Changing and Maintaining Health Behaviors: Adherence and Compliance Issues
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Healthy behaviors such as smoking cessation, adherence to a healthful diet, and regular physical activity are important for overall health status and quality of life in older adults. These modifiable healthy behaviors have all been associated with the prevention of chronic diseases (eg, heart disease, cancer, stroke, diabetes),1 all of which are leading causes of morbidity and mortality in older adults and impact quality of life.2 In addition to the individual impact of having chronic illnesses, the economic burden for society is significant in that 95% of all healthcare expenditures are for management of these illnesses.1
There are many guidelines for healthy behaviors established through organizations such as the American Heart Association and the American College of Sports Medicine for exercise,3 and the United States Department of Agriculture for dietary recommendations.4 The decisions about whether or not to recommend these guidelines to older patients are complicated by factors such as the provider’s beliefs about the benefits given the individual’s age, life expectancy, and/or quality of life, and the time challenge of incorporating health promotion into routine medical visits. For older adults, adherence is further compromised by numerous factors intrinsic to the individual (eg, motivation, cognitive status) and extrinsic (eg, environment, financial resources). Understanding what influences adherence to healthy lifestyles is critical so that healthcare providers, families, lay caregivers, and friends can help older individuals optimize adherence, improve quality of life, and help control healthcare costs.5
Prevalence of Nonadherence to Healthy Behaviors
The rate of nonadherence to healthy behaviors varies greatly across the type of behavior being considered. Only a small percentage of older adults smoke (< 10%), although annually 70% of older smokers want to quit, and 46% are quite successful in doing so.6 When comparing physical activity to other health behaviors such as diet and smoking cessation, older adults are less likely to adhere to regular physical activity.7 Based on data from the Centers for Disease Control and Prevention Behavioral Risk Factor Surveillance System,8 less than one-third of older individuals engage in regular physical activity, with the proportion meeting recommended guidelines dropping with advancing age. Likewise, data on 710 women from the Women’s Health and Aging study indicated that only 13% of these individuals meet the required 150 minutes per week of moderate-intensity physical activity.9 With regard to adhering to healthful diets, 11.2-63.3% of adults meet healthful diet recommendations as per the National Health and Nutrition Examination Survey.10
Even in persons previously identified as high-risk for specific medical problems such as cardiovascular disease (CVD), the health behaviors necessary to decrease risk factors are not adequately managed.11 In a sample of 364 community-dwelling stroke survivors age 34-88 years old, 99% of the participants had at least one suboptimally controlled risk factor, and 91% had two or more concurrent risk factors that were inadequately treated.12 Eighty percent of the participants had prehypertension or hypertension, 67% were overweight or obese, 60% had suboptimal low-density lipoprotein, 45% had impaired fasting glucose, 34% had low high-density lipoprotein, and 14% were current smokers.
Adherence to Multiple Health Behaviors
Given the many health behaviors that older adults are encouraged to adhere to, it is important to consider whether adherence to one is more likely to increase or decrease adherence to a second behavior.
1. Merck Institute of Aging & Health (MIAH). Spotlight: Physical activity and older Americans. The state of aging and health in America 2004. Centers for Disease Control Website. http://www.cdc.gov/Aging/pdf/State_of_Aging_and_Health_in_America_2004.pdf. Accessed July 7, 2009.
2. Arnold AM, Psaty BM, Kuller LH, et al. Incidence of cardiovascular disease in older Americans: The Cardiovascular Health Study. J Am Geriatr Soc 2005;53(2):211-218.
3. Nelson ME, Rejeski WJ, Blair SN, et al; American College of Sports; American Heart Association. Physical activity and public health in older adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007;116(9):1094-1105. Published Online: August 1, 2007.
4. Healthy food choices for people with heart failure. American Heart Association Website. http://www.americanheart.org/presenter.jhtml?identifier=353. Updated March 12, 2009. Accessed July 8, 2009.
5. Markle-Reid M, Weir R, Browne G, et al. Health promotion for frail older home care clients. J Adv Nurs 2006;54(3):381-395.
6. Hyland A, Rezaishiraz H, Bauer J, et al. Characteristics of low-level smokers. Nicotine Tob Res 2005;7(3):461-468.
7. Persky I, Spring B, Vander Wal JS, et al. Adherence across behavioral domains in treatment promoting smoking cessation plus weight control. Health Psychol 2005;24(2):153-160.
