Methods: We surveyed 138 community-dwelling women who were at least 65 years of age and had one or more diagnosed chronic illnesses about their usual adherence to ten key positive health behaviors. A hierarchical multiple regression analysis was used to assess the unique contribution of physical health, emotional health, and social support on self-management health behaviors. Variables in the model were entered in the following blocks: 1) demographics (income, age, and marital status), 2) health and functioning (ADL's, SF-12, chronic illness co-morbidity), 3) instrumental support and subjective support (Duke Social Support Index), and 4) depressive symptoms (CES-D 20). An open-ended question requested respondents to explain why key health behavior tasks were not usually performed.
Results: Respondents' mean age was 72.7 years (SD=6.2 years); 32% were African American and 68% were White, and these women reported an average of 3.93 chronic illnesses. Three quarters of the sample reported three or more chronic conditions. The most prevalent chronic illnesses were hypertension, arthritis and diabetes. Those with diabetes, followed by arthritis, reported the highest levels of interference with daily activities. Key health behaviors included regular provider visits, healthy diet, regular exercise, medication compliance and pacing themselves. The majority of the sample reported they regularly performed all ten health behaviors, with positive endorsement ranging from 56.9% to 98.6% for these items. The three behaviors with the highest non-endorsement by the sample were 1) exercise, 2) researching their health conditions via media, and 3) adequate sleep. Most notably, 43.1% reported they did not get regular exercise or physical activity and 23.2% did not regularly get enough sleep. The fourteen written reasons offered for not exercising regularly focused on difficulties exercising due to respondents' pain (arthritis, foot or knee issues) or other health-related reasons (reliance on oxygen, becoming easily winded). Ten reasons given for insufficient sleep focused on pain or worry keeping the women from sleep. In the final regression model, depressive symptoms were the only statistically significant predictor of positive health behaviors (Adj. R2=.221).
Conclusions and Implications: Qualitative findings suggest that barriers to participation in health behaviors are primarily attributed to physical health limitations, while quantitative results indicate that depressive symptoms predicted less adherence to positive health behaviors for these older women. Both poor health and depressive symptoms can restrict older adults from performing healthy behaviors. This study points to the importance of proper assessment, case management, and treatment of the mental and physical health needs of older women with a high co-morbidity of chronic illness.
