title: Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study.
abstract: Control beliefs are important psychological factors that likely contribute to heterogeneity in health outcomes for older adults. We evaluated whether control beliefs are associated with risk for 4-year mortality, after accounting for established "classic" biomedical risk factors. We also determined if an enhanced risk model with control beliefs improved identification of individuals with low vs. high mortality risk.
  
  
  
  We used nationally representative data from the Health and Retirement Study (2006-2012) for adults 50 years or older in 2006 (n = 7313) or 2008 (n = 6301). We assessed baseline perceived global control (measured as 2 dimensions-"constraints" and "mastery"), and health-specific control. We also obtained baseline data for 12 established biomedical risk factors of 4-year mortality: age, sex, 4 medical conditions (diabetes mellitus, cancer, lung disease and heart failure), body mass index less than 25 kg/m2, smoking, and 4 functional difficulties (with bathing, managing finances, walking several blocks and pushing or pulling heavy objects). Deaths within 4 years of follow-up were determined through interviews with respondents' family and the National Death Index.
  
  
  
  After accounting for classic biomedical risk factors, perceived constraints were significantly associated with higher mortality risk (third quartile scores odds ratio [OR] 1.37, 95% CI 1.03-1.81; fourth quartile scores OR 1.45, 95% CI, 1.09-1.92), while health-specific control was significantly associated with lower risk (OR 0.69-0.78 for scores above first quartile). Higher perceived mastery scores were not consistently associated with decreased risk. The enhanced model with control beliefs found an additional 3.5% of participants (n = 222) with low predicted risk of 4-year mortality (i.e., 4% or less); observed mortality for these individuals was 1.8% during follow-up. Compared with participants predicted to have low mortality risk only by the classic biomedical model, individuals identified by only the enhanced model were older, had higher educational status, higher income, and higher prevalence of diabetes mellitus and cancer.
  
  
  
  Control beliefs were significantly associated with risk for 4-year mortality; accounting for these factors improved identification of low-risk individuals. More work is needed to determine how assessment of control beliefs could enable targeting of clinical interventions to support at-risk older adults.
authors.affiliation: Minneapolis VA Health Services Research and Development, One Veterans Dr, Minneapolis, MN, 55417, USA. wei.duanporter@va.gov.
authors.forename: Wei
authors.initials: W
authors.lastname: Duan-Porter
authors.affiliation: Durham VA Health Services Research and Development, Durham, NC, USA.|Durham VA Geriatrics Resarch, Education, and Clinical Center, Durham, NC, USA.|Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA.|Duke University Center for the Study of Aging and Human Development, Durham, NC, USA.
authors.forename: Susan Nicole
authors.initials: SN
authors.lastname: Hastings
authors.affiliation: Department of Public Health Sciences,Medical University of South Carolina, Charleston, SC, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Neelon
authors.affiliation: Durham VA Geriatrics Resarch, Education, and Clinical Center, Durham, NC, USA.|Department of Medicine, Division of Geriatrics, Duke University School of Medicine, Durham, NC, USA.|Duke University Center for the Study of Aging and Human Development, Durham, NC, USA.
authors.forename: Courtney Harold
authors.initials: CH
authors.lastname: Van Houtven
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D003920:Diabetes Mellitus / Q000401:mortality* / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000523:psychology; D006801:Humans; D007389:Internal-External Control; D008171:Lung Diseases / Q000401:mortality* / Q000523:psychology; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality* / Q000523:psychology; D011446:Prospective Studies; D012307:Risk Factors; D012649:Self Concept; D016019:Survival Analysis
keywords: Biomedical predictors; Control beliefs; Mortality risk