Long-term Physical Health Problems Research Articles

Leisure engagement in older age is related to objective and subjective experiences of aging

Leisure engagement has potential to slow health and functional decline in older age. However, the benefits of different leisure domains for different aspects of aging remains unclear. In 8771 older adults from the Health and Retirement Study (a longitudinal panel study), we measured engagement in physical, creative, cognitive, and community activities. Outcome-wide analyses used 23 aging experiences across seven domains eight years later (daily functioning, physical fitness, long-term physical health problems, heart health, weight, sleep, subjective perceptions of health). Physical activity was related to more positive experiences in all domains but heart health eight years later. Creative engagement was positively related to aging experiences in four domains longitudinally. Cognitive and community engagement were less consistently related to aging experiences. Physical and creative activities may influence important aging metrics, reducing age-related decline and keeping older adults functionally independent for longer, potentially limiting increasing healthcare costs.

Association Between Men’s Exposure to Intimate Partner Violence and Self-reported Health Outcomes in New Zealand

Health implications of intimate partner violence (IPV) against men is relatively underexplored, although substantial evidence has identified associations between IPV and long-term physical health problems for women. Given the gendered differences in IPV exposure patterns, exploration of men's IPV exposure and health outcomes using population-based samples is needed. To assess the association between men's lifetime IPV exposure and self-reported health outcomes. This cross-sectional study analyzed data from the 2019 New Zealand Family Violence Study, which was conducted across 3 regions of New Zealand. The representative sample included ever-partnered men aged 16 years or older. Data analysis was performed between May and September 2022. Lifetime IPV against men by types (physical [severe or any], sexual, psychological, controlling behaviors, and economic abuse), any IPV (at least 1 type), and number of IPV types experienced. The 7 health outcomes were poor general health, recent pain or discomfort, recent use of pain medication, frequent use of pain medication, recent health care consultation, any diagnosed physical health condition, and any diagnosed mental health condition. The sample comprised 1355 ever-partnered men (mean [SD] age, 51.3 [16.9] years), who predominantly identified as heterosexual (96.9%; 95% CI, 95.7%-97.8%). Half of the sample (49.9%) reported experiencing any lifetime IPV, of whom 62.1% reported at least 2 types. Of all sociodemographic subgroups, unemployed men had the greatest prevalence of reporting exposure to any IPV (69.2%) and all IPV types. After adjustment for sociodemographic factors, men's exposure to any lifetime IPV was associated with an increased likelihood of reporting 4 of the 7 assessed health outcomes: poor general health (adjusted odds ratio [AOR], 1.78; 95% CI, 1.34-2.38), recent pain or discomfort (AOR, 1.65; 95% CI, 1.21-2.25), recent use of pain medication (AOR, 1.27; 95% CI, 1.00-1.62), and any diagnosed mental health condition (AOR, 1.66; 95% CI, 1.11-2.49). Specific IPV types were inconsistently associated with poor health outcomes. Any physical IPV exposure was associated with poor general health (AOR, 1.80; 95% CI, 1.33-2.43), recent pain or discomfort (AOR, 2.23; 95% CI, 1.64-3.04), and frequent use of pain medication (AOR, 1.69; 95% CI, 1.08-2.63), which appeared to be associated with exposure to severe physical IPV. Exposure to sexual IPV, controlling behaviors, and economic abuse was not associated with any assessed outcomes after sociodemographic adjustment. Experience of a higher number of IPV types did not show a clear stepwise association with number of health outcomes. Results of this study indicate that exposure to IPV can adversely affect men's health but is not consistently a factor in men's poor health at the population level. These findings do not warrant routine inquiry for IPV against men in clinical settings, although appropriate care is needed if IPV against men is identified.