8. Behavioral Risk Factor Surveillance System (BRFSS). Turning information into health. Centers for Disease Control Website. www.cdc.gov/brfss/. Updated April 30, 2009. Accessed July 8, 2009.
9. Jerome GJ, Glass TA, Mielke M, et al. Physical activity participation by presence and type of functional deficits in older women: The Women’s Health and Aging Studies. J Gerontol A Biol Sci Med Sci 2006;61(11):1171-1176.
10. Davis AM, Vinci LM, Okwuosa TM, et al. Cardiovascular health disparities: A systematic review of health care interventions. Med Care Res Rev 2007;64(5 suppl):29S-100S.
11. Hajjar I, Kotchen TA. Trends in prevalence, awareness, treatment and control of hypertension in the United States, 1988-2000. JAMA 2003;290(2):199-206.
12. Kopunek SP, Michael KM, Shaughnessy M, et al. Cardiovascular risk in survivors of stroke. Am J Prev Med 2007;32(5) 408-412.
13. Pierce JP, Newman VA, Natarajan L, et al. Telephone counseling helps maintain long-term adherence to a high-vegetable dietary pattern. J Nutr 2007;137(10):2291-2996.
14. Pronk NP, Anderson LH, Crain AL, et al. Meeting recommendations for multiple healthy lifestyle factors. Prevalence, clustering, and predictors among adolescent, adult, and senior health plan members. Am J Prev Med 2004;27(2 suppl):25-33.
15. Johnson SS, Paiva AL, Cummins CO, et al. Transtheoretical model-based multiple behavior intervention for weight management: Effectiveness on a population basis. Prev Med 2008;46(3):238-246. Published Online: October 23, 2007.
16. Noar SM, Chabot M, Zimmerman RS. Applying health behavior theory to multiple behavior change: Considerations and approaches. Prev Med 2008;46(3):275-280. Published Online: August 11, 2007.
17. Allegrante JP, Peterson JC, Boutin-Foster C, et al. Multiple health-risk behavior in a chronic disease population: What behaviors do people choose to change? Prev Med 2008;46(3):247-251. Published Online: October 10, 2007.
18. Schalk BW, Visser M, Penninx BW, et al. Change in serum albumin and subsequent decline in functional status in older persons. Aging Clin Exp Res 2005;17(4):297-305.
19. Kenny SJ, Aubert RE, Greiss LS. Prevalence and incidence of non-insulin-dependent diabetes. In: Aubert R. Diabetes in America. 2nd ed. Bethesda, MD: National Diabetes Data Group; 1995:47-68.
20. Morley JE, Haren MT, Kim MJ, et al. Testosterone, aging and quality of life. J Endocrinol Invest 2005;28(3 suppl):76-80.
21. Nair KS. Aging muscle. Am J Clin Nutr 2005;81(5):953-963.
22. Hicks G, Simonsick EM, Harris TB, et al. Trunk muscle composition as a predictor of reduced functional capacity in the health, aging and body composition study: The moderating role of back pain. J Gerontol A Biol Sci Med Sci 2005;60:1420-1424.
23. Essential Medicines Library (EMLib). Iron deficiency anaemia. World Health Organization (WHO) Website. http://gujhealth.gov.in/medi_servi/WHO%20Formulary/mf_misc/Wcc92333ca0e8.... Accessed July 8, 2009.
24. Penninx BW, Pahor M, Cesari M, et al. Anemia is associated with disability and decreased physical performance and muscle strength in the elderly. J Am Geriatr Soc 2004;52(5):719-724.
25. Houston DK, Cesari M, Ferrucci L, et al. Association between vitamin D status and physical performance: The InCHIANTI Study. J Gerontol A Biol Sci Med Sci 2007;62(4):440-446.
26. van Wijk I, Algra A, van de Port IG, et al. Change in mobility activity in the second year after stroke in a rehabilitation population: Who is at risk for decline? Arch Phys Med Rehabil 2006;87(1):45-50.
27. Martin FC, Hart D, Spector T, et al. Fear of falling limiting activity in young-old women is associated with reduced functional mobility rather than psychological factors. Age Ageing 2005;34(3):281-287.
