The prevalence of two major health risk behaviours in an Irish older adult population & their relationship to ageing self-perceptions: Findings from the Irish Longitudinal Study on Ageing
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The leading causes of death among older Irish adults are diseases of the circulatory system. These are in a major part, diseases of lifestyle and so health behaviours across the lifecycle, including older age, are important targets for prevention. It is imperative to understand older adults’ engagement in preventive health behaviours such as not smoking and drinking sensibly. While research on the association between ageing self-perceptions and health behaviours is relatively novel, studies have shown that ageing self-perceptions arising from age stereotypes, influence the health behaviours of older adults in that older adults with positive ageing self-perceptions are more likely to practice preventive health behaviours over time. The aim of this thesis was to document the patterns of these behaviours and determine the nature of the relationship between ageing self-perceptions and the two health behaviours.
Design and setting:
Participants were 6,576 community-dwelling Irish adults (age 50+ years), who took part in the first wave of the Irish Longitudinal Study on Ageing (TILDA). They completed the Ageing Perceptions Questionnaire (APQ) and answered the questions regarding their smoking and alcohol behaviours. The APQ measures individual views on own ageing across seven domains (timeline chronic, timeline cyclical, consequences positive, consequences negative, control positive, control negative, and emotional representations).
To examine the study hypotheses that strong beliefs on each of the APQ domains would be related to drinking and smoking behaviours, multinomial logit models (MNLM) were fitted using each of the seven domains on the APQ as the main independent variables and drinking category as one dependent variable with non-drinkers being the omitted group and smoking status as the other dependent variable with never smokers the reference group. Covariates included age, gender, education, marital status, self-rated health, depression, smoking status (or drinking status) and physical activity. The regression parameter estimates for all variables were estimated relative risk ratios (RRR). The study hypotheses that the relationship of the APQ domains to drinking and smoking would be stronger when there was an inter-relationship between the two health behaviours, was tested using multivariate IX analyses of covariance (MANCOVA). All tests were one-tailed and a critical alpha level of 0.05 was used.
Overall, TILDA’s participants expressed positive views regarding the ageing process in that they acknowledged more positive than negative aspects to ageing. However, the oldest age group perceived their ability to cope with ageing more negatively. Nonetheless, the variability of ageing beliefs at an individual level indicated that many older Irish adults did not incorporate negative ageing stereotypes into their own self-perceptions.
In the TILDA population overall, most men and women stayed within recommended daily limits of 4 units on a drinking occasion for men and 3 units for women, with men consuming on average 4 units of alcohol per drinking occasion and women consuming 2.5 units. Women were more likely to be non-drinkers (30% vs. 20%) while men displayed significantly higher alcohol use patterns (39% vs. 22%). The highest proportion of non-drinkers was among the oldest age group (75+). However, one third of older drinkers were at risk either because of drinking to excess in a single drinking episode or because they exceeded the weekly drinking limits.
In the overall TILDA population, one in five older Irish adults was a current smoker with more women (54%) than men in this category (46%). The highest percentage of current smokers reported that they smoked between 20-39 cigarettes per day (41%). They were also more likely to have been educated to secondary school level (57%) and to be in the 50-64 year age category (69%). Consistent with previous studies, this study noted a decreasing trend in smoking prevalence associated with age, for both men and women.
With regard to the study hypotheses, the study revealed that while some of the individual domains of the APQ were implicated as risk factors for engaging in harmful health behaviours others were found to be protective against harmful engagement. Pertaining to alcohol consumption, the RRRs indicated that a chronic awareness of age and ageing and beliefs about control over both positive and negative ageing experiences were associated with drinking status. Individuals who were constantly preoccupied with their experiences of age or ageing were 14% more likely to be X harmful drinkers. Moreover, individuals who perceived that they were in control over positive ageing experiences were 12% more likely to be moderate drinkers and 15% more likely to be harmful drinkers than those who perceived less control. Finally, individuals who perceived more control over negative ageing experiences had a reduced risk of being either moderate drinkers (10%) or harmful drinkers (13%) when compared with non-drinkers.
In relation to smoking, the RRRs indicated that a lack of stability in the individual’s experience of ageing, having a negative outlook, and negative beliefs about control over ageing experiences were associated with smoking status. In this study, former smokers were 10% more likely to be more preoccupied with their own experiences of age or ageing when compared with never smokers. Additionally, individuals who perceived negative consequences associated with the ageing process had a reduced risk of being either former smokers (11%) or current smokers (20%) when compared to never smokers. Finally, individuals who perceived less control over negative ageing experiences were 13% more likely to be current smokers over never smokers.
The investigation into the strength of the relationship of the APQ domains to the interaction between the two health behaviours indicated that three ageing self-perceptions played a stronger role over and above that of the established covariates. Perceived levels of pessimism regarding both the positive and negative consequences of ageing were associated with a decreased risk of engaging in more than one risky health behaviour (expected to decrease by 0.135 units and 0.121 units respectively). In addition a strong negative emotional response to ageing was associated with an increased level of engagement in risky health behaviour (expected to increase by 0.128 units)
Although the explanatory power of some of the established covariates of alcohol and tobacco consumption was stronger than that of the individual APQ domains, this study demonstrated the benefits to applying the psychology of ageing to health behaviours. By looking at health behaviours in this way we are able to gain a better understanding of the ways in which our cognitive representations of age and ageing are associated with how we might regulate our health behaviours to manage XI our ageing and how we in turn might appraise our ability to cope with our actions. These findings have some implications at a practical level as the individual domains of the ageing experience can be targeted in interventions aimed at facilitating more desirable or adaptive outcomes or to moderate maladaptive outcomes associated with old age. Such interventions could be implemented at an individual level, at a societal level by means of public education, or at a clinical level by means of psychological intervention. The findings also have implications at a theoretical level as further development of the APQ using the self-regulation model (SRM) framework might further elucidate the adaptive or maladaptive value that specific ageing self-perceptions may play in shaping clusters of health-risk behaviour.
In light of population ageing, there is an increasing need to give ageing self-perceptions more detailed consideration in ageing research, to help us understand why some older adults engage in preventive health behaviours while others do not. It is hoped that the information generated from this thesis will promote a greater understanding of the role of ageing self-perceptions that will shape healthcare delivery and social policy and to foster disease prevention with health promotion efforts and systemic reforms.