The Impacts Of Socio-Economic Challenge On Long-Term Physical and Mental Health In Retirement Age

Our objective was to measure the association between structural racism, a previously unmeasured but theoretically causal factor, and assisted living communities (ALCs) location as fewer ALCs are located in counties with a greater percentage of the population reported as Black (PPB). We used a recently developed measure of structural racism—the racial opportunity gap (ROG), which compares the economic mobility of Black and White people who grew up in the same area with parents who had similar incomes. We estimated a multilevel mixed-effects bivariate regression model to examine the factors contributing to the presence of ALC. We relied on state and county random effects. The likelihood of an assisted living being located in a census tract in 2019 was significantly positively associated with the percent of the population over the age of 65 (OR=150.1573, p=<0.001), the PPB (OR=2.9916, p=0.004), and higher median incomes (OR=1.0, p=<0.001). In contrast, rurality (OR=0.5656, p=<0.001), unemployment rates (OR=0.0288, p=<0.001), and census tracts that have a high PPB in addition to a high county ROG (OR=.0058, p=0.0137) are all associated with a lesser likelihood of an ALC. The interaction coefficient between the ROG and PPB reverses the previously documented negative association between the PPB and ALC presence. This result empirically supports the premise that structural racism, not population race alone, is a negative determinant of where an ALC is located within a county.

The Impacts Of Socio-Economic Challenge On Long-Term Physical and Mental Health In Retirement Age

Married and cohabiting couples have important influences on one another’s stress and well-being. Pandemic-related stress may influence the extent to which couples' stress levels are coregulated. This study examined the experience of nonspecific stress and pandemic-related stress and the moderating role of closeness among couples aged 50 and over in which at least one member had hypertension. A total of 30 couples reported their feelings of closeness to one another in a baseline interview and their feelings of nonspecific stress and pandemic-related stress every three hours for 5 days. There was no difference in closeness and nonspecific stress between husbands and wives. Wives reported greater pandemic-related stress than husbands. Actor-partner interdependence models revealed that wives’ nonspecific stress predicted husbands’ nonspecific stress (b = 0.17, SE = 0.04, p < .001) and that husbands’ nonspecific stress predicted wives’ nonspecific stress in each three hour period (b = 0.19, SE = 0.04, p < .001) and these associations were not moderated by closeness. Coregulation in pandemic-related stress among husbands and wives was moderated by wives’ feelings of closeness such that when wives’ feelings of closeness were lower, greater husband pandemic-related stress predicted lower pandemic-related stress for wives (b = -0.16, SE = 0.07, p < .05) whereas when wives’ feelings of closeness were higher, greater husband pandemic-related stress predicted greater pandemic-related stress for wives (b = 0.22, SE = 0.09, p < .05). These findings indicate that closeness may have detrimental effects especially when considering emotional coregulation in couples regarding the pandemic.

Audit of physical health monitoring on admission to Mill Lodge (CAMHS Inpatient Unit, York)

AimsThis audit aimed to evaluate the standard of initial physical health assessment that young people receive on admission to Mill Lodge.Adherence to recommendation 2.6.3 of the service specification for Tier 4 CAMHS was assessed. Standard 2.6.3 of the service specification for Tier 4 child and adolescent mental health services states that “on admission all young people must have an initial assessment (including a risk assessment) and care-plan completed within 24 hours. Where admission is for day/in-patient care this will include a physical examination.” In line with this standard this audit will evaluate the use of physical examination, baseline blood tests and ECG carried out on young people.BackgroundMental health problems in children and young people are associated with both short- and long-term physical health problems. It is therefore important that they undergo full physical health assessment on admission to a Tier 4 inpatient unit.MethodElectronic records were reviewed for all patients admitted within a 6 months period, between 1st August 2018 and 1st February 2019. Data were collected in March 2019 and entered directly into an excel spread sheet designed for data collection. A total of 23 patients were identified for inclusion in this audit.Simple statistical analysis was carried out using excel.ResultOver 80% of patients who did not refuse had a completed physical examination (85%), blood results recorded (82%) and ECG (84%) within the first 24 hours of their admission. 100% of patients who did not refuse had bloods and ECG checked at some time during their admission, with 90% having a physical examination.For several patients (3 physical examination, 2 bloods, 3 ECG), no reason was documented as to why the procedure or examination did not take place. For 1 patient, blood tests were delayed due to having no blood tubes available.ConclusionTaken into account the result of this audit and bearing in mind the importance of physical examination as part of the admission process, it is important to try and support both regular Mill Lodge staff and on-call junior doctors to follow Standard 2.6.3's guidance around physical examination on admission to hospital. While good results were seen in many areas, the ward is not yet achieving the standard of 100%. A re-audit will take place in twelve months’ time to review recommendation and compliance.

