Aging Workers with Coronary Heart Disease - PowerPoint PPT Presentation

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Aging Workers with Coronary Heart Disease

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Aging Workers with Coronary Heart Disease Victoria Vaughan Dickson, PhD, CRNP Assistant Professor Brookdale Fellow 2010 College of Nursing New York University – PowerPoint PPT presentation

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Title: Aging Workers with Coronary Heart Disease


1
Aging Workers with Coronary Heart Disease
  • Victoria Vaughan Dickson, PhD, CRNP
  • Assistant Professor
  • Brookdale Fellow 2010
  • College of Nursing
  • New York University

2
Brookdale Fellowship Goals
  • Conduct an independent research project focused
    on aging workers with CHD
  • Engage in interdisciplinary scholarship in aging
    health issues
  • Gain expertise in organization of work theory and
    research
  • Develop proficient written and oral presentation
    skills

To become an independent scientist and nursing
leader focused on improving the health and
quality of life of older adults with coronary
heart disease (CHD).
3
Self-Care and Organization of Work Among Aging
Workers with CHD
  • Americas workforce is aging
  • By 2015, 31.2 million workers over age 55
  • Over 3.5 million workers with CHD
  • 31 hyperlipidemia 15 hypertension
  • Within 6 months of MI, 22 men 46 women are
    disabled from work
  • 2009 costs associated with CHD among workers
    estimated 475.3 billion

4
Conceptual Model
Organizational structure Work climate Workplace
policies (shiftwork, flexibility pay structure)
Job control Job demands Workplace
support Physical demands
Demographics Mood Social support Cognition Physica
l functioning
Self-care maintenance Adherence to medication,
diet, exercise symptom monitoring Self-Care
management of symptoms
5
Phase I Cross-sectional descriptive study
  • N88
  • mean age 63.3 7.1 yr
  • 56.8 female
  • 34.4 AA
  • 79.6 actively employed

6
Self-Care Behaviors
7
Individual-Level Factors
  • Older individuals (gtage 62) had better self-care
  • Depression was associated with poorer self-care
    and age. (p.01)
  • Positive relationship of self-care and physical
    functioning stronger in older workers (p.002)
  • Better self-care was associated with better HRQL
    (plt.001)

8
Job-Level Factors
  • 79.8 Job Satisfaction
  • ? Job Demands ?Self-Care (p.006)
  • ? Job Control
  • ? Workplace Support
  • ? Self-Care (p.004)

? Self-Care (p.02)
9
Regression Analysis
  • Mood and Physical Functioning are strongest
    predictors of HRQL in older working adults (46.8
    variance)
  • How much of the variance in self-care can be
    explained by job characteristics?

Self-Care ß p-value R2
Model Controls
Depression -.216 .037 .119
Physical Functioning .196 .058 .119
Job Characteristics
Job Demands -.184 .04 .096
Job Control .024 .803 .096
Workplace Support .208 .035 .096
Quality of Life ß p-value R2
Depression -.505 .000 .468
Physical Functioning .301 .000 .468
Self-Care .048 .54 .02
10
Brookdale Research Status
  • Recruitment of healthcare
  • workers from 4 NYC
  • Healthcare systems
  • Data collection baseline data
  • qualitative interviews
  • Awarded 11k grant from NYU University Research
    Challenge Fund

The purpose of this longitudinal prospective
mixed methods study is to investigate the
self-care practices of aging workers with CHD and
the relationship of organization of work,
resultant job-level risk factors, self-care, and
health and productivity outcomes
11
Aging Health Research Organization of Work
Secondary Data Analysis
Research Affiliate
Older Worker RIG
Associate Faculty Summer Scholars Program 2010
12
Publications Presentations
  • Aging Workers with Coronary Heart Disease
  • Dickson, VV, Howe, A, Deal, J, McCarthy, M.
    Increased Psychological Demands of Work are
    Associated with Poor Adherence and Poor
    Health-Related Quality of Life Among Workers with
    Cardiovascular Disease. American Heart
    Association Scientific Sessions, November 2010.
    Circulation 122S21.
  • Dickson, VV, Howe, A, Deal, J, The Influence of
    Work Organization Job-Level Factors on Self-Care
    and Health-Related Quality of Life Among Older
    Workers with Cardiovascular Disease, Work,
    Stress, and Health 2011 Work and Well-Being in
    an Economic Context, May 2011.
  • Dickson, VV (Invited Presentation) Self-Care
    Among Adults with Cardiovascular Disease 2011
    XXIII Congreso Interamericano de Cardiología y
    VII Simposio Internacional de Cardiología y
    Cirugía Cardiovascular, Cartegna de Indias,
    Colombia March 10-12, 2011
  • Dickson, VV, Improving Self-Care Among Aging
    Workers with Coronary Heart Disease A Growing
    Priority, CPH News and Views, Issue 19 2011.
    retrieved from http//www.uml.edu/centers/cph-new
    /Documents/CPH20News-Views_19.pdf
  • Witkoski, A Dickson, VV Hospital staff nurses
    work hours, meal periods and rest breaks A
    review from an occupational health nurse
    perspective. AAOHN J 58(11) 489-97, 2010.
  • McCarthy MM, Dickson VV, Chyun D Barriers to
    Cardiac Rehabilitation in Women with
    Cardiovascular Disease An Integrative Review.
    Journal of Cardiovascular Nursing November 2010
    epub ahead of print.
  • Dickson, VV Increased Psychological Work Demands
    Associated with Poor Self-Care Among Older
    Working Adults with Cardiovascular Disease, Heart
    Lung (in review).
  • Dickson, VV Working with heart disease A
    descriptive analysis of older workers with
    coronary heart disease. Submitted to 2011 AHA
    Scientific Sessions (abstract in review).
  • Heart Failure Self-Care
  • Dickson, VV, Lee, C, Riegel, B. How Do Cognition
    and Knowledge Affect Heart Failure Self-Care.
    Journal of Mixed Methods Research 5(2)167-189,
    2011.
  • Dickson, VV, Buck, HL, Riegel, B. Qualitative
    Meta-Analysis of Heart Failure Self-Care
    Practices Among Individuals with Multiple
    Comorbid Conditions. Journal of Cardiac Failure
    17(5)413-9., 2011.
  • Dickson, VV, Kuhn, L, Worrall-Carter, L, Riegel,
    B. Whose Job is It? Examining Gender
    Differences in Perceptions About the Heart
    Failure Self-Care Role. Journal of Nursing and
    Healthcare of Chronic Illness. epub ahead of
    print May 2011.
  • Riegel, B, Dickson VV, Lee, CS. Self-care in
    Patients with Chronic Heart Failure Predictors,
    Outcomes, Public-Health and Policy Implications.
    Nature Reviews Cardiology (accepted).
  • Dickson, VV. Using Mixed Methodology to Advance
    Heart Failure Self-Care Science A Typology of
    Self-Care Leads to Implications for a
    Skill-Building Intervention Council for the
    Advancement of Nursing Science, September 2010.
  • Dickson, VV, Buck, H, Riegel, B. "No Sugar, No
    Fat, No Salt...Whats Left? Perceptions of
    Self-Care among Individuals with Heart Failure
    Plus Comorbid Conditions" Heart Failure Society
    of America, September 2010, Journal of Cardiac
    Failure, 16S109.
  • Dickson, VV, McCarthy, MM, Howe, A, Schipper, J,
    Gonzalez, J, Katz, S. "Socio-Cultural Influences
    of Self-Care among African Americans with Heart
    Failure" Heart Failure Society of America,
    September 2010, Journal of Cardiac Failure,
    16S109.
  • Dickson, VV, Buck, H, Riegel, B. Self-Efficacy
    When Multiple Comorbid Conditions Challenge Heart
    Failure Self-Care A Qualitative Meta-Analysis
    Study, 23rd Annual ENRS Scientific Sessions,
    March 2011.

