their sixties or seventies and ends in death. What is meant by the elderly here is a group of people or people who are old, they carry out religious activities carried out by themselves and others. Along with the aging process in the elderly, it will result in a decline in physical abilities, vision, hearing, and motor changes that make the elderly need assistive devices to carry out their activities. The aging process requires balanced health attention to changes in body systems in the elderly (Wakhid et al. in Komang, 2018) The number of elderly people in Indonesia is increasing from year to year. Indonesia is an old structured country, this can be seen from the percentage of elderly people in 2008, 2009 and 2012 which reached more than 7%. Based on the BPS survey, the condition of the elderly in Indonesia shows that the female elderly population is higher than the male elderly (Central Bureau of Statistics, 2017). This shows that the life expectancy of women is higher than that of men. When viewed from the distribution of the elderly by province, the percentage of the elderly population is above 10% and the highest is in the provinces of DI Yogyakarta (13.04), East Java (10.40%) and Central Java (10.34%) (Dewi, 2014in Zumrotul, 2018 Physical changes that occur in the elderly will certainly affect the independence of the elderly. Independence is the freedom to act, not dependent on others, not influenced by others and free to regulate oneself or one's activities both individually and in groups from various health or diseases (Ediawati, 2012in Slamet, 2016. Independence in the elderly is very important to take care of themselves in meeting basic human needs. Although it is difficult for younger family members to accept parents complete and slow daily activities. With their own thoughts and ways, the elderly are recognized as individuals who have unique characteristics, therefore nurses need knowledge to understand the ability of the elderly to think, argue and make decisions to improve their health (Atut, 2013in Slamet, 2016. Hypertension is an increase in blood pressure above normal values (O'brien et al., 2003). Hypertension is an increase in systolic blood pressure of about 140 mmHg or diastolic pressure of about 90 mmHg (Flint et al., 2019). Hypertension is a problem that needs to be watched out for, because there are no specific signs of hypertension and some people still feel healthy to carry out activities as usual (Weber et al., 2014). This is what makes hypertension a silent killer, people will realize they have hypertension when the symptoms they feel are getting worse and seek medical attention. Symptoms that are often complained of by patients with hypertension are headache, dizziness, weakness, fatigue, shortness of breath, restlessness, nausea, vomiting, epistaxis, and decreased consciousness. Hypertension occurs because it is influenced by risk factors (Ewald & Haldeman, 2016). The risk factors that cause hypertension are age, gender, obesity, alcohol, genetics, stress, salt intake, smoking, physical activity patterns, kidney disease and diabetes mellitus.
The cause of the elderly suffering from hypertension is due to the decline in body work functions. Another factor that causes hypertension in the elderly is lifestyle, such as consumption of junk food, cigarettes, alcohol, and lack of exercise. On junk food that is high in calories, high in fat, low in fiber, and high in sodium or salt. High fat and sodium or salt are one of the factors that cause hypertension, then cigarettes contain nicotine which triggers the adrenal glands to release epinephrine or adrenaline causing constriction of blood vessels and making the heart pump harder due to higher pressure. Alcohol consumption can increase the acidity of the blood which makes the blood thicker and the heart becomes harder to pump while lack of exercise is an independent risk factor for chronic and overall disease that is estimated to cause death globally.

RESULTS AND DISCUSSION
The mechanism for implementing community service activities includes the following stages: (1) Counseling on increasing independence in hypertension; (2) Consultation with the orphanage for the elderly in the city of Gorontalo; (3) Preparation of tools and materials for extension activities.
The form of community service activities that will be carried out by Lecturers and Students of the University of Muhammadiyah Gorontalo is counseling on Increasing Elderly Independence in Hypertension. The method of activities carried out in this activity is the percentage with the help of Powerpoint, Leaflets, lectures, demonstrations, and discussions with documentation, materials and attendance list attached.
The results achieved with this activity the Wisma are very supportive and give thanks because the Muhammadiyah University of Gorontalo, especially the Nurses study program, has collaborated with the Community Service activities in carrying out this activity, all series of activities have been carried out by achieving good results because