Now more than ever, an increasing number of people can look forward to reach old age. However, increasing age is associated with increasing morbidity.

Multiple illnesses are often associated with decreases in quality of life and life expectancy. There are, however, substantial differences between persons. PREFER examined whether the way individuals cope with their illnesses, think about their illnesses and act despite or because of their illnesses could explain such differences in quality of life and autonomy

Individual attitudes and thoughts, health behaviors and individual health affect each other reciprocally over time. For example, physical limitations might affect individual attitudes towards health. On the other hand, such changes in attitudes might affect individual behavior, which in turn impacts on behavior and health.

In order to examine such reciprocal relations, we designed PREFER as a longitudinal study with three measurement points over one year.

The main aim of the study was to identify factors that allow older people with multiple illnesses to maintain or improve their health behaviors and health status. The results of PREFER can inform effective interventions to support older people with multiple illnesses in their autonomy and quality of life.

Basic conceptual model
Figure: Basic conceptual model

Here are some basic results from PREFER:

  • Self-efficacy and social support interact in promoting physical activity in older people with multiple illnesses: A moderate amount of both resources is needed to promote physical activity (Warner et al., 2011-b)
  • Self-efficacy for physical activity is mostly based on previous mastery experiences and on model learning – verbal persuasion seems less important (Warner et al., 2011-a)
  • Illness representations for multiple illnesses depend on both illness-specific information and on factors on the level of the person (e.g., self-efficacy) - this means that on top of illness-related information, personal characteristics affect the way we think about different illnesses (Schüz et al., 2012)
  • Individual views on aging affect how people cope with serious health events: People who expect more losses in old age are less likely to adaptively engage in health-promoting activities (Wurm et al., 2013).
  • Changes in functional health affect what people think about their medicines – Functional improvement leads to less perceptions of necessity, and changes in such perceptions affect individual adherence behavior (Schüz et al., 2011)


  • Schüz, B., Wurm, S., Warner, L. M., & Ziegelmann, J. P. (2012). Self-efficacy and multiple illness representations in older adults: A multilevel approach. Psychology & Health, 21, 13-29. doi: 10.1080/08870446.2010.541908
  • Schüz, B., Wurm, S., Ziegelmann, J. P.,  Warner, L.M., Tesch-Römer, C., & Schwarzer, R. (2011). Changes in functional health, changes in medication beliefs and medication adherence. Health Psychology, 30, 31-39.
  • Warner, L.M.,  Schüz, B., Knittle, K., Ziegelmann, J. P., & Wurm, S. (2011-a). Sources of perceived self-efficacy as predictors of physical activity in older adults. Applied Psychology: Health and Well-Being, 3, 172–192.
  • Warner, L.M., Ziegelmann, J. P., Schüz, B., Wurm, S., & Schwarzer, R. (2011-b). Synergistic effect of social support and self-efficacy on physical exercise in older adults. Journal of Aging and Physical Activity, 19, 249-261.
  • Wurm, S., Warner, L. M., Ziegelmann, J. P., Wolff, J. K., & Schüz, B. (2013). How do negative self-perceptions of aging become a self-fulfilling prophecy? Psychology and Aging, 28, 1088-1097. doi: 10.1037/a0032845