Extra-individual Factors Research Articles

Determinants of functional disability trajectories: An assessment of the disablement model and life-course perspective.

Functional disability is a widespread challenge faced by the older population in China, where those with functional disabilities demand greater healthcare and geriatric services. This study performs a longitudinal analysis examining the effects of physiological conditions, intra-, and extra-individual factors, and life-course socioeconomic status risk factors on the disability levels and change rates of functional disability trajectories in old age. Data for this study came from the four waves of the China Health and Retirement Longitudinal Survey. A latent growth model was used to analyze the functional disability of 5044 older adults aged 60 and over in 2011 who survived to 2018. Pathologies are closely associated with functional disability trajectories, and higher numbers of comorbidities relate to more disabilities. Risk factors and intra- and extra-individual factors affect functional disability trajectories and work through independent and shared mechanisms. The effects of risk factors can be traced to childhood conditions, and higher childhood and adulthood socioeconomic status is related to fewer functional disabilities. Functional disability trajectories are dynamic processes related to pathologies, intra-, and extra-individual factors, and life-course risk factors, and thus prevention and control measures should focus on both childhood and adulthood. Promoting working in later life and improving childhood socioeconomic statusdeserve prompt attention. Geriatr Gerontol Int 2023; 23: 817-829.

Minority Stress in the Context of the Disablement Process Model

The benefits of health literacy are well-documented. Health literacy is a set of skills to locate, understand, and use health-related information to make optimal health decisions. However, relatively less is known about the long-term relationship between health literacy and overall health conditions among older adults. Additionally, health literacy and health at the intersection of gender and race/ethnicity, rather than gender and race separately, are yet to be investigated. This study analyzed sub-samples (n = 1,260 adults age 50+) of the 2010 Health and Retirement Study (HRS) health literacy module data, and the 2012, 2014, and 2016 HRS data to examine the trajectories of health based on eight physical and mental conditions (0-8 points: better-worse) among older adults. Latent growth curve mixture models were used to investigate the changes in health and six groups defined by gender (women and men) and race/ethnicity (White, Black, and Hispanic). Results showed that overall health deteriorated over time (latent-slope = 0.19, p < 0.001) but the trajectories were diverse (latent-slope variance = 0.06, p < 0.001). Greater health literacy (0-5 points: worse-best scaling), which was measured with a validated scale, was associated with better overall health only among White women and men. Notably, White women received the baseline health benefits (b = -0.20, p < 0.05) from health literacy whereas Black women (b = 0.09, p > 0.05) did not [Δb = 0.09 -(-0.20) = 0.29, p < 0.05]. Other detailed comparisons, theoretical explanations, and public health policy implications for diverse older populations were evaluated.

Minority Stress in the Context of the Disablement Process Model

The changing demographics and growing diversity in the United States pose significant challenges for researchers, particularly scholarship involving sexual minority adults’ health and aging processes. Not much is known about how all minority stressors could lead to a disability. Sexual minority adults are at a greater risk of developing a disability later in life than their heterosexual counterparts (Fredriksen-Goldsen, Kim, & Barkan, 2012). Drawing from critical components of the disablement process model (Verbrugge & Jette, 1994), this dissertation sought to understand the relationship between minority stress and disability status among sexual minority adults 50 years and older. Minority stress in the context of the disablement process model is a social condition. While exploring the relationship between minority stress and disability status, intra-individual factors and extra-individual factors were assessed to see if they mediated the relationship between minority stress and disability status among sexual minorities 50 years and older. Discrimination is significantly associated with having a disability. None of the intra-individual factors and extra-individual factors mediated the relationship between minority stress and disability; however, several intra- and extra-individual were associated with greater or lesser odds of experiencing a disability. This dissertation concluded that discrimination is associated with disability status among sexual minority adults 50 years and older. On the other hand, the disablement process model does not support minority stress as a social condition leading to a disability. On the other hand, this dissertation's results support the ideology that experiencing discrimination is associated with a disability.

