Health Behavior Change Following Chronic Illness

Chronic illnesses like heart disease, cancer, cerebral vascular disease, respiratory disease, and diabetes are considered preventable because they are substantially influenced by modifiable behaviors such as smoking cessation, increased physical activity, and decreased alcohol consumption.  The basic tenets of several health behavior models suggest that the diagnosis of a chronic disease should encourage lifestyle changes; however, advanced age can translate into a lifetime of habit formation which suggests that adopting long-term health behavior changes may be a challenge. Therefore, understanding lifestyle improvements among older adults with the diagnosis of a chronic illness is critical to developing interventions meant to increase longevity and improve quality of life.

Previous research examining health behavior changes following the diagnosis of a chronic illness have considered only short-term changes and relied on retrospective accounts, which are prone to reporting biases. A recent prospective study published in The Journals of Gerontology adds to the literature by examining health behavior changes in prior to diagnosis of a chronic illness and after diagnosis up to 14 years.  Data were examined from the U.S. Health and Retirement Study (HRS). The researchers explored changes in smoking, alcohol use, and exercise two to 14 years after a diagnosis of heart disease, diabetes, cancer, stroke, or lung disease for all HRS participants aged 50 to 85 years old who began the study without diagnosis of any of the previously mentioned diseases. Data from a set of healthy respondents served as a basis of comparison.

At two years after diagnosis, findings indicate that those with heart disease experienced the largest observed health behavior change in smoking cessation (40 percent of smokers quit). No significant increases in physical activity were observed for any of the health conditions at two years. Changes in alcohol use were small. Significant declines in excessive drinking were observed among those with diabetes and lung disease. The percentage of individuals abstaining from alcohol consumption increased for those diagnosed with cancer, stroke, and lung disease.  When data were examined over the long term (up to 14 years post diagnosis), results indicated that the vast majority of individuals diagnosed with a new chronic illness do not adopt healthier behaviors.

This study highlights the fact that intensive interventions are necessary to ensure long-term health behavior changes. It is not clear whether the lack of long-term behavior change is due to misattribution of disease symptoms to aging, rather than to the disease itself, or if the lack of change is due to intransigent addiction that has developed over several years. Clear diagnosis of a condition and goal setting directed by a physician may motivate patients to be more likely to participate in healthy behavior change programs. The impact of intervention programs may be diminished unless health care providers offer their support and encouragement to hold their patients accountable for change. Intervention efforts should focus on a health care approach that includes clear communication and involvement of a comprehensive, multidisciplinary team of health care providers.


Newsom, J. T., Huguet, N., McCarthy, M. J.,  Ramage-Morin, P., Kaplan, M. S., Bernier, J., McFarland, B. H., & Oderkirk, J. (2012). Health behavior change following chronic illness in middle and later life. The Journals of Gerontology: Series B: Psychological Sciences and Social Sciences, 67, 279-288.

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