Duan-Porter Wei, Hastings Susan Nicole, Neelon Brian, Van Houtven Courtney Harold
Minneapolis VA Health Services Research and Development, One Veterans Dr, Minneapolis, MN, 55417, USA.
Durham VA Health Services Research and Development, Durham, NC, USA.
BMC Geriatr. 2017 Jan 11;17(1):13. doi: 10.1186/s12877-016-0390-3.
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.
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' family and the National Death Index.
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.
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.
控制信念是重要的心理因素，可能导致老年人健康结果的异质性。在考虑既定的“经典”生物医学风险因素后，我们评估了控制信念是否与4年死亡率风险相关。我们还确定了包含控制信念的增强风险模型是否能更好地识别低死亡率风险和高死亡率风险的个体。
我们使用了来自健康与退休研究（2006 - 2012年）的具有全国代表性的数据，这些数据来自2006年年龄在50岁及以上的成年人（n = 7313）或2008年的成年人（n = 6301）。我们评估了基线时的总体控制感（以“限制”和“掌控”两个维度衡量）以及特定健康方面的控制感。我们还获取了12种既定的4年死亡率生物医学风险因素的基线数据：年龄、性别、4种疾病（糖尿病、癌症、肺部疾病和心力衰竭）、体重指数低于25kg/m²、吸烟以及4种功能困难（洗澡、理财、步行几个街区以及推或拉重物）。通过与受访者家属的访谈和国家死亡索引确定随访4年内的死亡情况。
在考虑经典生物医学风险因素后，感知到的限制与较高的死亡率风险显著相关（第三四分位数得分的比值比[OR]为1.37，95%置信区间为1.03 - 1.81；第四四分位数得分的OR为1.45，95%置信区间为1.09 - 1.92），而特定健康方面的控制与较低风险显著相关（第一四分位数以上得分的OR为0.69 - 0.78）。较高的感知掌控得分与风险降低之间没有始终一致的关联。包含控制信念的增强模型发现另外3.5%的参与者（n = 222）4年死亡率的预测风险较低（即4%或更低）；在随访期间这些个体的观察到的死亡率为1.8%。与仅通过经典生物医学模型预测死亡率风险较低的参与者相比，仅通过增强模型识别出的个体年龄更大、教育程度更高、收入更高，糖尿病和癌症的患病率也更高。
控制信念与4年死亡率风险显著相关；考虑这些因素可更好地识别低风险个体。需要开展更多工作来确定对控制信念的评估如何能够针对有风险的老年人进行临床干预。