Exploring Supports and Barriers to Physical Activity in Catholic Priests.

Although physical activity has been examined in many different populations, little is known about the physical activity of religious leaders. Religious leaders have considerable demands on their time and energy resulting in fewer opportunities for self-care, including participating in regular physical activity. The purpose of our study was to better understand the role of physical activity in Roman Catholic priests and in particular, the supports and barriers they face. We conducted one-on-one semi-structured interviews with eight priests regarding their perceived motivators and impediments to physical activity. Following a socioecological framework, we noted two common themes from the priests' interviews regarding their lived experiences. Our first theme included intra-individual characteristics such as personal factors including personality, knowledge, attitudes, and beliefs regarding physical activity. Our second theme contained extra-individual factors such as environmental influences including community involvement, accessible resources, and weather determinants. Both themes reflected supports and barriers to the priests' physical activity. Overall, our results indicated that although Roman Catholic priests experience unique barriers to physical activity related to their social identity, similar to other men of the same age, they are also affected by common factors that support or prohibit engagement in physical activity. The priests shared that health benefits and being physically active with others were their main supports, while busy work schedules, lack of knowledge, and poor health were barriers to their physical activity participation. These results suggest physical activity programming should be considered as part of seminary education, in particular, as a method of proactively taking care of physical and mental health so priests can manage the persistent and consistent demands made upon them. Further, once working as priests, physical activity programs should involve individualized approaches that include personal interests, and available resources while recognizing personal, social, and environmental barriers.

Do nutritional behaviors depend on biological sex and cultural gender?

Conventional knowledge, resulting from observations and experience, maintains the conviction that there are gender differences in the acquisition, preparation and consumption of food. This review shows differences between the sexes in eating behavior, food choice and nutritional strategy which were conditioned by evolution and by intra-individual (biological or psychological) and extra-individual (socioeconomic and cultural) factors. Women manifest a more pronounced trust in healthy nutrition, greater engagement in controlling body weight, a higher tendency to eat in a group and in stressful situations, and they frequently experience frustration due to their own nutritional behaviors, which reflects higher social pressure and their attempts to reduce eating-related pleasure. On the other hand, men prefer fatty meals with a strong taste, and are directed mainly by the pleasure of consumption; they more frequently furtively eat sweet foods while watching television, use more dietary supplements and more frequently visit fast food restaurants. Nutritional behavior, styles of nutrition, dietary profiles, approach to nourishment, approach to the place of meal consumption, and the sources of nutritional knowledge all demonstrate associations with gender. Reciprocal interactions between gender and diet are conditioned by physiological, psychological and sociocultural factors. This system of reciprocal interactions includes feedback: biological sex and cultural gender shape one's diet and, reciprocally, one's diet affects the deepening or flattening of gender differences. The analysis of reciprocally interacting factors entangled in the formation of a nutritional model may also represent an important element of pro-health prophylaxis and should be used in medical and dietary practice. Males in particular should be informed and educated about health-promoting diets.

Individual, Service, and Neighborhood Predictors of Aggression Among Persons With Mental Disorders

We examined the predictive validity of individual, service, and neighborhood factors for aggression by 1,491 forensic clients found Not Criminally Responsible on account of Mental Disorder (NCRMD), under the jurisdiction of a Review Board, and thus subject to supervision conditions. Younger patient age and personality disorder diagnosis were associated with both clinically documented aggression and recidivism. Medication adherence was related to clinically documented aggression, but not criminal recidivism. Number of reports from an institution (possibly reflecting assessor or institutional experience with NCRMD assessments) did not predict clinically documented aggression, but more comprehensive risk reports were associated with fewer such clinical incidents. More community mental health resources within a 45-min drive of an individual’s residence were associated with less recidivism, but not less clinically documented aggression. We conclude that extra-individual factors are related to aggression, the neighborhood to which forensic clients return matters, and effects can differ for criminal recidivism versus clinically documented aggression.

