Gender differences in use of primary and secondary control strategies in older adults with major health problems

Abstract

The present study examined primary and secondary control strategies among 143 men and women (73–98 years) who either reported having had or not had an acute event (heart attack or stroke), all of whom had health-related restrictions on everyday tasks and activities. Repeated measures of ANCOVAs tested the between-group effects of gender (men, women) and Acute Event (no, yes) and the within-subject effect, strategy type, on the frequency ratings of multiple control strategies. For men, having suffered an acute health event was unrelated to their use of primary control strategies. In contrast, women who had experienced an acute health event reported significantly less frequent use of primary control strategies than their counterparts who had not, perhaps suggesting that acute health events undermine proactive control striving and precipitate a shift to secondary control. Moreover, women differed significantly from men in their use of secondary control strategies, using them more often and displaying more diversity in their use. By demonstrating that women's use of primary control strategies is related to their past health events and that they adopt secondary control strategies more often than men and in a more differentiated or selective way, our findings underscore the importance of examining gender differences in strategy use during later life.

Keywords:

• Control strategies
• gender
• chronic health problems
• acute health problems

Acknowledgements

The authors acknowledge the support of the late Dr. Betty Havens and her staff for access to the Aging in Manitoba interview data and the expertise required to link our data sets. Access to the hospitalization data was provided by Manitoba Health and the Manitoba Centre for Health Policy; funding was provided by Canadian Institutes of Health Research (CIHR) Awards (Investigator & Partnership) and an operating grant (SSC-42790) to the first author and a Social Sciences and Humanities Research Council operating grant (501-2002-0059) to the second author.

Notes

∗Faculty of Physical Education and Recreation Studies, Arts (Department of Psychology) and Medicine (Department of Community Health Sciences) and Centre on Aging and the Health, Leisure, & Human Performance Research Institute.

[1] We restricted our analysis of primary control strategies to selective strategies because, as outlined elsewhere (Chipperfield & Perry, in press), a substantial proportion of the participants had missing values on our measure of compensatory primary control. Our analysis of secondary control strategies was also restricted to only compensatory strategies that become increasingly profitable in later life when goals are unachievable. Thus, selective secondary control strategies that involve enhancing commitment to a goal were not included because they become less relevant when goals are unachievable.

[2] The original wave of AIM participants was interviewed in 1971, and new waves were added in 1976 and 1983. Follow-up AIM interviews were conducted with all surviving individuals at five subsequent points in time, 1983, 1990, 1996, 2001, and 2005 producing both cross-sectional and longitudinal data. The selection of AIM subjects for each new wave involved rigorous randomization techniques, resulting in probability samples stratified by age, gender and region. Previous analyses show that the sampling procedures successfully minimized selection bias and selective attrition and achieved representativeness, initially (e.g., Mossey, Havens, Roos, & Shapiro, 1981) and at follow-up (Chipperfield, Havens, & Doig, 1997).

[3] The SAS that was conducted approximately three months after the AIM follow-up study included those who were interviewed as part of the AIM 1996 study and who met further eligibility criteria as determined by reviewing the 1996 interview data. Excluded from participating in SAS were those respondents who at the time of the AIM interview: (a) lived outside of the major centres and surrounding areas, (b) resided in personal care homes, (c) had poor comprehension and/or (d) were unable to respond to the interview in English or without proxy help. Interviewers contacted all eligible SAS participants by telephone to introduce themselves, describe the overall goal of the study and arrange an interview time. Of those who met the eligibility criteria, we interviewed 77% (353/458). Reasons for nonparticipation included our inability to make contact (n = 18), participants’ unwillingness (n = 72) and illness (n = 15). In-home, face-to-face SAS interviews lasted approximately 11/4 h and included questions on various issues related to control beliefs and strategies, emotions, health and well-being.

[4] This involved the medical residents reviewing the scores for the 19 chronic conditions that had seriousness scores and then asking them to “provide your best estimation as to a ranking for the seriousness of the three unranked conditions. For example, if you think Alzheimer's is more serious than palsy, but less serious than a heart attack, you might provide a ranking of 120”.

Additional information

Notes on contributors

Judith G. Chipperfield∗

∗Faculty of Physical Education and Recreation Studies, Arts (Department of Psychology) and Medicine (Department of Community Health Sciences) and Centre on Aging and the Health, Leisure, & Human Performance Research Institute.