Health behaviour changes after diagnosis of chronic illness among Canadians aged 50 or older

Changes in health behaviours (smoking, physical activity, alcohol consumption, and fruit and vegetable consumption) after diagnosis of chronic health conditions (heart disease, cancer, stroke, respiratory disease, and diabetes) were examined among Canadians aged 50 or older. Results from 12 years of longitudinal data from the Canadian National Population Health Survey indicated relatively modest changes in behaviour. Although significant decreases in smoking were observed among all groups except those with respiratory disease, at least 75% of smokers did not quit. No significant changes emerged in the percentage meeting physical activity recommendations, except those with diabetes, or in excessive alcohol consumption, except those with diabetes and respiratory disease. The percentage reporting the recommended minimum fruit and vegetable intake did not increase significantly among any group.

Ambivalent versus problematic social ties: implications for psychological health, functional health, and interpersonal coping

Older adults often seek to manage their social networks to foster positive interactions, but they nonetheless sometimes experience negative interactions that detract from their health and well-being. Negative interactions may occur with ambivalent social partners (i.e., partners involved in both positive and negative exchanges) or exclusively problematic social partners (i.e., partners involved in negative exchanges only), but conflicting views exist in the literature regarding which type of social partner is likely to be more detrimental to older adults' physical and emotional health. This study examined the implications of the two kinds of network members for physical and psychological health and interpersonal coping responses in a representative sample of 916 older adults. Analyses revealed that ambivalent social ties were more strongly related to functional health limitations than were exclusively problematic social ties, whereas problematic ties were more consistently related to psychological health than were ambivalent ties. Furthermore, negative exchanges that occurred with exclusively problematic social ties, compared to those that occurred with ambivalent social ties, were associated with more avoidant and fewer conciliatory coping responses, stronger and longer-lasting negative emotions, and lower perceived coping effectiveness. Within this elderly sample, older age was associated with having fewer ambivalent and exclusively problematic kin ties. A comprehensive understanding of the significance of social network ties in older adults' lives may benefit not only from attention to sources of social support but also from efforts to distinguish between different sources of conflict and disappointment.

Health behavior change following chronic illness in middle and later life

OBJECTIVES

Understanding lifestyle improvements among individuals with chronic illness is vital for targeting interventions that can increase longevity and improve quality of life.

METHODS

Data from the U.S. Health and Retirement Study were used to examine changes in smoking, alcohol use, and exercise 2-14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease.

RESULTS

Patterns of behavior change following diagnosis indicated that the vast majority of individuals diagnosed with a new chronic condition did not adopt healthier behaviors. Smoking cessation among those with heart disease was the largest observed change, but only 40% of smokers quit. There were no significant increases in exercise for any health condition. Changes in alcohol consumption were small, with significant declines in excessive drinking and increases in abstention for a few health conditions. Over the long term, individuals who made changes appeared to maintain those changes. Latent growth curve analyses up to 14 years after diagnosis showed no average long-term improvement in health behaviors.

DISCUSSION

Results provide important new information on health behavior changes among those with chronic disease and suggest that intensive efforts are required to help initiate and maintain lifestyle improvements among this population.

Adopting leisure-time physical activity after diagnosis of a vascular condition

BACKGROUND

A better understanding of factors associated with adopting leisure-time physical activity among people with chronic vascular conditions can help policy-makers and health care professionals develop strategies to promote secondary prevention among older Canadians.

DATA AND METHODS

Cross-sectional data from the 1994/1995 National Population Health Survey (NPHS), household component, and the 2007/2008 Canadian Community Health Survey were used to estimate the prevalence of inactivity. Longitudinal data from eight cycles (1994/1995 through 2008/2009) of the NPHS, household component, were used to examine the adoption of leisure-time physical activity, intentions to change health risk behaviours, and barriers to change.

RESULTS

Over half (54%) of the population aged 40 or older were inactive during their leisure time in 2007/2008. A new vascular diagnosis was not associated with initiating leisure-time physical activity. Among the newly diagnosed, those with no disability or a mild disability had higher odds of undertaking leisure-time physical activity.