It’s not just physical: a qualitative study regarding the illness experiences of people with facioscapulohumeral muscular dystrophy

Purpose: Little is known about the illness experiences of people with Facioscapulohumeral Muscular Dystrophy (FSHD). The aim of this study was to provide insight into the illness experiences of people with FSHD in order to tailor rehabilitation programs to individual needs and expectations.Methods: Twenty-five semi-structured interviews were conducted with people with FSHD. The interviews were audiotaped, transcribed and member checked. Computerized (MAXqda) and manual techniques were used for thematic data analysis.Results: Intra- as well as extra-individual aspects play a role in the illness experiences of people with FSHD. Integrating the consequences of the diagnosis and symptoms, coping with heredity and progenity, adjusting to a decreasing independence, and the accompanying changing relationship with one’s partner, are mentioned as intra-individual aspects. As extra-individual factors are the responses of the social environment, which was mentioned as well as used assistive devices, and maintaining or giving up work.Conclusions: Better understanding of the individual illness experiences, cognitions, and social context of people with FSHD can give health professionals tools to improve their care and give researchers direction for future studies to evaluate healthcare improvements from a holistic, patient-centred perspective.Implications for RehabilitationFSHD has a major impact on people’s lives. Besides the physical consequences, issues such as heredity, progenity, changing (intimate) relationships, social interactions and work should be addressed by rehabilitation professionals.Dependent on the timing of the diagnosis (early or later in life) people with FSHD could, in addition to medical consultation and physical therapy, profit from support by a social worker, occupational therapist and/or genetic Counselor for the above-mentioned themes to be addressed more extensively.It is relevant for rehabilitation professionals to become familiar with the personal characteristics and social circumstances of the patient before communicating the diagnosis and prognosis in order to individually tailor the content of the communication.

Factors associated with disability among middle-aged and older African American women with osteoarthritis

BackgroundMiddle-aged and older African American women experience disproportionate rates of functional limitations and disability from osteoarthritis (OA) compared to other racial ethnic groups; however, little is known about what factors contribute to this disparity within African American women. ObjectiveTo examine factors associated with physical function and disability among African American women ages 50–80 with OA using the disablement process model. MethodsThis descriptive study included 120 African American women with OA from the Southwestern region of the United States. Regression techniques were used to model the correlates of physical function and disability and to test a mediation model. ResultsBMI and pain severity were significantly related to functional limitations. Depressive symptoms mediated the relationship between racial discrimination and disability. ConclusionBiological, intra-individual, and extra-individual factors are related to disablement outcomes in this sample of African American women, which is consistent with theory suggesting the need for treatment coupled with environmental modifications. This study can inform the development of future bio-behavioral interventions.

Determinants of rate of change in functional disability: An application of latent growth curve modeling

Our aim was to identify disablement factors, including predisposing, intra-individual, and extra-individual factors, which predict the rate of change in general functional disability (GFD) in older adults. This study utilized the Taiwan Longitudinal Study on Aging Survey in 1996–2007 (N=3,186). Multiple-indicator latent growth curve modeling was used to examine how 12 disablement factors predicted the rate of change in GFD. GFD trajectories were modeled using Nagi’s functional limitations, activities of daily living, and instrumental activities of daily living. Greater age (B=.025), female gender (B=.114), and greater numbers of comorbidities (B=.038) were associated with faster increase in GFD. Education (B=−.005) and participation in physically active leisure time activities (B=−.031) were associated with slower increase in GFD. Our findings add to the understanding of how disablement factors contribute to the rate of change in GFD. Predisposing factors played the main role. However, the factors we found to be associated with the rate of change in GFD in older adults were slightly different from the factors reported in the literature. Decreasing the number of comorbidities and increasing the level of physically active leisure time activity should be considered priorities for preventing disability as people age.

An Examination of the Disablement Process Among Older American Indians: The Native Elder Care Study.

