Control beliefs and risk for 4-year mortality in older adults: a prospective cohort study

W. Duan-Porter, S.N. Hastings, B. Neelon, C.H. Van Houtven

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Background: 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. Methods: 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. Results: 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. Conclusion: 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. © 2017 The Author(s).
Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalBMC Geriatrics
Issue number1
StatePublished - 2017

Bibliographical note

Cited By :1

Export Date: 26 December 2018

Correspondence Address: Duan-Porter, W.; Minneapolis VA Health Services Research and Development, One Veterans Dr, United States; email:

Funding details: U.S. Department of Veterans Affairs, VA

Funding details: Office of Academic Affiliations, Department of Veterans Affairs, OAA, VA, CIN 13-410

Funding text 1: Support for Wei Duan-Porter was provided by Grant No. TPH 21-024 from the Department of Veterans Affairs Office of Academic Affiliations. Publication support was provided by the Durham VA Health Services Research Center of Innovation funding (CIN 13-410). The sponsors had no role in the design, collection, analysis, interpretation of data, or preparation of the manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.


  • Biomedical predictors
  • Control beliefs
  • Mortality risk
  • age
  • aged
  • control
  • daily life activity
  • diabetes mellitus
  • female
  • heart failure
  • human
  • lung disease
  • male
  • middle aged
  • mortality
  • neoplasm
  • prospective study
  • psychology
  • risk factor
  • self concept
  • survival analysis
  • Activities of Daily Living
  • Age Factors
  • Aged
  • Diabetes Mellitus
  • Female
  • Heart Failure
  • Humans
  • Internal-External Control
  • Lung Diseases
  • Male
  • Middle Aged
  • Neoplasms
  • Prospective Studies
  • Risk Factors
  • Self Concept
  • Survival Analysis


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