Older Adults’ Explanatory Models of High Blood Pressure

Shared Explanatory Models (EM) of High Blood Pressure (HBP)/Hypertension (HTN) were explored using systematic data collection and analysis methods from cognitive anthropology. Older adults who were members of a Medicare HMO in Los Angeles were asked to list all the illnesses experienced by older adults that they could recall, and those listing HBP or HTN were asked to further list and discuss its symptoms, causes, treatments and prevention. Responses were tape recorded, transcribed, and analyzed to develop a systematic “sentence completion by card sort” follow-up procedure. Consensus Analysis (CA) of the systematically collected data identified shared EM for HBP/HTN. The model presented here is similar to models of HBP/HTN described by researchers working with patients from different regions and different ethnic groups, suggesting that there is a widely shared lay or popular model for this disease. Stress, lifestyle (diet, exercise, weight, and substance use), heredity and aging are thought to be the major causes of HBP/HTN. Physicians are thought to be the appropriate source of care, as HTN/HBP is serious, life threatening, and potentially disabling. The study of cultural understandings and shared EM of disease has direct relevance for clinical practice and public health education. For a disease such as HTN/HBP, knowing where and how such explanations differ systematically between patients and clinicians, and what impact this may have on patterns of adherence to prescribed treatment is a crucial area of concern.

Older Adults’ Explanatory Models of Colds and Flu

Systematic data collection and analysis techniques were used in Los Angeles to discover older adults’ shared explanatory models (EM) of the causes, prevention, symptoms, treatment and consequences of late life illnesses, including influenza and the common cold. Recorded narratives also were analyzed to illustrate similarities and differences in shared cultural knowledge of these illnesses. Consensus analyses results suggest that shared EM of influenza and the common cold are similar. Participants identified both illnesses as contagious, caused or exacerbated by bad weather, but not the result of lifestyle, aging or heredity. Other shared cultural knowledge includes that both illnesses can be treated with home remedies, over-the-counter medications and medical care;both illnesses cause discomfort but are not serious, life-threatening or disabling. Despite the similarities and the apparent merging of the two illnesses in popular thought, many older adults do distinguish them, based on symptom patterns and severity, as revealed in their transcribed narratives. Consistent with other studies, participants attribute gastrointestinal symptoms to influenza but not to colds. They do not understand the potential role of lifestyle, age and chronic conditions in etiology and onset, and they are not concerned with their vulnerability to the potential sequelae of influenza. Public health education explaining the effects of lifestyle on susceptibility and vulnerability to the flu, how to distinguish and appropriately treat colds and the flu, and when to contact physicians, is recommended for older adults. Mixed method studies can prove useful at the planning stages of such interventions.

Race, gender, and lifestyle discussions in geriatric primary care medical visits

Increasingly, healthcare providers are required to spend more time and effort aimed at prevention and lifestyle modification. Many argue that providers are in a unique position to provide information for effective lifestyle and behavior change. Yet, relatively little is known about how in- terpersonal provider and patient characteristics, such as race and gender, affect discussions of lifestyle choices about public health issues. To understand better how patient and physician characteristics influence discussions of lifestyle behaviors, we conducted a prospective, cohort study of interactions between primary care physicians and their geriatric patients. We videotaped 381 elderly patient visits with 35 primary care physicians. We coded the encounters to indicate whether the patient and physician discussed lifestyle issues around nutrition, physical activity, and smoking. The independent variables were patient and physician race, gender, and concordant status. Discussions about nutrition were the most common lifestyle topic (47.8%), followed by physical activity (40.3%) and smoking (14.2%). Multivariate analysis indicate white patients are significantly less likely to have discussions with their physicians about nutrition (OR = 0.32, p = 0.02) and same gender encounters are also less likely to discuss diet/nutrition (OR = 0.59, p = 0.04). There were no significant differences for discussions about physical activity or smoking. Previous research has shown that differences persist in the quality of care and certain outcomes. Our results suggest these differrences are not exclusively the result of differences in the prevalence of lifestyle discussions based on patient and physician race or gender.