Older American Indians disproportionately suffer from poorer physical and mental health and have greater disability compared to their racial and ethnic counterparts. The purpose of this study was to examine the disablement process among older American Indians. Data analyzed were from the Native Elder Care Study, which included in-person interviews with 505 community-dwelling American Indians aged ≥55 years. We used structural equation modeling to examine the contributive direct and indirect effects of health, demographic, and psychosocial risk factors on disability. Pathology had direct and indirect effects through social support and depressive symptoms on chronic pain intensity. Pathology also had direct and indirect effects on disability. Chronic pain intensity was a significant mediator between pathology and functional limitations. With contributive effects of older age and female sex, greater functional limitations were associated with increased disability. Our results support the theorized main pathway of the Disablement Process Model with our sample of older American Indians. Our findings support the importance of taking into account intra and extraindividual factors in assessing the prevalence and incidence of disability for older American Indians.

Disability trajectories and associated disablement process factors among older adults in Taiwan

ObjectivesWe aimed to identify disability trajectories and examine whether the predisposing, intra-individual, and extra-individual factors in the disablement process predicted different disability trajectories among older adults in Taiwan. MethodsData were from the Taiwan Longitudinal Study on Aging (TLSA) Survey in 1996–2007 (n=3186). Disability trajectories for activities of daily living (ADLs) and instrumental activities of daily living (IADLs) were identified by using latent class growth curves modeling. Factors including demographics, health conditions, health behaviors, social relations, and use of assistive devices were significantly predicted different disability trajectories of older adults over the following 11 years by applying hierarchical logistic regression. ResultsThree disability trajectories – maintained function, progressive disability, and consistent disability – were identified. Predisposing factors such as younger age, more educational attainment, and better health conditions had protective effects of leading to a later healthier maintained function trajectory. Intra-individual factors such as engaging in leisure time activities (LTAs) were positively related to the maintained function trajectory but negatively related to the consistent disability trajectory; decreasing social networks was common to those on consistent disability trajectory; dissatisfaction with social support was noted in maintained function trajectory group. An extra-individual factor, using assistive devices, was significantly related to maintaining older adults’ disability levels, even for those who started disabled. ConclusionsThe findings suggested that predisposing, intra-individual, and extra-individual factors play different roles in the development of later disability trajectories. More educational attainment, better health conditions, active in LTAs, and using assistive devices might benefit the maintenance of functioning in Taiwanese older adults.

Factors Associated With Toileting Disability in Older Adults Without Dementia Living in Residential Care Facilities

Older adults without dementia living in residential care facilities with toileting disability have increased care costs and dependency. Understanding associated factors could guide prevention and management strategies. The aim of this study was to identify the prevalence of and factors associated with toileting disability in this population. This was a cross-sectional analysis of the 2010 National Survey of Residential Care Facilities. A subsample (n = 2,395) of adults aged 65 years or older, without dementia, and with the potential to implement behavioral interventions was examined. Associated factors were classified according to the disablement process as pathologies, impairments, functional limitations, coexisting disabilities, and intraindividual and extraindividual factors. Logistic regression models accounting for the stratified two-stage probability sampling design were used to identify factors associated with toileting disability. Residents were mostly White women, aged 85 years and older. Prevalence of toileting disability was 15%. Associated factors included reporting fair or poor health; living in a facility with four or less residents; living in a for-profit facility; having bowel incontinence, urinary incontinence, more physical impairments, and visual and hearing impairments; and needing assistance with bathing, dressing, and transferring. Multicomponent and multidisciplinary prevention and management efforts should be designed for residents without dementia. Future studies testing the efficacy of prevention efforts are needed and should include treatments for incontinence; physical activity programs targeting impairments with walking, standing, sitting, stooping, reaching, and grasping; and therapy to improve dressing, bathing, and transferring skills.

Perspectives on healthy eating among Appalachian residents.

