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Staying in Control

Can believing we are in control of our health make us live longer?

What is perceived control?

Defined as “the belief that one has the ability to make a difference in the course or the consequences of some event or experience; often helpful in dealing with stressors”, perceived control can be a key factor in living longer.  Also known as locus of control, the confidence we have in our ability to control our own lives plays an important role in maintaing a healthy lifestyle and avoiding high-risk activities that can cause medical problems later in life. 

Beginning in adolescence, perceived control shapes our abiity to develop good health habits that can prevent future problems.  Research has shown that higher perceived control in adolescents is linked to lower psychological stress, better cardiovascular health, lower inflammation, and reduced obesity by the time those adolescents reach young adulthood. The healthy decisions that come from perceived control can lead to favourable outcomes much later in life as well.  

Researchers have already demonstrated a link between perceived control and reduced cardiovascular disease and even delaying death in older adults. Studies of patients with diseases such as amyotrophic lateral sclerosis (ALS) and kidney disease have also shown increased rates of survival linked to how much confidence people have in their ability to control their disease.

While other factors can help account for these results, including socioeconomic and comorbid health factors,  people who see themselves in charge of their lives are more likely to take active steps to ensure they remain healthy. That includes healthy behaviours such as eating sensibly, exercise, and complying with medical treatment. Perceived control may also influence how we regulate emotions and handle stress as well as helping us develop social support networks, especially during crises, that can help us cope more effectively  

But does perceived control change over time?  As people age, they may find themselves more pessimistic about physical and cognitive declines and lose the confidence they had when younger. Even middle-aged people who finds themselves for an aging parent might find their sense of perceived control fading due to concerns about that parent’s health and the prospect of mortality.    With that loss of confidence, comes greater reluctance to try staying healthy. After all, if you don’t believe that eating sensibly, exercising, and taking medication as prescribed will really help you, why do them?

And age is going to play a factor in how much control we think we have over our lives. According to longitudinal studies, perceived control increases when we are young adults, remains fairly stable throughout middle age, and starts to decline once we reach our golden years. Unfortunately, it is in old age when perceived control becomes especially important in protecting us from the various medical problems that grow worse with time. 

As young adults and adolescents, we develop confidence in our ability to remain healthy due to the successful choices we make and our various life experiences. Still, a serious health crisis can be enough to remove that sense of perceived control and leave us believing that nothing we can do would make a difference. Research has shown that people who develop cancer or who care for a loved one with dementia often show reduced perceived control. Losing the sense of control we once depended on can mean greater depression, pessimism, difficulty coping with stress, and neglecting personal health needs.  

A new research study published in Developmental Psychology examined how perceived control changes over time and the impact it hs on long-term health, including mortality risk. Conducted by a team of researchers at the Max Planck Institute for Human Development in Berlin, Germany, the study used data from the Americans’ Changing Lives Study (ACL).   Collecting nationwide data on sociological, psychological, and physical health measures since 1986, the ACL is the oldest demographic project of its kind in the United States and includes measures of perceived control and well-being as part of the dataset. 

Using ACL data, the Max Planck researchers examined perceived control in nearly three thousand participants over a sixteen-year period. Statistical analysis of the data showed that level of perceived control predicted long-term mortality risks independent of demographic factors. Long-term changes in perceived control over time (which the authors termed control trajectory) strongly predicted risk of reduced mortality but that the link between perceived control and mortality declined as people grew older.  

Breaking the results down even further, the researchers found that seeing life as controllable and predictable helps protect against the negative emotions that contribute to despair and apathy.   While the link between perceived control and health can be influenced by different factors, the Planck researchers found little evidence that physical activity or social support helped explain the perceived control-mortality connection. Although  this contradicted the findings of other studies, the authors suggested that the role of social support might be more apparent during specific medical crises rather than looking at general mortality. 

Can perceived control be taught as a way of promoting good health? Since the link between perceived control and health seems particularly strong in young adulthood, the researchers suggest that encouraging young adults to develop health habits based on their own sense of self-control might be especially effective. It is also important to understand how major life events can cause people to lose this perceived control. Along with health-related events such as becoming disabled,  the onset of  a serious disease, or a loved one developing health problems, factors such as unemployment, a financial reversal, or other crises can result in people becoming more prone to believing that they are not in control of their lives.

Though the relationship between perceived control and survival is stronger for younger people, the consequences of the health decisions they make then can still be critical later in life. Diabetes, heart disease, lung cancer due to smoking, and other conditions that can all shorten a person’s lifespan are often related to health choices we make when we are younger. 

Not that perceived control will necessarily ensure health in young people with serious illness such as cancer or who have pre-existing stress problems. Even in people with serious medical problems, maintaining a sense of control can help protect against further health declines or making lifestyle decisions that might shorten their lives. 

While promoting perceived control can be a useful strategy for community health programs designed to foster healthy living, the study authors recognize that there are limits to how useful a feeling of self-efficacy can be with certain medical conditions. For older people, perceived control likely plays a greater role in cardiovascular problems than in diseases such as cancer. Still, a positive attitude can help with day-to-day lifestyle decisions such maintaining a healthy diet or regular exercise.  On the other hand, apathy and a sense of fatalism can be, well, fatal.  

Understanding how a sense of confidence in our ability to control our health can be the key to a longer and more active life. Though perceived control has a stronger role on maintaining good health when we are younger, maintaining a sense of confidence will always be important at any age. 

Romeo Vitelli, Ph.D. is a psychologist in private practice in Toronto, Canada.

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