Lisa M. Warner

Medication beliefs predict medication adherence in older adults with multiple illnesses

OBJECTIVE To examine factors preventing medication nonadherence in community-dwelling older adults with multiple illnesses (multimorbidity). Nonadherence threatens successful treatment of multimorbidity. Adherence problems can be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage) or unintentional (e.g., forgetting to take medication) and might depend on a range of factors. This study focused in particular on the role of changes in beliefs about medication to explain changes in adherence. METHODS Longitudinal study with N = 309 individuals aged 65-85 years with two or more diseases at three measurement points over six months. Medication adherence and beliefs about medicines were assessed by questionnaire. Hierarchical weighted least squares regression analyses were used to predict individual intentional and unintentional nonadherence. RESULTS Changes in intentional nonadherence were predicted by changes in specific necessity beliefs (B = -.19, P<.01), after controlling for sociodemographic factors, health status and number of prescribed medicines. Changes in unintentional nonadherence were predicted by changes in general overuse beliefs (B = .26, P<.01), controlling for the same covariates. CONCLUSION Beliefs about medication affect both intentional and unintentional adherence to medication in multimorbid older adults. This points to the importance of addressing medication beliefs in patient education to improve adherence.

How do negative self-perceptions of aging become a self-fulfilling prophecy?

Recent studies have provided considerable evidence on long-term effects of self-perceptions of aging (SPA) on indicators of successful aging such as health or life satisfaction. To date, little is known about the mechanisms underlying these effects. This study therefore examined whether negative SPA impair the use of self-regulation strategies that include selection, optimization, and compensation (SOC) in case of a serious health event and thus turn into self-fulfilling prophecies for health and life satisfaction. Based on a longitudinal nationwide study with 2 measurement points over a 6-month period in 309 older people (65+ years of age) with multiple illnesses, 2 major findings emerged: First, the occurrence of a serious health event predicted increased use of SOC strategies, which in turn predicted higher self-rated health and life satisfaction. Second, this effect was moderated by negative SPA, that is, in case of a serious health event, the perception that aging is associated with physical losses led to lower use of SOC strategies promoting a healthy lifestyle (B = -0.43, SE = 0.15, p < .01). These findings contribute to a better understanding of the underlying mechanisms of SPA on health by showing that negative SPA as associated with physical losses might impair health-related strategies that are important for maintaining a healthy lifestyle. Future intervention studies could attempt to challenge negative SPA to support effective strategy use in older adults with serious illnesses.

What do targeting positive views on ageing add to a physical activity intervention in older adults? Results from a randomised controlled trial

Objective: Physical activity is a key factor for healthy ageing, yet many older people lead a sedentary lifestyle. Traditional physical activity interventions do not consider the specific needs and views of older adults. As views on ageing are known to be related to health behaviours, the current study evaluates the effectiveness of prompting positive views on ageing within a physical activity intervention. Design: Randomised controlled trial with three groups aged 65+: Intervention for physical activity with ‘views-on-ageing’-component (n = 101; IGVoA), and without ‘views-on-ageing’-component (n = 30; IG), and active control intervention for volunteering (n = 103; CG). Main outcome measures: Attitudes towards older adults and physical activity were assessed five weeks before intervention, two weeks, six weeks and 8.5 months after the intervention. Results: Compared to the IG and CG, positive attitudes towards older adults increased in the IGVoA after the intervention. For IGVoA, the indirect intervention effect on change in activity via change in attitudes towards older adults was reliable. Conclusion: A ‘views-on-ageing’-component within a physical activity intervention affects change in physical activity via change in views on ageing. Views on ageing are a promising intervention technique to be incorporated into future physical activity interventions for older adults.

Emotional and uncontrolled eating styles and chocolate chip cookie consumption. A controlled trial of the effects of positive mood enhancement

The study tested the effects of positive mood enhancement on chocolate chip cookie consumption in the context of emotional and uncontrolled eating styles. The relationship between emotional eating style and chocolate chip cookie intake was assumed to be mediated by uncontrolled eating style. Further, it was hypothesized that the effectiveness of the positive mood enhancement may be more salient among those who have effective control of their eating. In this experimental study, respondents (N=106, 70% women, aged 16-45 years old) were assigned by means of cluster randomization to the control or positive mood enhancement condition (a comedy movie clip). Compared to the control condition, positive mood enhancement resulted in consuming on average 53.86 kcal less. Relationships between emotional eating style and cookie intake were mediated by uncontrolled eating. Moderated mediation analysis indicated that the effect of a mediator (uncontrolled eating) on cookie intake was moderated by the group assignment. Positive mood enhancement resulted in eating on average 3.3 cookies less among individuals with a more controlled eating style. By contrast, among those who presented uncontrolled eating, positive mood enhancement led to consuming an average of 1.7 cookies more.

Perceived Self-Efficacy and its Relationship to Resilience

The construct of perceived self-efficacy is the belief that one can perform novel or difficult tasks and attain desired outcomes, as spelled out in the Social Cognitive Theory (Bandura, 1997). This “can do”-cognition reflects a sense of control over one’s environment and an optimistic belief of being able to alter challenging environmental demands by means of one’s own behavior. Hence, it represents a self-confident view of one’s capability to deal with certain stressors in life.