13
Other Activities
Assessing the Impact of Medicares Non-Payment
Policy for Hospital-Acquired Harms of Care A
Nursing Perspective, Wald, H, Richards, A,
Dickson, VV, Boltz, M and Capezuti, E 2011 NICHE
Conference, Las Vegas, NV Understanding
Institutional Responses to Medicares
Hospital-Acquired Conditions Non-Payment Policy
Cause for Optimism, (in review) Wald, H,
Richards, A, Dickson, VV, Boltz, M and Capezuti,
American Heart Association Grant 10CRP4140049 PI
VVDickson, Co-Inv GDMelkus SKatz
14
2011-2012 Plans
  • Complete data collection and analysis
  • Coursework Advanced Quantitative Statistics
    Secondary Data Analysis
  • Dissemination of results
  • NIA R21 Interaction of Health and Work

15
Acknowledgments
  • Brookdale Foundation
  • Gail DEramo Melkus, EdD, C-NP, FAAN
  • Center for Promotion of Health New England
    Workforce

Dean Terry Fulmer Dr. Elizabeth Capezuti Dr.
Deborah Chyun
16
Additional Slides
17
Self-Care is a Process of Maintenance and
Management
17
18
Organization of Work
  • the nature of the work process (the way jobs
    are designed and performed) and to the
    organizational practices (e.g., management and
    production methods and accompanying human
    resource policies) that influence the design of
    jobs.

Centers for Disease Control and Prevention (CDC).
The NIOSH Document The Changing Organization of
Work and the Safety and Health of Working People.
Department of Health and
Human Services. NIOSH Publication Number 2002-116
19
Data Collection
Instrument and Data Collection Interval 0 mo 2 mo 4mo
Organization of Work Organization- Job-Level Factors Organization of Work Organization- Job-Level Factors Organization of Work Organization- Job-Level Factors Organization of Work Organization- Job-Level Factors Organization of Work Organization- Job-Level Factors
Organization of Work Survey Job Content Questionnaire Effort Reward Imbalance Questionnaire NIOSH Generic Job Stress Questionnaire Work -Life Balance Survey X X X X X X X X X X X
Self-Care Self-Care Self-Care Self-Care Self-Care
Self-Care Heart Disease/Heart Failure Index X X X
Personal Factors Psychological, Physiological Social Factors Personal Factors Psychological, Physiological Social Factors Personal Factors Psychological, Physiological Social Factors Personal Factors Psychological, Physiological Social Factors Personal Factors Psychological, Physiological Social Factors
Self-efficacy Attitudes qualitative interview Mood Brief Symptom Inventory Social support MPSS Functional capacity DASI X X X X X X
Health and Productivity Outcomes Health and Productivity Outcomes Health and Productivity Outcomes Health and Productivity Outcomes Health and Productivity Outcomes
Work Ability Index SF-36 X X X X X
Work Limitations Questionnaire WHO Work Performance Questionnaire X X X X X X
Potentially Confounding Variables Potentially Confounding Variables Potentially Confounding Variables Potentially Confounding Variables Potentially Confounding Variables
Sociodemographic Survey Charlson Co-morbidity Index X X
20
Secondary Data Analysis Health and Retirement
Survey
  • 26.7 CHD diagnosis
  • 18 diabetes, 53 hypertension 56 arthritis
  • 55 employed
  • Health behaviors were poor regardless of work
    status
  • lt50 exercised, 14 smoked, 74.6
    overweight/obese
  • Depression greater in those with CHD (plt.0001)
    and in those who were not working (plt.0001)
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