Leslie McDonald-Miszczak

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.

Self-Reported Medication Adherence and Health Status in Late Adulthood: The Role of Beliefs

In this study, we explore the role of subjective beliefs in determining self-reports of medication adherence and health status in 90 older adults (M age = 71.7 years, SD= 7.44). Self-reported adherence was predicted by personal health locus of control beliefs, but not by medical factors nor beliefs regarding ones own health care professionals. Self-reported health was predicted by medical factors, perceptions of ones health care professional, and health locus of control. These results suggest that self reported adherence is primarily a belief-laden construct whereas self reported health consists of both an objective assessment of health and a subjective belief-laden component. Exploratory analyses conducted on younger-old and older-old age groups indicated that medical factors may be less important to older-old adults perceived health status than the younger-old adults.

A pilot study examining older adults' beliefs related to medication adherence: the BERMA survey.

Objective: To establish a multifactorial measure of older adults’ beliefs related to medication adherence. Methods: Ninety-two older adults (M = 71.42 years) were asked to provide medication and health-related information, memory strategies, and complete the Beliefs Related to Medications (BERMA) Survey. Results: The final version of the BERMA survey contains 53 questions with three scales. The overall reliability of the scale is excellent (Cronbach’s alpha = .94), as is the reliability of the scales. Correlations show that better rated memory for medications was associated with higher reported adherence and fewer external memory strategies. Higher perceived ability to deal with health professionals was related to higher importance of medication adherence and greater perceived seriousness of one’s medical condition. Finally, more positive attitudes about medications were associated with better self-rated health and fewer side effects. Discussion: The results indicate that the BERMA survey is a potentially useful research tool for understanding older adults’medication adherence.

A Cognitive-Behavioral Model of Post-Traumatic Stress for Sexually Abused Females

The goal of this study was to evaluate Joseph, Williams, and Yules cognitive-behavioral model of response to traumatic stress when applied to a sample of 122 female sexual abuse survivors. Participants completed surveys that measured each variable presented in Joseph, Williams, and Yules model (i.e., event stimuli, personality, appraisals, coping, crisis support, event cognitions, and emotional states). Path analysis showed that although Joseph, Williams, and Yules model did not fit the data, a modified version based on the sexual abuse literature fit the data well. Modifications to the model included the removal of the variable coping and the addition of paths from event characteristics to crisis support and from personality to event characteristics.

Predicting Self-Care Behaviors Among Older Adults Coping With Arthritis A Cross-Sectional and 1-Year Longitudinal Comparative Analysis

Objective: The purpose of this investigation is to examine correlates and predictors of self-care activities for persons diagnosed with arthritis both cross-sectionally and longitudinally. Method: Data from telephone surveys conducted with 313 older (M = 68.8, SD = 8.93) individuals, chosen from a larger sample, who reported professionally diagnosed arthritis, were used. Results: A total of 10 of the 11 self-care activities changed significantly during the 1-year interval, with 9 showing increased participation. Results from hierarchical regressions showed that all three blocks of predictors explained significant portions of variance, with gender and perceived importance of general health significantly predicting self-care activities at Time 1, at Time 2, and longitudinally. Discussion: These results highlight the influence of demographic, health status, and health belief variables on self-care both cross-sectionally and longitudinally. Future work should focus on the mediating effects of these and other variables to better understand the processes by which individuals engage in self-care behavior.

Does Cognitive Ability Explain Inaccuracy in Older Adults’ Self-Reported Medication Adherence?

This study examines the accuracy of younger-old and older-old adults’ self-reported adherence over a 3-month period and the potential interactive relationship between self-report accuracy and cognitive abilities. For 3 months, 71 younger-old (M = 68.10, range = 57 to 74) and 62 older-old (M = 80.31, range = 75 to 89) adults had their actual and self-reported adherence monitored. Cognitive tests assessing episodic and prospective memory were given at the beginning of the study. Multilevel models indicate that 32% of the variability in objective adherence was from between-person differences whereas 68% was from within-person fluctuations. There were age differences in the coupling of actual and self-reported adherence over time, such that younger-old adults’ self-reports less accurately reflected their actual adherence. Subsequent models indicate that age differences in the coupled relationship were further moderated by cognitive abilities. Results suggest that the relationships among age, cognitive abilities, and accuracy of self-reported adherence are far from simple.