Andrew V. Wister

One-year follow-up of a therapeutic lifestyle intervention targeting cardiovascular disease risk

Background: In this study, we tested the efficacy of a low-intensity lifestyle intervention aimed at reducing the risk of cardiovascular disease among mid-life individuals. Methods: We conducted a randomized controlled trial in which participants were randomly assigned either to receive a health report card with counselling (from a Telehealth nurse) on smoking, exercise, nutrition and stress or to receive usual care. The patients were divided into 2 groups on the basis of risk: the primary prevention group, with a Framingham risk score of 10% or higher (intervention, n = 157; control, n = 158), and the secondary prevention group, who had a diagnosis of coronary artery disease (intervention, n = 153; control, n = 143). The primary outcome was a change in the Framingham global risk score between baseline and 1-year follow-up. Data were analyzed separately for the 2 prevention groups using an intention-to-treat analysis controlling for covariates. Results: Within the primary prevention group, there were statistically significant changes for the treatment group relative to the controls, from baseline to year 1, in Framingham score (intervention, –3.10 [95% confidence interval (CI) –3.98 to –2.22]; control, –1.30 [95% CI –2.18 to –0.42]; p < 0.01) and scores for total cholesterol (intervention, –0.41 [95% CI –0.59 to –0.23]; control, –0.14 [95% CI –0.32 to 0.04]; p < 0.05), systolic blood pressure (intervention, –7.49 [95% CI –9.97 to –5.01]; control, –3.58 [95% CI –6.08 to –1.08]; p < 0.05), nutrition level (intervention, 0.30 [95% CI 0.13 to 0.47]; control, –0.05 [95% CI –0.22 to 0.12]; p < 0.01), and health confidence (intervention, 0.20 [95% CI 0.09 to 0.31]; control, 0.04 [95% CI –0.07 to 0.15]; p < 0.05), with adjustment for covariates. No significant changes in outcome variables were found for the secondary prevention group. Interpretation: We found evidence for the efficacy of an intervention addressing multiple risk factors for primary prevention at 1 year using Framingham risk score report cards and telephone counselling. (Requirement for clinical trial registration waived [enrolment completed before requirement became applicable].)

The Family Environment and Leaving the Parental Home.

This study tests a set of hypotheses relating key aspects of the family environment to the timing of home-leaving among youths. A central research question is whether youths living in stepfamilies, single-parent families, and those with two biological parents display different patterns of leaving the parental home. The data used for this study were drawn from the 1984 Family History Survey collected by Statistics Canada on the timing of home-leaving, marriage, divorce, and remarriage, as well as a number of important sociodemographic variables. The total sample includes 14,004 respondents between the ages of 18 and 64. A multivariate analysis was performed on a subset of the data with multiple classification analysis. The results of the data analysis support the central hypothesis that exposure to stepand single-parent family types promotes earlier homeleaving. Number of children in the family, sex of the child, and region also arose as important predictors of age at final home-leaving. Contrary to the hypothesis, socioeconomic status of the family (measured by education) did not surface as a significant factor.

The Importance of Transportation and Prioritization of Environmental Needs to Sustain Well-Being among Older Adults:

This study examines the influence of transportation dependence and fulfillment of transportation needs on well-being based on a community sample (N = 174). The majority (54.4%) of transportation-dependent participants had unfulfilled transportation needs, whereas this was the case for very few (7.1%) of those independent of transportation support. Regression analyses revealed that the transportation needs variable was statistically significant, whereas the transportation dependence factor was not. In terms of the prioritization of environmental components, elderly dependent on transportation support placed higher importance on housing than on neighborhood or community elements compared to more mobile seniors. Participants with unmet transportation needs were more likely to depend solely on family to provide transportation, whereas participants with fulfilled transportation needs were more likely to include friends or neighbors for providing transportation support. Results suggest that prioritization of needs enables seniors to maintain positive wellbeing despite experiencing functional limitations or being dependent on transportation services.

Altruistic behaviour and social capital as predictors of well-being among older Canadians

ABSTRACT Self-reported altruistic activity and social capital were examined as predictors of perceived happiness and life satisfaction among a sample of 4,486 Canadians aged 65 or more years from the 2003 Canadian General Social Services Survey, Cycle 17. Altruistic behaviour was measured by number of volunteer hours per month and helping others (not including family and friends). Social capital was measured using dimensions of belonging to ones community, community and neighbour trust, and group activities. Drawing on generativity and role-identity theories, it was hypothesised that altruistic behaviour and social capital are positively associated with well-being (using perceived happiness and life satisfaction), and that social capital mediates the relationship. For both perceived happiness and life satisfaction, after controlling for demographic, health status, and social support variables, measures of altruistic behaviour demonstrated statistically significant associations. Once measures of social capital were entered into the analysis in the final block, however, the altruistic behaviour variables were no longer statistically significant. Robust associations were found for social capital and the two measures of well-being, particularly between sense of belonging, trust in neighbours, and perceived happiness and life satisfaction. The findings suggest that altruistic behaviour is mediated by social capital. The implications of these findings are discussed with respect to understanding the well-being of older Canadians.

