The Increasing Level of Comfort and Decreasing Blood Pressure of Hypertensive Elderly with “TERTARIK”

Changes in people's activity patterns during the pandemic caused discomfort responses that had implications for blood pressure fluctuations in hypertensive elderly. This phenomenon is significant because high blood pressure can cause complications and hospitalisation. This study aimed to determine the effect of TERTARIK on the comfort level and blood pressure of hypertensive elderly. A quantitative approach with a quasi-experimental pre-post test design with a control group was chosen. The sampling technique was purposive sampling with inclusion and exclusion criteria. The sample size obtained was 64 (32 per group)


INTRODUCTION
Hypertension is the condition of blood pressure greater than or equal to 140/90 mmHg (Miller, 2012;Indonesian Ministry of Health, 2014).Hypertension is a health problem experienced by many elderly in several countries, including Indonesia.The Psychological stress is one of the most common psychological discomforts due to a lack of social interaction and family support (Tutpai, Unja and Nura, 2021).In addition, older adults also experience physical discomfort, namely pain.Li et al. (2022) stated that as many as 56,21% of hypertensive elderly in the United States experienced pain, with the highest percentage of locations in the back area (Li et al., 2022).The interaction between physical and psychological discomfort will affect blood pressure through the mechanism of endothelial function changes, including decreased nitric oxide bioavailability, causing blood vessel vasoconstriction (Puzserova & Bernatova, 2016).So, efforts to control blood pressure are also expected to be able to manage physical and psychological discomfort.
Blood pressure that is not controlled for a long time can raise the risk of complications such as stroke, kidney disease and other catastrophic diseases (Anshari, 2020).This will increase the number of hospitalisations that can potentially cause nosocomial infections (Mohamadi et al., 2020).So, the blood pressure of the hypertensive elderly must be controlled.The problem-solving approach in this study was carried out with complementary interventions.This intervention is relevant to nursing because it emphasises non-pharmacological aspects.
One intervention that can be a solution is laughter therapy.This intervention can lower blood pressure by suppressing epinephrine and cortisol (Bete, Kurniyanti and Mayasari, 2022).However, older adults also need a cultural approach to optimise comfort levels.
Music therapy has a solid attachment to cultural aspects, and traditional instrument music increases emotional sensitivity, which can affect mood (Geraldina, 2017;Suguna, 2018).One of the soothing traditional Balinese music is Rindik`s music.Rindik's music was initially intended to entertain farmers working in the fields.Over time, this music is used as accompaniment in wedding and religious receptions.This soft and soothing music is also sourced from natural sounds to have a relaxing effect (Kurniawan et al., 2015).

RESULTS AND DISCUSSION
The following tables present the research results to answer this study's objectives.Table 1 shows that most respondents in both groups were female, had no family history of hypertension, and had never smoked.(Miller, 2015).Changes in the cardiovascular organ system of older adults are arterial wall thickening or arteriosclerosis (Miller, 2012).This study's results also show that most respondents are female.Menopause is one of the most substantial non-modifiable risk factors for hypertension in women, which has implications for estrogen deficiency (Weyer et al., 2016).
Another result of this study was that most respondents did not have a family history of hypertension.However, heredity is one factor that contributes 20 to 50% to fluctuations in blood pressure (Abebe et al., 2015;Atinyi et al., 2017).The majority of respondents in this study also did not have smoking habits.This result is reasonable because exposure to one cigarette smoke raises the risk of an increase of 1.865 mmHg in passive smoker's systolic blood pressure (Fitri et al., 2018).(p-value of 0.001).However, there was no significant difference in the control group before and after the intervention (p-value of 0.087).In addition, there was a significant difference in systolic blood pressure between the intervention group and the control group after being given the intervention (p-value of 0.001).Significant differences existed in the intervention group before and after the intervention (p-value of 0.001).However, there was no significant difference in the control group before and after the intervention (p-value of 0.571).In addition, there was a significant difference in diastolic blood pressure between the intervention group and the control group after being given the intervention (p-value of 0.001).
The results of this study are supported by the results of several previous studies, which stated that the intervention of laughter therapy and traditional music was able to control blood pressure in people with hypertension.Previous studies have stated that laughter therapy can significantly reduce the mean systolic and diastolic blood pressure of hypertensive older people in the community (Eryani & Martaliana, 2019;Bete et al., 2022).The occurrence of a decrease in blood pressure in hypertensive elderly who received laughter therapy intervention was mentioned because there was stimulation of the release of endorphins.
This mechanism helps reduce pain and increase comfort, which causes vasodilation so that blood pressure decreases (Kezia et al., 2020) (Kurniawan et al., 2015).Traditional music significantly reduces blood pressure in hypertensive patients (Im-oun et al., 2018).The limbic system is activated when the body is relaxed.
Music can stimulate the body to produce Nitric oxide (NO) molecules, which act on blood vessel tone to control blood pressure (Pratama et al., 2023).which is characterised by an increase in the hormone serotonin and a decrease in salivary concentration (Yoshikawa et al., 2019).Laughter therapy is a non-invasive, cost-effective, easy-to-implement intervention to reduce symptoms of psychological disorders (Akimbekov & Razzaque, 2021).In addition, music therapy is also said to be able to significantly reduce the level of anxiety and depression in older adults (Rummy et al., 2020;Yang, 2021).