The employment and mental health impact of integrated Improving Access to Psychological Therapies: Evidence on secondary health care utilization from a pragmatic trial in three English counties.

Patients with a combination of long-term physical health problems can face barriers in obtaining appropriate treatment for co-existing mental health problems. This paper evaluates the impact of integrating the improving access to psychological therapies services (IAPT) model with services addressing physical health problems. We ask whether such services can reduce secondary health care utilization costs and improve the employment prospects of those so affected. We used a stepped-wedge design of two cohorts of a total of 1,096 patients with depression and/or anxiety and comorbid long-term physical health conditions from three counties within the Thames Valley from March to August 2017. Panels were balanced. Difference-in-difference models were employed in an intention-to-treat analysis. The new Integrated-IAPT was associated with a decrease of 6.15 (95% CI: -6.84 to -5.45) [4.83 (95% CI: -5.47 to -4.19]) points in the Patient Health Questionnaire-9 [generalized anxiety disorder-7] and £360 (95% CI: -£559 to -£162) in terms of secondary health care utilization costs per person in the first three months of treatment. The Integrated-IAPT was also associated with an 8.44% (95% CI: 1.93% to 14.9%) increased probability that those who were unemployed transitioned to employment. Mental health treatment in care model with Integrated-IAPT seems to have significantly reduced secondary health care utilization costs among persons with long-term physical health conditions and increased their probability of employment.

Physical Health Conditions Among a Population-Based Cohort of Vietnam-Era Women Veterans: Agreement Between Self-Report and Medical Records.

Little is known about medical morbidity among women Vietnam-era veterans, or the long-term physical health problems associated with their service. This study assessed agreement comparing data on physical health conditions from self-report and medical records from a population-based cohort of women Vietnam-era Veterans from the Health of Vietnam Era Women's Study (HealthViEWS). Women Vietnam-era veterans (n = 4219) self-completed a survey and interview on common medical conditions. A subsample (n = 900) were contacted to provide permission to obtain medical records from as many as three of their providers. Medical record reviews were conducted using a standardized checklist. Agreement and kappa (agreement beyond chance) were calculated for physical health condition groups. Of the 900, 449 had medical records returned, and of those, 412 had complete surveys/interviews. The most commonly reported conditions based on self-report or medical record review included hypertension, hyperlipidemia, or arthritis. Kappa scores between self-reported conditions and medical record documentation were 0.75-0.91 for hypertension, diabetes, most cancers, and neurological conditions, but lower (k = 0.29-0.55) for cardiovascular diseases, musculoskeletal, and gastrointestinal conditions. Generally, agreement did not significantly vary by different sociodemographic groups. There was relatively high agreement for physical health conditions when self-report was compared with medical record review. As more women are increasingly represented in the military and more veterans in general seek care outside the Veterans Health Administration, accurate measurement of physical health conditions among population-based samples is crucial.

Counseling People Displaced by War: Experiences of Refugees from the Former Yugoslavia