28. Jensen LW, Decker L, Andersen MM. Depression and health-promoting lifestyles of persons with mental illnesses. Issues Ment Health Nurs 2006;27(6):617-624.
29. Bonnet F, Irving K, Terra JL, et al. Anxiety and depression are associated with unhealthy lifestyle in patients at risk of cardiovascular disease. Atherosclerosis 2005;178(2):339-344.
30. Deshpande N, Metter EJ, Bandinelli S, et al. Psychological, physical, and sensory correlates of fear of falling and consequent activity restriction in the elderly: The InCHIANTI study. Am J Phys Med Rehabil 2008;87(5):354-362.
31. Wanke KL, Daston C, Slonim A, et al; Polyp Prevention Study Group. Adherence to the polyp prevention trial dietary intervention is associated with a behavioral pattern of adherence to nondietary trial requirements and general health recommendations. J Nutr 2007;137(2):391-398.
32. Kadner KD. Resilience. Responding to adversity. J Psychosoc Nurs Ment Health Serv 1989;27:20-25.
33. Inguito P, Resnick B. Factors related to long-term adherence to regular exercise in older women post hip fracture. Paper presented at: 19th International Nursing Research Congress; July 7, 2008; Newark, DE.
34. Casado B, Resnick B, Zimmerman S, et al. Social support for exercise by experts in older women post-hip fracture. J Women Aging 2009;21(1):48-62.
35. Dunn MZ. Psychosocial mediators of a walking intervention among African American women. J Transcult Nurs 2008;19(1):40-46.
36. Bandura A. Self-efficacy: The Exercise of Control. New York, NY: W.H. Freeman and Company; 1997.
37. Bandura A. Social cognitive theory: An agentic perspective. Annu Rev Psychol 2001;52:1-26.
38. Dailey R, Schwartz KL, Binienda J, et al. Challenges in making therapeutic lifestyle changes among hypercholesterolemic African-American patients and their physicians. J Natl Med Assoc 2006;98(12):1895-1903.
39. Resnick B, Luisi D, Vogel A. Testing the Senior Exercise Self-Efficacy Pilot project (SESEP) for use with urban dwelling minority older adults. Public Health Nurs 2008;25(3):221-234.
40. Netz Y, Raviv S. Age differences in motivational orientation toward physical activity: An application of social-cognitive theory. J Psychol 2004;138(1):35-48.
41. Schwarzer R, Schuz B, Ziegelmann JP, et al. Adoption and maintenance of four health behaviors: Theory-guided longitudinal studies on dental flossing, seat belt use, dietary behavior, and physical activity. Ann Behav Med 2007;33(2):156-166.
42. Chiang KC, Seman L, Belza B, Tsai JH. “It is our exercise family”: Experiences of ethnic older adults in a group-based exercise program [published correction appears in Prev Chronic Dis 2008;5(2):A70]. Prev Chronic Dis 2008;5(1):A05.
43. Shaughnessy M, Michael K, Resnick B, et al. Clinical trials and tribulations: Challenges to realizing intervention research. Symposium. Presented at: Gerontological Society of America Conference; November 22, 2005; Orlando, FL.
44. Wilcox S, Castro C, King A. Outcome expectations and physical activity participation in two samples of older women. J Health Psychol 2006;11(1):65-77.
45. Resnick B. Reliability and validity of the Outcome Expectations for Exercise Scale-2. J Aging Phys Act 2005;13(4):382-394.
46. Thomas CM. The influence of self-concept on adherence to recommended health regimens in adults with heart failure. J Cardiovasc Nurs 2007;22(5):405-416.
47. Humpel N, Owen N, Leslie E. Environmental factors associated with adults’ participation in physical activity: A review. Am J Prev Med 2002;22(3):188-199.
48. Takano T, Nakamura K, Watanabe. Urban residential environments and senior citizens' longevity in megacity areas: The importance of walkable green spaces. J Epidemiol Community Health 2002;56:913-918.
49. Salzberg PM, Moffat JM. Ninety five percent: An evaluation of law, policy, and programs to promote seat belt use in Washington state. J Safety Res 2004;35(2):215-222.
50. Faxon D, Brown M. Antiplatelet therapy for postdischarge medical management of acute coronary syndrome. Am J Med 2008;121(3):171-178.
