Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study

Abstract

BackgroundControl 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.MethodsWe 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/m2, 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.ResultsAfter 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.ConclusionControl 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.

Lifetime trauma, perceived control, and all-cause mortality: Results from the Midlife in the United States Study.

“…In this study, lifetime trauma interacted with mastery but not constraints, which exhibited an independent association with mortality. These results parallel recent reports of differential effects for mastery and constraints-including a stronger main effect of constraints on mortality (Duan-Porter, Hastings, Neelon, & Van Houtven, 2017) and a moderating effect of mastery in relation to CRP (Elliot et al, 2017)-and further suggest examining these constructs separately. Constraints may be an independent risk factor, whereas mastery may buffer excess risk associated with stress exposure (viewed alternatively, it may be protective only at higher levels of stress exposure).…”

Meaning in Life among Older Adults: An Integrative Model

“…People with an internal locus of control perceive self-accountability for shaping and controlling their lives, while those with an external locus of control perceive being controlled by luck, fate, opportunities, others, and events [ 35 ]. A high internal locus of control was linked with physical and mental outcomes including lower pain [ 36 ], better physical functionality [ 36 ], higher self-reported health [ 37 ], lower mortality [ 38 ], and better quality of life [ 39 ]. Meaning in life is based on feelings of coherence, purpose and existential mattering [ 40 ], although both of these concepts relate to feelings of coherence and purpose.…”

Awareness of Age-Related Change as a Behavioral Determinant of Survival Time in Very Old Age

“…However, it is obvious to also expect more general negative consequences for late-life survival via reduced motivation for or limited perceived control over health-related behavior in very old age. Multiple studies have established an association between control beliefs and mortality hazard in older adult samples ( Infurna et al, 2011 , 2013 ; Wiest et al, 2013 ; Infurna and Okun, 2015 ; Duan-Porter et al, 2017 ; Hülür et al, 2017 ). For example, Infurna et al (2011) noted that perceived control may be related to all-cause mortality through various mechanisms, including the absence of health promoting behaviors, ineffective emotion regulation, low social integration, and the absence of stress buffering effects.…”