Health-related messages in consumer magazine advertising.

OBJECTIVE: To characterize the patterns of health-related messages in consumer advertising from U.S. magazines. DESIGN: Observational survey of advertisements occupying a third of a page or more from the January 1994 issues of the 11 most popular consumer magazines. MEASUREMENTS AND MAIN RESULTS: Health messages were present in 22.8% (85/372) of all the advertisements reviewed. Of the advertisement categories (prescription medication, over-the-counter medication, exercise-related product, health service, health device, diet/health-related food, and other), over-the-counter medications were the most common among the advertisements that had health messages (32.9%, 28/85) (7.5% of the total advertisements, 28/372). The five advertisements for prescription medications were duplications of two different advertisements, one for a hair promotion product and one for hormone replacement therapy. Products related to diet and exercise together represented 29.4% (25/85) of all advertisements with health messages. Three advertisements (3.5%) were for health devices, and five (5.9%) were for health services. CONCLUSIONS: Health-related messages are frequent in consumer advertising. The effects of health marketing on consumer protection, health care costs, and the physician-patient relationship are discussed.

Restraint reduction: can it be achieved?

This article describes a step-by-step process for implementing restraint reduction programs in two skilled nursing facilities. The combination of using standardized guidelines, customizing others, and involving direct-care staff in facing challenges led to success. A research-practice partnership enabled a formal evaluation of the program. A pre- and posttest study design revealed significant reductions in physical restraints without increasing staff. This project demonstrates that frail, elderly people in nursing homes need not be physically restrained to receive effective care, but that alternatives can include more dignified options.

New cohorts of urban elders: are they in trouble?

Recent social and economic trends suggest that the health and welfare of elderly persons living in urban areas may have deteriorated during the past two decades. Two representative samples of noninstitutionalized urban persons aged 65 and over were interviewed, one in 1975 (n = 1598) and the other in 1987 (n = 1491). Cohorts of "young-old" (ages 65-76), "old-old" (ages 77-88), and "oldest-old" (ages 89-100) urban residents were compared at the two time points by multivariate analysis. Over the 12 years studied, the proportion of Blacks and poor persons rose, while the educational level improved. The young-old cohort of 1987, in particular, reported more chronic illness, more psychological distress, more need for help with activities of daily living, more visits to physicians, and more need for additional medical care. We conclude that, between 1975 and 1987, a new cohort of urban residents who were more impaired, disabled, and disadvantaged than their predecessors entered the young-old age group.

Impaired and disabled elderly in the community.

A nine-year representative, longitudinal study of 1,598 urban elderly shows that two to eight times as many impaired or disabled are cared for in the community as in institutions. Younger age, male gender, better income, and living with others, especially children, favor continuing care in the home.

Race-related differences among elderly urban residents: a cohort study, 1975-1984.

A population-based cohort of 1,598 urban residents, aged 65 years and over, was studied in 1975, and 645 survivors were re-interviewed in their places of residence in 1984. Since 25.6 percent of the subjects were Black, it was possible to examine race-related changes in health, function, and socioeconomic status over nine years, as well as differences in rates of institutionalization and mortality. Aging urban Blacks continue to experience major social disadvantages, especially in education and income. After age 74, although Blacks probably experience more favorable mortality rates and less institutionalization, they consider themselves less healthy and are more likely to develop diabetes, hypertension, and glaucoma. Although Blacks rate their own mental health lower, this difference is not supported by other measures. Functionally, elderly Whites are more likely to be dependent in certain activities of daily living. The findings are consistent with the previously observed mortality crossover; predictors of mortality are identified but do not differ by race. Lower institutionalization rates among older Blacks may be partly explained by different living patterns, poverty, and a higher proportion of males among surviving Blacks.

Coping resources and selective survival in mental health of the elderly.

Analysis of longitudinal data (1975-1984) from the Cleveland GAO study shows that physical health and social support emerge as major coping resources for forestalling decline in mental health among the elderly over a nine-year period. However, social resources and poorer self-assessed physical health, which are significant predictors of decline in emotional health, have no effect in loss of cognitive ability, suggesting a biological component in such loss. However mortality over the nine-year time span is related to poorer initial mental health and cognitive ability, thus revealing that selective survival masks the extent to which mental conditions decline over time, with impaired White males the least likely to survive. Although measures of mental health and cognitive skills play a major role in predicting mortality, taken together they are less significant in explanatory power than the availability of social resources.

Health and function in the old and very old.

This report advocates conceptual separation and parallel assessment of medically diagnosed health conditions and functional disability in clinical and epidemiological studies of the aged. Data from a study of urban elderly are presented to demonstrate how this can be done and to reexamine the meaning of self-reported illness and disability. One hundred thirteen subjects 74 to 95 years old, recruited from a longitudinal study of a representative sample of the elderly population of Cleveland, Ohio, participated in structured interviews and epidemiologically based medical examinations, conducted by a physician-nurse team at the place of residence. The presence or absence of 11 common chronic conditions was determined according to preestablished criteria, by self-report and, separately, by medical diagnostic evaluation. Functional disability was estimated by self-report and by physician-nurse assessment, using established measures of mobility and activities of daily living. Results indicate that interview self-report can provide useful estimates of the prevalence of medical conditions and functional disabilities in elderly populations, although self-report alone is not a sufficiently sensitive measure to be used for case-finding or diagnosis. When functional disabilities are matched against the specific medical conditions that cause them and disease-specific mortality is also taken into account, a three-dimensional classification results that has implications for future clinical and survey work with the elderly.