The purpose of this qualitative study was to explore the lived experiences of refugees from the former Yugoslavia who migrated to the United States as a result of the civil wars in the 1990s. The present research utilized a phenomenological method, in which the researchers collected data using in-depth interviews with 10 participants; analyzed the data themes relating to the pre- and post-migration experiences; and documented high rates of exposure to war-related violence and the presence of multiple stressors during resettlement. The study offers an integration of the collective essence and meaning of refugees' experiences. Findings suggested that being a refugee and resettling in a new country constitute a complex and life-changing process. Overall, the results indicated that the migration process for refugees from the former Yugoslavia was modulated by stressors during the war, migration and resettlement. The study concludes with a discussion of implications for counseling practice and counselor education.Keywords: civil wars, refugees, migration, Yugoslavia, resettlement, stressorsViolent conflicts throughout the world have left millions of people displaced, some within their own country (the internally displaced) and some across international borders (refugees). The United Nations High Commissioner for Refugees (UNHCR) reported that in 2010,43.7 million people from over 125 countries were forcibly displaced from their homes by civil or interstate war (2011), and that the expense of meeting needs was nearly $2 billion. The psychological impact of war has been widely acknowledged and well documented (Miller & Rasco, 2004; Miller, Weine, et al, 2002; Mollica, 2006; Murthy & Lakshminarayana, 2006; Porter & Haslam, 2001; Summerfield, 2003; van den Heuvel, 1998).The most frequently reported consequence of war exposure is post-traumatic stress disorder (PTSD), followed by depression, recurrent nightmares, insomnia, chronic hyperarousal, impaired concentration and irritability (Miller & Rasco, 2004). It has been estimated that 50% of refugees experienced higher levels of PTSD, depression and other psychiatric problems (de Jong, Scholte, Koeter, & Hart, 2000), with the lifetime prevalence of PTSD among specific groups of trauma survivors ranging from 15%-24%, compared to 8% in the general United States population (de Jong et al., 2001). PTSD is associated with long-term physical health problems, higher mortality rates and heart disease (Hamblen & Schnurr, 2007).One country in particular, the former Socialist Federative Republic of Yugoslavia, experienced similar issues. The breakup of Yugoslavia in the 1990s produced an estimated 992,200 refugees and 1,203,000 internally displaced people, which constituted 3% of the total population (U.S. Department of Health & Human Services [USDHHS], 1999). From 1983-1999, the United States accepted an estimated 200,000 refugees from the former Yugoslavia (USDHHS, 1999). Furthermore, in 1998 and 1999, refugees from the former Yugoslavia were the largest refugee group admitted into the United States, representing 36% of all arrivals (USDHHS, 1999).Consistent with other wars, the hardships in the former Yugoslavia were particularly acute for women, children and the elderly (Weiss & Pasic, 1998). Thousands of people suffered through war trauma, persecution, torture, abrupt and sometimes repeated displacements, physical violence against themselves or their family, rape and other forms of sexual violence. As a result of this exposure, refugees from the former Yugoslavia have reported high rates of depressive symptoms, PTSD and other trauma-related issues (Porter & Haslam, 2001; Vojvoda, Weine, McGlashan, Becker, & Southwick, 2008; Weine et al., 1998).Purpose of StudyResettling in the United States is not an easy process, and many refugees experience numerous problems in their new host country. Some of these problems include poverty, illiteracy, prolonged dependence on government aid, cultural differences, social isolation, the language barrier, and loss of status (Carlson & Rosser-Hogan, 1993, p. …

Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems

BackgroundMental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting.MethodsA naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis.ResultsHealth professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients.ConclusionsEstablished divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.

Using daily diaries to study family settings, emotions, and health in everyday life

Despite well documented links between family functioning and long-term physical health problems, prior studies using cross-sectional, laboratory, or traditional longitudinal designs are limited in their ability to address everyday family encounters, emotions, biological processes, and physical health. Here, we describe our ongoing study of family settings and upper respiratory infections (URIs) to demonstrate the value of daily diary approaches. Families completed a daily diary assessing social interactions within and outside the family, daily mood, health behaviors, and URIs every day for two months. We collected objective assessments of URI symptoms when parents or children reported they were sick. This paper demonstrates feasibility in terms of compliance and acceptance by families, and describes methods for assessing URI symptoms and episodes.

Pathways to Lifespan Health Following Childhood Parental Death

The death of a parent is a profoundly stressful form of childhood adversity, increasing the short- and long-term risk of mental health problems. Emerging research suggests it may also disrupt biological regulatory systems and increase the risk of long-term physical health problems. This article presents a theoretical framework of the process by which the experience of parental death during childhood may influence mental and physical health outcomes over time. Drawing from a broad literature on adaptation following childhood parental loss, we focus on risk and protective factors in the childhood environment that are theoretically and empirically linked to emotional and biological regulatory responses to stress later in life, the effects of which may accumulate to impact long-term health.

Physical long-term health problems and mental comorbidity: evidence from Vietnam

Objective:The mental health of children living in low-income countries remains a neglected research area despite the high burden of disease. This study is one of the first that examines the...

