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 • America’s 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. Work Organization Individual-Level Factors Job Level Factors Self-Care Health Quality of Productivity Life Conceptual Model Organizational structure Work climate Workplace policies (shiftwork, flexibility & pay structure) Demographics Mood Social support Cognition Physical functioning Job control Job demands Workplace support Physical demands Self-care maintenance: Adherence to medication, diet, exercise & symptom monitoring; Self-Care management of symptoms

5. Phase I: Cross-sectional descriptive study • N=88 • 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 (>age 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 (p<.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 • How much of the variance in self-care can be explained by job characteristics? • Mood and Physical Functioning are strongest predictors of HRQL in older working adults (46.8% variance)

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 122:S21. • 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/CPH%20News-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...What’s Left? Perceptions of Self-Care among Individuals with Heart Failure Plus Comorbid Conditions" Heart Failure Society of America, September 2010, Journal of Cardiac Failure, 16:S109. • 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, 16:S109. • 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. Chronic Comorbid Conditions • Dickson, VV, Hammer,M, Newlin, K, Ercolano, E, Chyun, D, Melkus, G. “Systematic Review of Nurse-Led Experimental  Studies of Self-Management Interventions for Chronic Illness”, 1st International Symposium on Nursing Intervention Research, Montreal Canada, April 2011.

13. Other Activities Assessing the Impact of Medicare’s 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 Medicare’s 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 D’Eramo 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

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 • <50% exercised, 14% smoked, 74.6% overweight/obese • Depression greater in those with CHD (p<.0001) and in those who were not working (p<.0001)