Unanticipated Consequences: A Comparison of Expected and Actual Retirement Timing Among Older Women

ABSTRACT The present study adds to the growing body of literature on women and retirement by means of a comparative analysis of the factors associated with anticipated retirement timing (among pre-retirees) and actual retirement timing (among retirees). Adopting a political economy of aging perspective, we argue that socially-structured patterns of gender inequality related to womens multiple roles across the life course affect patterns of retirement timing. Specifically, we hypothesize that the gendered nature of womens work-retirement decision-making is unanticipated during pre-retirement years. Logistic regression analyses are performed on data drawn from a sample of 275 women aged 45 and older living in the Vancouver area of British Columbia. A central finding is that while actual timing of retirement is affected by family caregiving responsibilities and by health/stress factors, pre-retirees do not perceive these to be important in their own expected retirement timing. Implications for social policy, education, and womens financial and psychological well-being in old age are elaborated.

Environmental Adaptation by Persons in their Later Life

In an attempt to delay institutionalization among elders while supporting their widespread desire for privacy and independence in living style, it has been deemed necessary to adapt the physical and social milieu to fit declining competence. The theoretical rationale underlying current housing policy can be identified in person-environment theories of aging. The aims of this article are to (1) assess critically and expand Lawtons ecological model of aging as it pertains to environmental decisions among the elderly, and (2) test a series of hypotheses derived from the theoretical discussion using a 1987 study of environmental adaptation among 280 elderly, 74 years of age and over, living in the community. The most striking finding is the tendency for older elderly to engage in psychological processes of adaptation to a greater extent than altering the physical or social characteristics of the home environment. The findings suggest extending the Lawton model to include a wider range of subjective attributes of the individual.

The Effects of Socioeconomic Status on Exercise and Smoking Age-Related Differences

The aim of this article is to examine the effects of socioeconomic status (as measured by education, income, and labor force status) on patterns of exercise and smoking for three age groups: persons aged 25 to 44, 45 to 64, and 65 and over. Two hypotheses drawn from the literature are tested: (a) that socioeconomic status is associated with risky lifestyle behaviors and (b) that the effect of socioeconomic status is greater for younger and middle-aged groups than for older age groups. Logistic regression analyses are performed on the 1990 Canadian Health Promotion Survey. Our results indicate that socioeconomic status affects health behaviors in relatively important ways, but this depends on the measure, the specific behavior, and the age group. The findings are discussed in relation to controversies about the existence of a culture of poverty and its impact on health behaviors, as well as to several age pattern hypotheses.

Living Arrangements of Older Women: The Ethnic Dimension.

The major task of this paper is to examine the effect of cultural or normative structures, as measured by ethnicity, on living arrangements of older, previously married women. The data were drawn from the 1/100 Public Use Sample of the 1971 Canadian Census. Two discriminant function analyses were undertaken. Ethnicity consisted of the British/French dichotomy in the first analysis and of the Jewish/Italian dichotomy in the second. In addition to ethnicity, other independent variables included in the analyses are age, education, fertility, and income. The results of both analyses indicate that fertility is the major determinant of whether or not older women live alone, followed closely by ethnicity. Income, education, and age also have some effect on living arrangements; however, these variables tend to be weaker predictors of household status than fertility and ethnicity are.

Self-care dimensions of complementary and alternative medicine use among older adults.

Background: There is a lack of understanding about the patterns and rates of CAM use among older adults owing to a lack of research on specific types of CAM. Objectives: This study examines several dimensions of self-care deemed to be associated with CAM. Unmet health care needs, self-care attitudes, and spirituality are interpreted as health belief structures underlying CAM. Methods: Logistic regression analysis was used to examine use of three groups of practitioner-based CAM: (a) chiropractic; (b) massage, and (c) acupuncture, homeopathy and/or naturopathy use. We analyze a subsample of 4,401 older adults drawn from the 1996/1997 and 1998/1999 waves of the Canadian National Population Health Survey. Results: The logistic regression analyses indicate that self-care attitude and spirituality represent important predictors of practitioner-based CAM use. The associations for unmet health care needs were not supported. The strongest factors associated with CAM use were the illness context variables, which suggest that measures of need are key factors in leading individuals to seek other forms of health care. Discussion: Practitioner-based CAM use among older adults is influenced by self-care attitude and spirituality, in addition to health status, but to varying degrees depending on the type of CAM. Support of these self-care facets suggests that there is a desire on the part of consumers to exercise choice and to participate in health care decisions when considering CAM.

Self-Care among Older Adults An Analysis of the Objective and Subjective Illness Contexts

Objectives: The authors hypothesize that older adults diagnosed with arthritis showa greater reliance on objective factors in their self-care behaviors, whereas those diagnosed with heart problems or hypertension demonstrate a greater reliance on more general belief-laden factors. Methods: A total of 794 older adults (mean age = 69.3) who were professionally diagnosed with arthritis, heart problems, or hypertension completed a telephone survey about a number of aspects of their illness condition and their general well-being. Results: The results from the hierarchical regression analyses indicate that objective factors and illness-specific beliefs are better predictors of self-care behavior in the arthritis group, whereas general beliefs (e.g., self-efficacy and general well-being) are better predictors of such behavior in the heart problems and hypertension groups. Discussion: The analyses support the authors’ hypothesis. The results are discussed in the context of expanding the Health Belief Model of self-care.