@article {8857, title = {Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study.}, journal = {BMC Geriatr}, volume = {17}, year = {2017}, month = {2017 01 11}, pages = {13}, abstract = {

BACKGROUND: Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for established "classic" biomedical risk factors. We also determined if an enhanced risk model with control beliefs improved identification of individuals with low vs. high mortality risk.

METHODS: We used nationally representative data from the Health and Retirement Study (2006-2012) for adults 50~years or older in 2006 (n = 7313) or 2008 (n = 6301). We assessed baseline perceived global control (measured as 2 dimensions-"constraints" and "mastery"), and health-specific control. We also obtained baseline data for 12 established biomedical risk factors of 4-year mortality: age, sex, 4 medical conditions (diabetes mellitus, cancer, lung disease and heart failure), body mass index less than 25~kg/m, smoking, and 4 functional difficulties (with bathing, managing finances, walking several blocks and pushing or pulling heavy objects). Deaths within 4~years of follow-up were determined through interviews with respondents{\textquoteright} family and the National Death Index.

RESULTS: After accounting for classic biomedical risk factors, perceived constraints were significantly associated with higher mortality risk (third quartile scores~odds ratio [OR] 1.37, 95\% CI 1.03-1.81; fourth quartile scores~OR 1.45, 95\% CI, 1.09-1.92), while health-specific control was significantly associated with lower risk (OR 0.69-0.78 for scores above first quartile). Higher perceived mastery scores were not consistently associated with decreased risk. The enhanced model with control beliefs found an additional 3.5\% of participants (n = 222) with low predicted risk of 4-year mortality (i.e., 4\% or less); observed mortality for these individuals was 1.8\% during follow-up. Compared with participants predicted to have low mortality risk only by the classic biomedical model, individuals identified by only the enhanced model were older, had higher educational status, higher income, and higher prevalence of diabetes mellitus and cancer.

CONCLUSION: Control beliefs were significantly associated with risk for 4-year mortality; accounting for these factors improved identification of low-risk individuals. More work is needed to determine how assessment of control beliefs could enable targeting of clinical interventions to support at-risk older adults.

}, keywords = {Activities of Daily Living, Age Factors, Aged, Diabetes Mellitus, Female, Heart Failure, Humans, Internal-External Control, Lung Diseases, Male, Middle Aged, Neoplasms, Prospective Studies, Risk Factors, Self Concept, Survival Analysis}, issn = {1471-2318}, doi = {10.1186/s12877-016-0390-3}, url = {https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/28077089/}, author = {Wei Duan-Porter and Susan Nicole Hastings and Brian Neelon and Courtney Harold Van Houtven} } @article {8144, title = {Control Beliefs and Risk for Death, Stroke and Myocardial Infarction in Middle-aged and Older Adults: An Observational Study.}, journal = {J Gen Intern Med}, volume = {30}, year = {2015}, note = {Export Date: 29 May 2015 Article in Press}, month = {2015 Aug}, pages = {1156-63}, publisher = {30}, abstract = {

BACKGROUND: Chronic health conditions account for the largest proportion of illness-related mortality and morbidity as well as most of healthcare spending in the USA. Control beliefs may be important for outcomes in individuals with chronic illness.

OBJECTIVE: To determine whether control beliefs are associated with the risk for death, incident stroke and incident myocardial infarction (MI), particularly for individuals with diabetes mellitus (DM) and/or hypertension.

DESIGN: Retrospective cohort study.

PARTICIPANTS: A total of 5,662 respondents to the Health and Retirement Study with baseline health, demographic and psychological data in 2006, with no history of previous stroke or MI.

MAIN MEASURES: Perceived global control, measured as two dimensions--"constraints" and "mastery"--and health-specific control were self-reported. Event-free survival was measured in years, where "event" was the composite of death, incident stroke and MI. Year of stroke or MI was self-reported; year of death was obtained from respondents{\textquoteright} family.

KEY RESULTS: Mean baseline age was 66.2 years; 994 (16.7\%) had DM and 3,023 (53.4\%) hypertension. Overall, 173 (3.1\%) suffered incident strokes, 129 (2.3\%) had incident MI, and 465 (8.2\%) died. There were no significant interactions between control beliefs and baseline DM or hypertension in predicting event-free survival. Elevated adjusted hazard ratios (HRs) were associated with DM (1.33, 95 \% CI 1.07-1.67), hypertension (1.31, 95\% CI 1.07-1.61) and perceived constraints in the third (1.55, 95\% CI 1.12-2.15) and fourth quartiles (1.61, 95\% CI 1.14-2.26). Health-specific control scores in the third (HR 0.78, 95\% CI 0.59-1.03) and fourth quartiles (HR 0.70, 95\% CI 0.53-0.92) were protective, but only the latter category had a statistically significant decreased risk. Combined high perceived constraints and low health-specific control had the highest risk (HR 1.93, 95\% CI 1.41-2.64).

CONCLUSIONS: Control beliefs were not associated with differential risk for those with DM and/or hypertension, but they predicted significant differences in event-free survival for the general cohort.

}, keywords = {Aged, Diabetes Mellitus, Female, Health Knowledge, Attitudes, Practice, Humans, Hypertension, Longitudinal Studies, Male, Middle Aged, Myocardial Infarction, Patients, Retrospective Studies, Risk Factors, Stroke, Treatment Outcome}, issn = {1525-1497}, doi = {10.1007/s11606-015-3275-9}, author = {Wei Duan-Porter and Susan Nicole Hastings and Brian Neelon and Courtney Harold Van Houtven} }