Social Well-Being, Psychological Factors, and Chronic Conditions Among Older Adults

Background

Aging is characterized by the decline in physical health, functional status, and loss of social roles and relationships that can challenge the quality of life. Social well-being may help explain how aging individuals experience declining physical health and social relationships. Despite the high prevalence of chronic conditions among older adults, research exploring the relationship between social well-being and chronic disease is sparse.

Objectives

The study aims were to investigate the relationship between social well-being and psychological factors (e.g., perceived control, life satisfaction, self-esteem, active coping, optimism, and religious coping) by chronic condition in older adults.

Design

Cross-sectional study.

Participants

The current study comprises older adults (N = 1,251, aged ≥ 65 y) who participated in the third wave of the National Survey of Midlife in the United States (i.e., MIDUS).

Setting

MIDUS was conducted on a random-digit-dial sample of community-dwelling, English-speaking adults.

Measurements

Six instruments representing psychological resources (life satisfaction, perceived control, self-esteem, optimism, active coping, and religious coping) and five dimensions of social well-being (social actualization, social coherence, social acceptance, social contribution, social integration) were measured. An index of chronic disease comprised of self-reported data whether they had received a physician's diagnosis for any chronic conditions over the past year.

Results

The findings indicated that the individuals without chronic conditions had significantly higher social integration, social acceptance, and social contribution scores than the individuals with chronic conditions (t = 2.26, p < 0.05, t = 2.85, p < 0.01, and t = 2.23, p < 0.05, respectively). For individuals diagnosed with more than one chronic condition, perceived control, self-esteem, and optimism were positively related to their social well-being (β = .33, p < .001, β = .17, p < .001, and β = .33, p < .001, respectively).

Conclusion

Findings suggested that older adults with multiple chronic conditions have a decrease in social well-being. Chronic disease management programs may help increase social well-being among individuals with multiple chronic conditions.

Identifying individuals with multiple non-communicable disease risk factors in Kenya: a latent class analysis

OBJECTIVES

Non-communicable diseases (NCDs) are the leading causes of death globally. In Kenya, the number of deaths resulting from NCDs is projected to surpass malaria and tuberculosis by 2030. Studies in Kenya show increasing NCDs; the aim of the present study is to examine the clustering of NCDs and risk factors in Kenya.

STUDY DESIGN

This is a cross-sectional study using data from the 2015 Kenya STEPwise Survey.

METHODS

This study examined relationships between NCDs (e.g. obesity, hypertension and diabetes) and health behaviours (e.g. sedentary activity, and fruit and vegetable consumption). Survey probability weights, which estimated the sampling design effect, were applied to consider the sampling units, and stratifications were used during sampling so that the results could be generalisable to the national adult Kenyan population. In total, 4350 adults were included in the study sample.

RESULTS

Overall, 24.43% of participants were classified as having hypertension, 1.88% as having type 2 diabetes, and 27.94% were classified as being overweight or obese. The best-fit model was a four-class solution. Class 1 is best described as 'young with high NCD risk' and had the highest sedentary activity. Class 2 is best described as 'poor rural with lower NCD risk' with a high chance of smoking and alcohol consumption. Class 3 is best described as 'rural with high NCD risk' and had the highest fruit and vegetable consumption. Class 4 is best described as 'wealthy young urban dwellers with high NCD risk' with a high chance of alcohol consumption and smoking. Individuals in Class 4 had the highest chance (40%) of being overweight/obese, a 2% chance of type 2 diabetes and a 23% chance of having hypertension.

CONCLUSIONS

NCDs are clustered in groups with high-risk behaviours. The group with the highest chance of having NCDs also had the highest chance of engaging in high-risk behaviours. The findings of this study suggest that smoking and alcohol consumption increase NCD risk in rural areas. Tailored and targeted interventions are needed to curb the increasing NCD prevalence in Kenya.

Sex differences in autonomic function following maximal exercise

Background

Heart rate variability (HRV), blood pressure variability, (BPV) and heart rate recovery (HRR) are measures that provide insight regarding autonomic function. Maximal exercise can affect autonomic function, and it is unknown if there are sex differences in autonomic recovery following exercise. Therefore, the purpose of this study was to determine sex differences in several measures of autonomic function and the response following maximal exercise.