‘Alchemy and Magic’: The Experience of Using Clay for People with Chronic Illness and Disability

Clay is used within various therapeutic settings, yet within the occupational therapy literature there is a significant lack of evidence to support its use. This phenomenological study sought to enquire into the experience of ceramics as a creative leisure pursuit for people living with long-term physical health problems. Six people responded to an invitation to participate published in an international ceramics journal. They were given the choice to be interviewed by telephone or in person, or to provide a written account about their experience of engaging in ceramics. The criteria for recruitment were people living with a chronic illness or a physical disability who currently engaged in the occupation of ceramics. The data collection and analysis utilised interpretative phenomenological analysis. Four main themes emerged from the data analysis: being productive and creating, promoting physical and psychological wellbeing, enhancing opportunities for social interaction and ‘alchemy and magic’. All the participants reported ways in which working with clay was beneficial to their health and contributed to personal wellbeing. The ceramic process afforded opportunities for experiencing flow and creative adventure, enabled social contacts, enhanced self-worth and provided the participants with a sense of achievement, all of which appeared to promote successful adaptation to ill health. For a minority, the material itself enabled expression about feelings of loss and, in some cases, maintained physical functioning. These findings have relevance for occupational therapists because they suggest that a meaningful creative occupation may be helpful for people learning to cope with chronic conditions.

Women with antisocial behaviour: long‐term health disability and help‐seeking for emotional problems

Previous studies have reported that women who display antisocial behaviour (ASB) as adults or adolescents are at increased risk of poor mental and physical health, but have not tested effects of sociodemographics, or used only incarcerated samples. The authors sought first to test associations between ASB and emotional or physical health problems in non-incarcerated women, and second whether any such association could be explained by sociodemographic factors. The sample was 1218 mothers, aged 22-59, of boys randomly selected from grades 1, 4 and 7 (aged about 7, 10 and 13 respectively) in US urban public schools in 1987 and 1988. The 30% of boys designated most antisocial on initial examination and a 30% random sample of the remainder entered the longitudinal study. Demographics for the mothers, data on their lifetime ASB, help-seeking for emotional and/or physical health problems were collected at interview with them. A history of adolescent conduct problems and/or lifetime police contacts led to classification as antisocial for this study. A total of 214 (17.6 %) of the mothers met our criteria for ASB. Compared with the women without such history, the women with ASB were younger, less well educated, of lower socioeconomic status, had a higher rate of unemployment and more of them were single mothers. They more often sought help for emotional problems and reported higher rates of long-term physical health problems, even when the effects of sociodemographic factors were taken into account. Although the findings rule out many sociodemographic factors as simple explanations for the association between ASB and poor emotional and physical health, more work is needed on the nature and extent of such disorder, and of temporal relationships between the key events: poor health and ASB.

Understanding Rape and Sexual Assault

During the past 20 years, researchers have documented the widespread problem of rape in American society. Approximately one in four women are raped in their adult lifetime, which causes severe psychological distress and long-term physical health problems. The impact of sexual assault extends far beyond rape survivors as their family, friends, and significant others are also negatively affected. Moreover, those who help rape victims, such as rape victim advocates, therapists, as well as sexual assault researchers, can experience vicarious trauma. Future research and advocacy should focus on improving the community response to rape and the prevention of sexual assault.

Sexual-Assault History and Long-Term Physical Health Problems

Having a history of sexual assault is associated with both poor general health and limitations in physical functioning, as well as with specific health problems such as chronic pelvic pain, premenstrual disturbance, other gynecologic symptoms, fibromyalgia, headache, other pain syndromes, and gastrointestinal disorders. In studies evaluating the possible role of depression in these associations, depression among sexually assaulted persons did not account for their poorer health. Although there are unanswered questions in the literature on the associations between sexual assault and health, existing findings are consistent with standard criteria for inferring causal relationships from observational data. For example, many assault-health associations are supported by multiple, independent studies, and many demonstrate dose-response relationships (i.e., more incidents of sexual assault, or more severe assaults, are associated with more adverse health outcomes).