Extensive attention has been focused on improving the dietary intake of Americans. Such focus is warranted due to increasing rates of overweight, obesity, and other dietary-related disease. To address suboptimal dietary intake requires an improved, contextualized understanding of the multiple and intersecting influences on healthy eating, particularly among those populations at greatest risk of and from poor diet, including rural residents. During 8 focus groups (N = 99) and 6 group key informant interviews (N = 20), diverse Appalachian rural residents were queried about their perceptions of healthy eating, determinants of healthy food intake, and recommendations for improving the dietary intake of people in their communities. Participants included church members and other laypeople, public health officials, social service providers, health care professionals, and others. Participants offered insights on healthy eating consistent with the categories of individual, interpersonal, community, physical, environmental, and society-level influences described in the socioecological model. Although many participants identified gaps in dietary knowledge as a persistent problem, informants also identified extraindividual factors, including the influence of family, fellow church members, and schools, policy, advertising and media, and general societal trends, as challenges to healthy dietary intake. We highlight Appalachian residents' recommendations for promoting healthier diets, including support groups, educational workshops, cooking classes, and community gardening. We discuss the implications of these findings for programmatic development in the Appalachian context.

The perspectives of users of antiretroviral therapy on structural barriers to adherence in South Africa

Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet, suboptimal adherence to ART and retention in care of patients still persists and, by many accounts, is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa. Method: In this qualitative study, semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa. Results: The results of the interviews were categorised according to poverty-related, institution-related and social barriers to clinic attendance and pill-taking, which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work, transport expenses, long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity, stigma and discrimination. Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors, such as a healthcare-enabling environment, might play an important role in influencing healthcare-promoting behaviour among patients.

A synthesis of qualitative research on overweight and obese people's views and experiences of weight management.

The effectiveness of existing weight management programmes may be improved by understanding overweight and obese people's perceptions of the reasons for successful and unsuccessful weight management. Many qualitative studies have investigated overweight and obese adults' experiences with weight management. This paper presents findings of a meta-ethnography that synthesized 17 qualitative studies of overweight and obese adults' weight management experiences, principally in the context of behavioural weight management programmes. Twelve themes were derived describing factors that overweight and obese people identify as relevant to weight management: health concerns, expectations towards weight management, attributions for weight gain, psychological barriers, psychological facilitators, self-perception and body image, stigmatization, socio-cultural factors, environmental barriers, environmental facilitators, experiences with weight management programmes and positive outcomes of programme participation. Interventions that address all of the modifiable factors identified in this review are likely to appear credible to participants and will engage with the intra- and extra-individual factors that they perceive as affecting their weight management efforts.

The course and prognosis of hip complaints in general practice

The general practitioner needs to discriminate complaints with need of specialist care from those that can be managed in primary care. However, no previous research has studied prognostic indicators for the course of hip complaints in a primary care population. The purpose of this study was to investigate the course of hip complaints presented in general practice and to identify relevant prognostic indicators of outcome. Data were collected by means of self-administered questionnaires containing questions about sociodemographic variables, characteristics of the complaints, and several intraindividual and extraindividual factors, including several psychosocial variables (e.g., pain coping, distress, and kinesiophobia). After 3 and 12 months of follow-up perceived recovery, change in pain intensity and change in functioning were assessed. Multiple regression analyses were performed to investigate the association between the potential prognostic indicators and the 3 outcome measures. We included 139 patients with hip complaints, presented in general practice. Only 24% reported recovery after 3 months, increasing to 37% after 12 months. A history of hip complaints, a longer duration of the current episode of hip complaints, or more severe complaints, were associated with a less favorable prognosis. Furthermore, more vital patients and patients who met the Norm for Healthy Activity had a higher probability of a favorable outcome. Pain transformation and worrying were significant associated with recovery and changes in functioning after 3 months. Different prognostic indicators were found to be associated with perceived recovery, changes in pain intensity, and changes in functioning. Future research should aim at investigating the mechanisms that can underlie these associations.

