Psychosocial Determinants of Self-Management Behaviors and Health Outcomes Among Older Adults

Chronic conditions have emerged as the primary cause of morbidity and mortality in the United States, and the prevalence of individuals contending with multiple chronic conditions, the co-occurrence of two or more chronic conditions, is increasing. Engaging in self-management behaviors is a core mechanism to promote health outcomes and prevent chronic disease complications. A sizable body of evidence has identified a number of psychosocial determinants of proper chronic disease self-management and health outcomes; despite this evidence, there has been slow progress in addressing these psychosocial factors to support proper self-management behaviors. This may be due to a lack of attention to the requisite skills individuals must employ to engage in self-care behaviors, and a lack of appreciation for the role which external contextual factors exert in health management. Therefore, as part of this dissertation I conducted three secondary data analyses with two National Institutes of Health cohort studies of older adults to investigate two understudied psychosocial factors, tangible social support and a daily routine, and their relation to older adults’ self-management behaviors and health outcomes. At the individual level I found that greater levels of daily routine were associated with better health status, but not urgent health care utilization. At the interpersonal level, the analyses related to social support underscored its multidimensional and complex nature. Contrary to my hypothesis, the second study observed a negative association between the frequency of functional support and adherence to asthma medications, while the third study found that unmet tangible support needs were associated with worse health status and greater urgent healthcare utilization. Differences in measurement between the two studies suggest that it is important to first isolate a need for tangible assistance in managing one’s health, and then examine perceptions related to the support’s availability and adequacy. In conclusion, as we seek to promote healthy aging, findings from this dissertation shed light on two psychosocial factors, a daily routine and unmet tangible social support needs, which could be leveraged, but also suggests that they must be acted on with simultaneous systemic changes.