INTERPRETATION

The majority of Canadians in mid- to late life are inactive. They tend to remain so when diagnosed with a vascular condition.

Does volunteering moderate the relation between functional limitations and mortality?

Previous studies have demonstrated that functional limitations increase, and organizational volunteering decreases, the risk of mortality in later life. However, scant attention has been paid to investigating the joint effect of functional limitations and organizational volunteering on mortality. Accordingly, we tested the hypothesis that volunteering moderates the relation between functional limitations and risk of mortality. This prospective study used baseline survey data from a representative sample of 916 non-institutionalized adults 65 years old and older who lived in the continental United States. Data on mortality were extracted six years later from the National Death Index. Survival analyses revealed that functional limitations were associated with an increased risk of dying only among participants who never or almost never volunteered, suggesting that volunteering buffers the association between functional limitations and mortality. We conclude that although it may be more difficult for older adults with functional limitations to volunteer, they may receive important benefits from doing so.

Suicide among male veterans: a prospective population-based study

OBJECTIVES

To assess the risk of mortality from suicide among male veteran participants in a large population-based health survey.

DESIGN AND SETTING

A prospective follow-up study in the US. Data were obtained from the US National Health Interview Surveys 1986-94 and linked to the Multiple Cause of Death file (1986-97) through the National Death Index.

PARTICIPANTS

The sample comprised 320 890 men, aged >/=18 years at baseline. The participants were followed up with respect to mortality for 12 years.

RESULTS

Cox proportional hazards analysis showed that veterans who were white, those with >/=12 years of education and those with activity limitations (after adjusting for medical and psychiatric morbidity) were at a greater risk for completing suicide. Veterans were twice as likely (adjusted hazard ratio 2.13, 95% CI 1.14 to 3.99) [corrected] to die of suicide compared with non-veterans in the general population. The risk of death from "natural" causes (diseases) and the risk of death from "external" causes did not differ between the veterans and the non-veterans. Interestingly, male veterans who were overweight had a significantly lower risk of completing suicide than those who were of normal weight.

CONCLUSIONS

Veterans in the general US population, whether or not they are affiliated with the Department of Veterans Affairs (VA), are at an increased risk of suicide. With a projected rise in the incidence of functional impairment and psychiatric morbidity among veterans of the conflicts in Afghanistan and Iraq, clinical and community interventions that are directed towards patients in both VA and non-VA healthcare facilities are needed.

The joint effects of life stress and negative social exchanges on emotional distress

OBJECTIVE

Negative social exchanges detract considerably from older adults' emotional health, but little is known about the specific factors that make some older adults more vulnerable than others to such exchanges. This study examined whether stressful life experiences compound the impact of negative social exchanges on emotional distress. We examined both linear and nonlinear models of the joint effects of negative social exchanges and stressful life experiences.

METHODS

In-person interviews took place with a representative sample of 916 noninstitutionalized older adults. We examined linear and nonlinear models for three classes of stressful life experiences (relationship losses, disruptive events, and functional impairment).

RESULT

Regression analyses that included first-order and second-order interaction terms revealed a linear pattern for loss events and functional impairment, and a nonlinear pattern for disruptive events.

DISCUSSION

This study suggests that negative social exchanges and stressful life experiences jointly affect emotional distress, but the particular nature of the joint effects varies by type and level of stressor. Negative social exchanges appear to have more severe effects in the context of some stressors but less severe effects in the context of other stressors.

Positive and negative social exchanges and disability in later life: an investigation of trajectories of change

OBJECTIVES

Various aspects of one's social ties are thought to influence the onset, progression, and course of disability in older adulthood. Although the longitudinal course of social ties and physical disability is likely to be marked by fluctuations over time and intraindividual variation, few studies have explored how patterns of change in positive and negative social exchanges relate to patterns of change in disability across time. The current study, therefore, examined the extent to which distinct longitudinal trajectories of positive and negative exchanges were associated with patterns of physical disability.

METHODS

We followed a sample of 482 community-dwelling older adults with little to no disability at baseline for 2 years.