CONCLUSION
The results of this study indicate that most of the two respondents are female, have no family history of hypertension, and have never smoked.In addition, the ages of the two groups of respondents were the same.
This study also showed that the TERTARIK intervention significantly reduced blood Researchers also hope that elderly cadres and families with hypertension will facilitate the elderly to continue listening to traditional music, laughter therapy, and antihypertensive treatment.
average prevalence of hypertension in Indonesia is 8.8% based on a doctor's diagnosis or taking antihypertensive medication in residents aged ≥ 18 years (Indonesian Ministry of Health, 2018a).Apart from that, hypertension is the most common health problem experienced by older people in Indonesia, namely 63,8% (Indonesian Ministry of Health, 2016).The vulnerability experienced by older adults is closely correlated with fluctuations in blood pressure.Blood pressure fluctuations are influenced by many factors, one of which is comfort status.
pressure and increased the comfort level of hypertensive older people.The significance value and the difference in the mean value of all variables between the pre-test and post-test evidence this.The results of this study are expected to be a reference for nurses in community settings to provide nursing interventions for hypertensive elderly.In addition, these results are expected to stimulate further research related to non-pharmacological therapy for elderly hypertension.

DOI: 10.32668/jitek.v11i1.1340
according to health centre standards, elderly who were able to stand, able to open their mouths, able to hear, and elderly who were able to communicate in Balinese and Indonesian.Meanwhile, the exclusion criteria in this study were the elderly who were isolated from COVID-19, experienced mental disorders, and the elderly with complications of hypertension such as stroke, heart disease, and kidney disease.The sample size was calculated using the formula for the average of two unpaired populations and obtained 64 samples (32 per group).The intervention group received standard antihypertensive treatment and the TERTARIK intervention.Meanwhile, the control group only received standard antihypertensive treatment.2 people in the intervention group dropped out, so the total sample until the end was 62.

Table 1 .
Description of Gender, Family History, and Smoking Habits (n=62)

Table 2 .
Description of Respondents' Age, Blood Pressure, and Comfort Level (n=62)

Table 2
illustrates that the mean age of respondents in the intervention and control groups is relatively the same.The median systolic and diastolic blood pressure in the N.L.P.D.Y.Sari, N.M.D.A. Martini.The Increasing Level of Comfort and Decreasing Blood Pleassure of Hypertensive Elderly with "TERTARIK" (Terapi Tertawa dengan Musik Rindik) 48 DOI: 10.32668/jitek.v11i1.1340

Table 3 .
Analysis of the Effect of TERTARIK on Systolic Blood Pressure in Elderly Hypertension (n=62)

Table 3
describes the results of the systolic blood pressure bivariate test in this study.The significance value was seen from paired and unpaired data before and after the intervention was given.Significant differences existed in the intervention group before and after the intervention 49 Jurnal Ilmu dan Teknologi Kesehatan,Vol.11,No.1,September 2023, pp: 43-55DOI: 10.32668/jitek.v11i1.1340

Table 4 .
Analysis of the Effect of TERTARIK on Diastolic Blood Pressure in Elderly Hypertension (n=62)

Table 5 .
Analysis of the Effect of TERTARIK on the Comfort Level of Elderly Hypertension (n = 62)

in Comfort Levels between the Intervention and Control Groups Before and After the Intervention
DOI: 10.32668/jitek.v11i1.1340psychological condition of older adults,