Giving and Taking —Differential Effects of Providing, Receiving and Anticipating Emotional Support on Quality of Life in Adults with Multiple Illnesses

Multimorbidity challenges quality of life (QoL) in old age. Anticipating and providing social support have been shown to promote QoL whereas receiving support often had detrimental effects. Little is known about which psychological processes explain these effects. This study examines the effects of receiving, anticipating and providing emotional support on QoL, with control beliefs and self-esteem as simultaneous mediators in an elderly multimorbid sample (N = 1415). Anticipating and providing support positively predicted QoL, mediated through self-esteem and control beliefs. Received support negatively predicted QoL, without mediation. Self-esteem and control beliefs can help to explain the relation between QoL and support.

Self-efficacy and multiple illness representations in older adults: A multilevel approach

Objectives: The Common-Sense Model assumes that individuals form subjective representations about their illnesses, which in turn guide cognitive and behavioural responses. This assumption is complicated in individuals with multimorbidity, and it is an open question to which degree illness-specific and person-level factors determine the representations of specific illnesses. This study examines the structure and interrelations of illness representations in multimorbidity employing a hierarchical framework based on Cognitive Theory. Methods: Multiple illness representations were assessed in 305 people aged 65 and older using two Brief Illness Perception Questionnaires. Multilevel modelling was used to explore the relations between illness representations and to explain how two illness-specific representations – personal control and treatment control – were determined by a person-level factor, self-efficacy. Results: Self-efficacy had significant main (B = 0.29; p < 0.01 for personal control; B = 0.19; p < 0.05 for treatment control) and interaction effects (B = 0.38; p < 0.01 personal control on self-efficacy × timeline; B = −0.31; p < 0.05 treatment control on self-efficacy × coherence). Conclusions: This study suggests that illness-specific representations of older people with multimorbidity are a product of both illness-specific and person-level factors, such as self-efficacy. Strengthening individual self-efficacy may improve illness controllability regardless and on top of illness-specific information.

Changes in functional health, changes in medication beliefs, and medication adherence.

OBJECTIVE Medication adherence often lies below recommendations although it is crucial for effective therapies, particularly in older adults with multiple illnesses. Medication beliefs are important factors for individual adherence, but little is known about their origin. We examine whether changes in functional health predict changes in medication beliefs, and whether such changes in beliefs predict subsequent medication adherence. DESIGN At three points in time over a 6-month period, 309 older adults (65-85 years) with multiple illnesses were assessed. Latent true change modeling was used to explore changes in functional health and medication beliefs. Adherence was regressed on changes in beliefs. MAIN OUTCOME MEASURES Medication beliefs were measured by the Beliefs About Medicines Questionnaire; medication adherence by the Reported Adherence to Medication Scale. RESULTS Functional health and medication beliefs changed over time. Increasing physical limitations predicted increases in specific necessity and specific concern beliefs, but not in general beliefs. Changes in specific necessity beliefs predicted intentional adherence lapses, changes in general overuse beliefs predicted unintentional adherence lapses. CONCLUSIONS Medication beliefs partly depend on health-related changes, and changes in beliefs affect individual adherence, suggesting to target such beliefs in interventions and to support older adults in interpreting health changes.

The role of physical activity in the relationship between self-perceptions of ageing and self-rated health in older adults

Objective: Positive self-perceptions of ageing are associated with better health; however, little is known about the potentially underlying mechanisms. The present longitudinal study examines whether the relationship between self-perceptions of ageing and self-rated health is mediated by physical activity in older adults with multiple chronic conditions. Design: A sample of 309 German community-dwelling older adults aged 65–85 years with two or more chronic conditions was assessed at three measurement occasions over 2.5 years. Participants provided information on self-perceptions of ageing, physical activity, self-rated health, number of chronic conditions and demographics (T1). Physical activity was reassessed six months later (T2) and self-rated health after 2.5 years (T3). Data were analysed using multiple regression and path analyses. Main outcome measures: Self-rated health and physical activity. Results: More positive self-perceptions of ageing were related to better self-rated health over a 2.5-year period controlling for confounding variables. Physical activity six months after T1 partially mediated this relationship. Conclusion: Having more positive self-perceptions of ageing is associated with higher levels of physical activity, which in turn predict better self-rated health over time. This supports the hypothesis of a behavioural pathway in the self-perceptions of ageing – health link.

Contextual and Individual Predictors of Physical Activity: Interactions Between Environmental Factors and Health Cognitions

OBJECTIVE Although health behavior theories assume a role of the context in health behavior self-regulation, this role is often weakly specified and rarely examined. The two studies in this article test whether properties of the environment (districts) affect if and how health-related cognitions are translated into physical activity. METHODS Multilevel modeling was used to examine the assumed cross-level interactions. Study 1 is a large-scale survey representative of the German adult population (N = 6,201). Gross domestic product (GDP) on the level of administrative districts was used to indicate environmental opportunities and barriers. Study 2 examined cross-level interactions of proximal predictors of physical activity (intentions, action planning, and coping planning) in older adults with multiple illnesses (N = 309), a high-risk group for health deteriorations. RESULTS Study 1 showed that on the individual level, health attitudes (B = .11) and education (B = .71) were significantly associated with physical activity. GDP moderated the attitudes-behavior relation (B = .01), with higher attitude-behavior relations in districts with higher GDP. Study 2 finds that intention (B = .16), action planning (B = .17), and coping planning (B = .13) significantly predict activity. In addition, district-level GDP significantly moderated the relations between action planning and coping planning, but not intention, on physical activity. CONCLUSIONS Results suggest that the effects of health attitudes and planning on physical activity are moderated by environmental factors. Districts with higher GDP provide better contextual opportunities for the enactment of concrete if-then plans for physical activity. This has implications for both theory and health promotion.