RESULTS

Results identified multiple, distinct trajectory groups for positive and negative exchanges and disability. Latent class growth analyses revealed that individuals with chronically high or low positive exchanges were likely to experience low and increasing levels of disability. With respect to negative exchanges, individuals with moderately increasing negative exchanges showed patterns of increasing disability and disability remission, whereas chronically low or absent negative exchanges were associated with low and increasing levels of disability.

DISCUSSION

Findings highlight the importance of evaluating multiple trajectories of change in older adults' social exchanges and disability.

Pain, Positive and Negative Social Exchanges, and Depressive Symptomatology in Later Life

Objectives: Pain in older adulthood is correlated with both depressive symptomatology and positive and negative social exchanges, but the direction of these relationships remains unclear. This study investigated whether (a) pain is associated with increases in negative exchanges and decreases in positive exchanges and (b) negative exchanges play a greater role than positive exchanges in accounting for the association between pain and depressive symptomatology. Methods: Data were derived from the Later Life Study of Social Exchanges, a longitudinal survey of noninstitutionalized older adults. Interviews assessed participants' sociodemographic and biopsychosocial characteristics, as well as their interactions with network members. Results: Pain was significantly associated with negative exchanges, and both pain and negative exchanges predicted greater depressive symptomatology over time. Positive social exchanges, however, were not related to either pain or depression. Discussion: The findings underscore the value of examining older adults' social exchanges in efforts to understand pain-induced depressive symptomatology.

Physical illness, functional limitations, and suicide risk: a population-based study

The purpose of this study was to assess the independent association of physical illness and functional limitations with suicide mortality risk. The Cox proportional hazards model was used with data from the 1986-1994 National Health Interview Survey linked to the 1986-1997 National Death Index to analyze the effects of chronic physical illness and functional limitations on suicide deaths (ICD-9 E950-959). After controlling for potential confounders at baseline, functional limitations were shown to be a significant predictor of suicide. Also, psychiatric comorbidity increased the risk of completing suicide. Interestingly, chronic conditions alone were not predictive of suicide completion when functional limitation was added to the model. Implications for the clinical management of suicidal behavior among patients with chronic conditions are discussed.

Sooner versus later: factors associated with temporal sequencing of suicide

There are few (if any) population-based prospective studies that provide information on factors associated with temporal sequencing of suicide. In this prospective population-based study, the National Health Interview Survey (NHIS), 1986-1994, was linked to the National Death Index (NDI), 1986-1997, to assess factors that predict recent (within 12 months of interview, termed sooner) suicide versus suicide further in the future (more than 12 months after interview, termed later). Of the 653 completed suicides in the NHIS cohort, 13.4 percent completed suicide within a year of interview, and 86.6 percent did so after a year. Sooner decedents were more likely to be White, less educated, unemployed, and to use firearms than any other method compared with later decedents. Surprisingly, sooner decedents had higher levels of self-rated health at baseline. These results have substantial implications for clinicians and other professionals who interact with people at highest risk of suicide. Unfortunately, it may be unrealistic to expect that health care providers can modify the behavior of individuals at highest risk of suicide.

Understanding the relative importance of positive and negative social exchanges: examining specific domains and appraisals

Negative social exchanges have been more reliably related to psychological health than have positive social exchanges. Little research, however, has sought to understand how underlying appraisal processes link such exchanges to psychological health. This study examined the frequencies of occurrence and appraisals of four parallel domains of positive and negative exchanges in relation to positive well-being and psychological distress in a national sample of 916 older adults. Structural equation analyses revealed that negative exchanges were related both to less well-being and greater psychological distress, whereas positive exchanges were related only to positive well-being. Furthermore, results supported a process in which appraisals mediated the link between social exchanges and psychological health. This social appraisal process helps explain the disproportionate impact of negative exchanges on psychological health.