The disablement process: Factors associated with progression of disability and recovery in French elderly people

Purpose: To study the factors associated with progression, recovery and death from different grades of disability in elderly people.Method: The sample included 3198 participants of the PAQUID (‘Personnes Agées QUID’) cohort, aged 65 and over and community-dwellers at baseline. Subjects were re-interviewed 1, 3, 5, 8 and 10 years after baseline. A five-state Markov model was used to estimate transition intensities between four grades of disability and toward death. We used a hierarchic scale of disability, which combines basic and instrumental activities of daily living and mobility. Several explanatory variables were investigated: medical, personal and environmental factors.Results: The factors associated with progression and/or no recovery of disability were cardiovascular diseases, stroke and diabetes, low cognition, visual impairment and dyspnoea (for pathologies and impairments), older age, female gender, low educational level (for risk factors), depression (for intra-individual factor) and being married, recent hospitalization and number of drugs (for extra-individual factors). Older age, male gender, tobacco consumption and living in an urban area were associated with mortality.Conclusions: These findings confirm the independent contribution of each group of variables in the disablement process and stress their different impact on progression of disability or on recovery from different grades of disability.

The Contribution of Dementia to the Disablement Process and Modifying Factors

The objective of this study was to examine the impact of dementia on disability progression and mortality, and to analyze the modifying effect of risk factors and extra-individual factors. A sample of 3,403 participants in the PAQUID study was followed for 10 years. Disability was assessed on a 4-grade scale: no disability, disabled only on the Rosow-Breslau scale, disabled on the Rosow-Breslau scale and on instrumental activities of daily living (IADL) scales, and disabled on the Rosow-Breslau, IADL and activities of daily living (ADL) scales. A Markov model was used to estimate the effect of explanatory variables on disability and mortality. Controlling for age, gender, education, place of residence, medical care and informal support, dementia had a strong significant effect on progression to IADL and then to ADL disability. Dementia did not increase the risk of death, once disability was taken into account, except from the lowest disability grade.

Toward a comprehensive model of physical activity

Background and purpose. Despite the widely acknowledged public health burden and years of individually based intervention approaches, physical inactivity remains a growing concern among industrialized nations. Interventions aimed at changing individual dispositions that increase physical activity generally result in small changes in behavior that dissipate within weeks. Correlational research testing theories and models focusing on these same individual dispositions explain, at best, 20–40% of the variance in physical activity. As a result, recent calls have been made for consideration of broader, multilevel, ecological approaches to physical activity promotion. The purpose of this article is to define a comprehensive model for understanding physical activity and consider future directions for research. Methods. Relevant literature is reviewed within each of the areas being discussed. Results and conclusions. Ecological models incorporate both intra- and extra-individual influences that may impact on individual physical activity. However, the role of extra-individual factors has not been clearly defined in current ecological models of physical activity. We present the theoretical background of ecological models of health behavior, and define an ecological model for physical activity promotion. This model portrays physical activity behavior as being influenced by interplay between environmental settings and biological and psychological factors. Further testing of this and existing ecological models of physical activity is recommended.

Le processus d’évolution vers l’incapacité dans la démence

The disablement process model (Verbrugge and Jette [ 1994]) can help to better understand and manage dementia. The disease is expressed by impairments in global cognitive processes (e. g. memory) which are responsible of functional limitations in generic cognitive tasks (e. g. to recall a list of words). These functional limitations are expressed by disability in instrumental, and then basic, activities of daily living. Genetic or environmental (e. g. education, nutrition) risk factors are predisposing characteristics which increase the risk of disease but they can also modulate its expression. Extra-and intra-individual factors are introduced factors which can speed up or slow down the disablement process. Intra-individual factors are positive (adaptation of activities) or negative (depression) strategies developed by the individuals in reaction to disease. Extra-individual factors are interventions by the health care system, informal or professional caregivers and society.