51. Preventive Services. Medicare.gov Web site. http://www.medicare.gov/health/physicalexam.asp. Accessed July 22, 2009.
52. Bailey TC, Noirot LA, Blickensderfer A, et al. An intervention to improve secondary prevention of coronary heart disease. Arch Intern Med 2007;167(6):586-590.
53. Galik EM, Resnick B, Pretzer-Aboff I. ‘Knowing what makes them tick’: Motivating cognitively impaired older adults to participate in restorative care. Int J Nurs Pract 2009;15(1) 48-55.
54. Thomas KS, Muir KR, Doherty M, et al. Home based exercise programme for knee pain and knee osteoarthritis: Randomised controlled trial. BMJ 2002;325(7367):752.
55. Resnick B, Orwig D, Yu-Yahiro J, et al. Testing the effectiveness of the exercise plus program in older women post-hip fracture. Ann Behav Med 2007;34(1):67-76.
56. Tinetti ME, Baker D, Gallo WT, et al. Evaluation of restorative care vs usual care for older adults receiving an acute episode of home care. JAMA 2002;287(16):2098-2105.
57. Galik EM, Resnick B, Gruber-Baldini A, et al. Pilot testing of the restorative care intervention for the cognitively impaired. J Am Med Dir Assoc 2008;9(7):516-522.
58. Boynton M, Boynton C. The Educator’s Guide to Preventing and Solving Discipline Problems. Alexandria, VA: ASCD; 2005.
59. Krein SL, Heisler M, Piette JD, et al. The effect of chronic pain on diabetes patients’ self-management. Diabetes Care 2005;28(1):65-70.
60. Martin Ginis K, Latimer AE, Brawley LR, et al. Weight training to activities of daily living: Helping older adults make a connection. Med Sci Sports Exerc 2006;38(1):116-121.
61. George SZ, Zeppieri G Jr, Cere AL, et al. A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain (NCT00373867). Pain 2008;140(1):145-157. Published Online: September 10, 2008.
62. Shaw WS, Linton SJ, Pransky G. Reducing sickness absence from work due to low back pain: How well do intervention strategies match modifiable risk factors? J Occup Rehabil 2006;16(4):591-605.
63. de Jong JR, Vlaeyen JW, Onghena P, et al. Fear of movement/(re)injury in chronic low back pain: Education or exposure in vivo as mediator to fear reduction? Clin J Pain 2005;21(1):9-17.
64. Jung D, Lee J, Lee SM. A meta-analysis of fear of falling treatment programs for the elderly. West J Nurs Res 2009;31(1):6-16. Published Online: July 30, 2008.
65. Cakit BD, Saracoglu M, Genc H, et al. The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease. Clin Rehabil 2007;21(8):698-705.
66. Zijlstra GA, van Haastregt JC, van Rossum E, et al. Interventions to reduce fear of falling in community-living older people: A systematic review. J Am Geriatr Soc 2007;55(4):603-615.
67. Boutin-Foster C. Getting to the heart of social support: A qualitative analysis of the types of instrumental support that are most helpful in motivating cardiac risk factor modification. Heart Lung 2005;34(1):22-29.
68. Rejeski WJ, Tian L, Liao Y, McDermott MM. Social cognitive constructs and the promotion of physical activity in patients with peripheral artery disease. J Cardiopulm Rehabil Prev 2008;28(1):65-72.
69. Focht BC, Brawley LR, Rejeski WJ, Ambrosius WT. Group-mediated activity counseling and traditional exercise therapy programs: Effects on health-related quality of life among older adults in cardiac rehabilitation. Ann Behav Med 2004;28(1):52-61.
70. Joseph A, Zimring C, Harris-Kojetin L, Kiefer K. Presence and visibility of outdoor and indoor physical activity features and participation in physical activity among older adults in retirement communities. In: Rodiek S, Schwarz B, eds. The Role of the Outdoors in Residential Environments for Aging. Binghamton, NY: Haworth Press, Inc.; 2005:141-165.
71. Hinman AR, Urquhart GA, Strikas RA; National Vaccine Advisory Committee. Immunization information systems: National Vaccine Advisory Committee progress report, 2007. J Public Health Manag Pract 2007;13(6):553-558.
72. Dunn MK, Misra S, Habermann R, Griffin MR. Pneumococcal vaccination in nursing homes: Does policy change practice? J Am Med Dir Assoc 2003;4(3):135-138.
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