A longitudinal study of the effects of dual-earner couples' utilization of family-friendly workplace supports on work and family outcomes

Little research exists on the effects of the utilization of workplace supports on work-family conflict and job satisfaction. With family systems theory as a framework, 2 waves of national survey data were collected from 234 couples (N = 468) caring for children and for aging parents. Data were analyzed with structural equation modeling techniques. Longitudinal results indicate that individuals' use of workplace supports was related to work-family conflict in the direction opposite to expectations and was related to job satisfaction in the direction consistent with expectations. Differential effects for wives versus husbands were found. In addition, couples' use of workplace supports was only minimally related to wives' outcomes. Results are discussed in terms of gender differences, family systems theory, and methodological and measurement issues related to the longitudinal study of utilization of workplace supports.

The health consciousness myth: implications of the near independence of major health behaviors in the North American population

Analysis of over 250,000 respondents from four of the largest epidemiological surveys in North America indicates that major health behaviors are largely unrelated to one another. On average, the percentage of shared variance among smoking, exercise, diet and alcohol consumption is approximately 1%. While many of these relationships are statistically significant, suggesting that the associations are nonzero in the population, they represent minute effect sizes. The weak associations among these behaviors are unlikely to be due to incorrect functional form of the relationship, measurement error, or biases in responding. The findings have implications for health behavior theories and interventions predicated on the notion that the health conscious individual attempts to improve his or her health by engaging in more than one of these behaviors at a time.

The association between length of residence and obesity among Hispanic immigrants

BACKGROUND

Newly arrived Hispanic immigrants are generally healthier than the U.S.-born population, but this distinction tends to diminish over time as immigrants adapt to a new and different sociocultural environment.

OBJECTIVE

This study sought to determine whether length of residence in the United States was associated with obesity (body mass index [BMI]>30 kg/m(2)) among Hispanic immigrants.

METHODS

Data for 2420 foreign-born Hispanic adults aged > or =18 years were obtained from the 1998 National Health Interview Survey.

RESULTS

The prevalence of obesity among those with 0 to 4, 5 to 9, 10 to 14, and > or =15 years of residence in the United States was 9.4%, 14.5%, 21.0%, and 24.2%, respectively. A logistic regression model adjusted for smoking, physical inactivity, self-assessed health, chronic conditions, functional limitations, nonspecific psychological distress, several sociodemographic characteristics, and access to health services found that longer-term Hispanic immigrants (> or =15 years) experienced a nearly four-fold greater risk of obesity than did recent immigrants (<5 years).

CONCLUSIONS

The higher risk for obesity associated with length of residence may be due to acculturation processes such as the adoption of the unhealthy dietary practices (i.e., a diet high in fat and low in fruits and vegetables) and sedentary lifestyles of the host country. The results of this study may facilitate the planning of public health interventions that are directed at subgroups of the Hispanic population.

Health Behaviors in a Representative Sample of Older Canadians: Prevalences, Reported Change, Motivation to Change, and Perceived Barriers

PURPOSE

Prevalence estimates of healthy behaviors and preventive care among older adults have not received sufficient attention, despite important health benefits such as longevity and better quality of life. Moreover, little is known about general population prevalences of older adults' efforts to change behavior, motivations to improve health behaviors, and perceived barriers to change.

DESIGN AND METHODS

This study estimates the prevalence of a wide range of health behaviors and preventive-care activities, self-reported behavior change, and perceived barriers to change in a 1996-1997 population-based survey of 17,354 Canadian adults aged 60 and older.

RESULTS

The findings indicate that a substantial proportion of older adults lead relatively inactive lives and often fall short of recommended standards for preventive health-care visits and screening tests. Moreover, nearly two thirds (63.2%) of older adults reported no efforts in the prior year to make changes to improve their health, and similar numbers (66.7%) indicated they thought no changes were needed. Differences in prevalences were found by gender, age, and education.

IMPLICATIONS

Results from this study are useful for policy makers who need to prioritize public health efforts, researchers studying interventions, and health professionals developing preventive-care guidelines.

Prevalence and correlates of overweight and obesity among older adults: findings from the Canadian National Population Health Survey

BACKGROUND

The prevalence of obesity among elderly persons in industrialized countries ranges from 15% to 20%. Little is known about variations of overweight within subgroups of the elderly population. This study examined the factors associated with overweight and obesity among older men and women.