Methods

Seventy-one (31 males and 40 females) healthy, nonsmoking, sedentary normotensive subjects between the ages of 18 and 35 underwent measurements of HRV and BPV at rest and following a maximal exercise bout. HRR was measured at minute one and two following maximal exercise.

Results

Males have significantly greater HRR following maximal exercise at both minute one and two; however, the significance between sexes was eliminated when controlling for VO₂ peak. Males had significantly higher resting BPV-low-frequency (LF) values compared to females and did not significantly change following exercise, whereas females had significantly increased BPV-LF values following acute maximal exercise. Although males and females exhibited a significant decrease in both HRV-LF and HRV-high frequency (HF) with exercise, females had significantly higher HRV-HF values following exercise. Males had a significantly higher HRV-LF/HF ratio at rest; however, both males and females significantly increased their HRV-LF/HF ratio following exercise.

Conclusions

Pre-menopausal females exhibit a cardioprotective autonomic profile compared to age-matched males due to lower resting sympathetic activity and faster vagal reactivation following maximal exercise. Acute maximal exercise is a sufficient autonomic stressor to demonstrate sex differences in the critical post-exercise recovery period.

Qualitative exploration of rural focus group members' participation in the Chronic Disease Self-Management Program, USA

INTRODUCTION

Nearly half of rural residents in the USA have at least one chronic condition, and meeting the complex needs of these individuals has become a challenge for the current healthcare system. A self-management approach enables individuals with chronic illnesses to gain skills needed to improve the management of their conditions. Rural areas have a higher proportion of individuals who are likely to be affected by chronic conditions. Based on these factors, it is necessary to provide programs to help rural residents self-manage their health. The purpose of this qualitative, exploratory study is to explore the benefits perceived by rural residents due to their participation in six weekly group sessions, which are referred to as the Chronic Disease Self-Management Program (CDSMP).

METHODS

Individuals who completed the CDSMP were recruited to participate in a focus group regarding their experience with the program. Thirty-four of the 45 respondents (75%) who completed the CDSMP participated in six focus groups. When the respondents returned for the scheduled focus groups, they were asked to share their experience with the CDSMP. Each focus group was located at the same site that housed the program in their community. Phenomenological and consensual qualitative approaches were used in the data analysis for the present study.

FINDINGS

The majority (91%) of the participants were female. Of those, 97% were non-Hispanic whites. The mean number of chronic conditions was two, with a range between one and eight chronic conditions per participant. Two prominent themes emerged from the six focus groups: respondent interaction in behavior change and prioritizing health behavior change.

CONCLUSIONS

The study findings support that chronic disease self-management programs can initiate positive behavioral changes, and those lifestyle changes can influence and improve the health of rural populations. Similar programs can yield beneficial results on important behavior change for the rural communities, an underserved population with chronic conditions.

Validity of predicting left ventricular end systolic pressure changes following an acute bout of exercise

OBJECTIVES

Left ventricular end systolic pressure (LV ESP) is important in assessing left ventricular performance and is usually derived from prediction equations. It is unknown whether these equations are accurate at rest or following exercise in a young, healthy population.

DESIGN

Measured LV ESP vs. LV ESP values from the prediction equations were compared at rest, 15 min and 30 min following peak aerobic exercise in 60 participants.

METHODS

LV ESP was obtained by applanation tonometry at rest, 15 min post and 30 min post peak cycle exercise.

RESULTS

Measured LV ESP was significantly lower (p<0.05) at all time points in comparison to the two calculated values. Measured LV ESP decreased significantly from rest at both the post15 and post30 time points (p<0.05) and changed differently in comparison to the calculated values (significant interaction; p<0.05). The two LV ESP equations were also significantly different from each other (p<0.05) and changed differently over time (significant interaction; p<0.05).

CONCLUSIONS

The two commonly used prediction equations did not accurately predict either resting or post exercise LV ESP in a young, healthy population. Thus, LV ESP needs to be individually determined in young, healthy participants. Non-invasive measurement through applanation tonometry appears to allow for a more accurate determination of LV ESP.