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Title:The influence of cognitive impairment on health behaviors among older adults: The moderating role of living arrangement
Author(s):Kang, Sung-Wan
Director of Research:Andrade, Flavia
Doctoral Committee Chair(s):Zhan, Min
Doctoral Committee Member(s):Wu, Chi-Fang; Hernandez, Rosalba
Department / Program:School of Social Work
Discipline:Social Work
Degree Granting Institution:University of Illinois at Urbana-Champaign
Degree:Ph.D.
Genre:Dissertation
Subject(s):Cognitive impairment, Dementia, Health Behaviors, Physical activity, Preventive health services, Living arrangement
Abstract:The purpose of this study was to examine the influence of cognitive impairment on health behaviors in older adults. This study further assessed whether this relationship differs by living arrangement. I hypothesized that older adults with cognitive impairment are less likely to engage in health behaviors compared to their counterparts without cognitive impairment. I also hypothesized that the adverse influence of cognitive impairment on health behaviors is stronger for older adults who live alone compared to those living with others. Data came from 1995 through 2012 of the Health and Retirement Study (HRS), a nationally representative longitudinal survey of non-institutionalized individuals aged 50 years and older. The study sample consisted of 19,556 older adults. The HRS cognitive function is measured using the Telephone Interview for Cognitive Status (TICS), a validated cognitive screening instrument. A composite score of cognitive function, ranging from 0 to 27, was created by summing up scores from immediate and delayed word recall, a serial 7’s, and backwards counting. Older adults were divided into three groups based on their cognitive functioning score: dementia (0 to 6); cognitive impairment without dementia (7 to 11); and no cognitive impairment (12 to 27). Health behaviors included physical activity (vigorous physical activity ≥ 3 times per week or no vigorous physical activity), no-smoking (yes or no), drinking behavior (no/moderate drinking or excessive drinking), and self-reported preventive services utilization (flu shot, cholesterol test, prostate exam for men, and mammogram for women). Living arrangement is defined as 1) living alone, 2) living with one person and 3) living with two or more people. Mixed-effects logistic regression was used to analyze the longitudinal influence of cognitive impairment on four different types of health behaviors. The moderating effect of living arrangement was tested by including an interaction term (living arrangement x cognitive impairment) in the model. After adjusting for sociodemographic characteristics and other significant factors, this study found that community-dwelling older adults with cognitive impairment or dementia were less likely to engage in vigorous physical activity or to receive cholesterol test, influenza vaccination, mammogram, or prostate cancer screening compared to those without cognitive impairment. Contrary to expectation, the results showed that living arrangement did not play a significant role in the relationship between cognitive function and health behavior practices. Findings from this study have the potential to advance the knowledge base of gerontological social work practice and to promote the development not only of effective strategies for enhancing health behavior engagement in older adults with cognitive impairment but also for health promotion interventions. Findings from this study also present several implications for practice, policy, and future research.
Issue Date:2018-06-27
Type:Thesis
URI:http://hdl.handle.net/2142/101773
Rights Information:Copyright 2018 Sung-Wan Kang
Date Available in IDEALS:2018-09-27
Date Deposited:2018-08


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