METHODS

Data for 12,823 community-dwelling persons aged 65 and older from the 1996-1997 Canadian National Population Health Survey were examined. Predictors of overweight (body mass index [BMI] = 25.0-29.9 kg/m2) and obesity (BMI = >30 kg/m2) relative to normal weight (BMI = 20.0-24.9 kg/m2) were examined using logistic regression analyses. Analyses were stratified by gender. The predictor variables included age, education, marital status, place of birth, region, smoking status, alcohol use, chronic conditions, physical activity, functional limitations, self-rated health, social support, and psychological distress.

RESULTS

Overall, 39% and 13% of Canadian older adults were classified as overweight and obese, respectively. Some of the risk factors for overweight were male gender, low education, being married, Canadian born, residence in the Atlantic provinces, no use of alcohol, comorbidity, physical inactivity, and limited functional status. Risk factors for obesity were similar to those for overweight except for being unmarried; American, European, and Australian born; lower and higher levels of alcohol use; poor self-rated health; and psychological distress.

CONCLUSIONS

The results could lead to more effective weight-control interventions that are designed to promote increased physical activity and healthy eating habits among obese older individuals.

The Relative Importance of Three Domains of Positive and Negative Social Exchanges: A Longitudinal Model With Comparable Measures

Researchers have expressed considerable interest in the question of whether positive or negative social exchanges more strongly affect psychological health, but previous studies have been limited by using nonparallel measures of positive and negative social exchanges, by measuring negative affect only, and by relying largely on cross-sectional designs. The independent effects of positive and negative exchanges on both positive and negative affect were examined in a short-term longitudinal study of 277 older adults, using social exchange measures with parallel content and equivalent reliability and validity. In cross-sectional analyses, positive exchanges predicted positive affect, and negative exchanges predicted negative affect. In longitudinal analyses, however, negative exchanges predicted both positive and negative affect, whereas positive exchanges were unrelated to either outcome. The more potent and longer-lasting effects of negative exchanges have important implications for theory and interventions.

Characteristics of physically inactive older adults with arthritis: results of a population-based study

BACKGROUND

Arthritis is the most prevalent chronic condition among persons age 65 and older in North America. Physical inactivity in this population is linked to functional limitations, increased risk for cardiovascular disease, diminished quality of life, and disability. The purpose of this study was to identify risk factors for inactivity.

METHODS

National data for 6256 community-dwelling older adults with arthritis from the 1996-1997 Canadian National Population Health Survey were examined using logistic regression analyses. The independent variables included sociodemographic characteristics, health status, psychosocial factors, health behaviors, and medication use.

RESULTS

Inactive persons were significantly (P < 0.05) more likely to be women, older (75+), have functional limitations, be underweight (BMI < 20) or overweight (BMI > 25), have severe pain, or not have prescription drug insurance coverage. The same group was less likely to be unmarried, well educated, from western provinces, attend church frequently, consume alcohol infrequently, have higher levels of social support, have better self-rated health, or use pain medication.

CONCLUSIONS

The profile presented in this study should be fully considered by health care providers when educating patients with arthritis about the adverse health effects of sedentary behavior. Prescription drug insurance coverage may facilitate activity among elders with arthritis.

Perceptions and implications of received spousal care: Evidence from the Caregiver Health Effects Study

The experiences of older care recipients have received far less theoretical and empirical attention than those of their family caregivers. In this study of 91 care recipients, the authors assessed perceptions of the amount, timing, and manner of spousal assistance; the amount of strain experienced from receiving care; and psychological well-being. Although female care recipients were more likely to report dissatisfaction with the manner in which assistance was provided, there were few gender differences in perceptions of care overall. In a stringent test of the hypothesis that perceived quality of spousal care affects recipient well-being, the authors found that poorer quality of care was related to increased depressive symptoms and a decreased sense of mastery 1 year later. These longitudinal effects were independent of the recipient's physical disability, marital quality, and care-receiving strain as well as the caregiver's well-being. These findings argue for a comprehensive assessment of the care-receiving experience that includes both care-recipient and caregiver perspectives.