Functional limitations and religious service attendance in later life: barrier and/or benefit mechanism?

OBJECTIVES: Why do some studies report a negative relationship between religious service attendance and functional limitations? Two possible mechanisms, the health benefit mechanism and the functional barrier mechanism, were systematically examined. METHODS: With 2 waves of a national probability sample of adults aged 60 years and older, this research used structural equation models to estimate the influence of these 2 mechanisms. RESULTS: Results indicated that functional limitations were associated with less frequent religious service attendance at the same wave, largely because of the barrier mechanism; no support was found for the benefit mechanism. Neither mechanism was significant over time. DISCUSSION: Findings suggest that there is a temporal and salient decline in social activities such as religious service attendance when lower body functional limitations are highest. However, long-term engagement in religious service attendance is not predicted by baseline functional limitations, indicating that there are not long-term declines in attendance because of higher levels of functional limitations.

Self-rated health and mortality among black and white adults: examining the dynamic evaluation thesis.

OBJECTIVES: Many studies of self-rated health show that it is a reliable predictor of mortality even when controlling for health-related variables and status characteristics. According to previous research, one reason for the consistent finding is that self-ratings of health represent judgments of health trajectories. Although self-ratings of health may be dynamic perceptions of health, relatively few studies have systematically examined this possibility. METHODS: This study reexamines the prognostic value of self-ratings of health on mortality with data from 20 years of the National Health and Nutrition Examination Survey-I Epidemiologic Follow-up Study (N = 6,833). Special attention is given to differences between White and African Americans. RESULTS: Results indicate that event history models of mortality with self-rated health treated as a time-dependent covariate are superior to those treating it as a baseline predictor only-the latter are likely to underestimate the effect. Moreover, self-ratings of health predict mortality for African Americans only when treated as a time-dependent covariate. DISCUSSION: The results suggest that self-ratings of health are sensitive to declines in physical health, especially those associated with terminal drop. The analysis also demonstrates the importance of using dynamic models for studying the link between self-rated health and mortality if data from multiple observation points are available.

Gerontology education in transition: considering disciplinary and paradigmatic evolution.

The disciplinary status of gerontology has long been the subject of much debate, but recent changes in higher education suggest the early development of a more integrated, interdisciplinary approach to gerontological education and research. We assert that gerontology is currently a multidisciplinary field of inquiry, but at selected schools it is moving toward an interdisciplinary field and may ultimately evolve into a new discipline. The risks and benefits attendant with this disciplinary evolution are reviewed in light of the historical development of other disciplines. Factors that may accelerate the development of interdisciplinary gerontology education include paradigm development in gerontology and the success of gerontology PhD programs, especially the placement of their graduates.

Physician-evaluated and self-reported morbidity for predicting disability.

OBJECTIVES: This study compared the predictive validity of physician-evaluated morbidity and self-reported morbidity on disability among adults. METHODS: Subjects from a large national survey (n = 6913) received a detailed medical examination by a physician and were asked about the presence of 36 health conditions at baseline. Disability measured 10 and 15 years later was regressed on the morbidity measures and covariates with tobit models. RESULTS: Although physician-evaluated morbidity and self-reported morbidity were associated with greater disability, self-reports of chronic nonserious illnesses manifested greater predictive validity. Disability was also higher for obese subjects and those of lower socioeconomic status. CONCLUSIONS: The findings demonstrate the predictive utility of self-reported morbidity measures on functional disability.

Measuring morbidity: disease counts, binary variables, and statistical power.

OBJECTIVES: This study compares the use of the binary disease variables with counts of the same conditions in models of self-rated health to better understand the advantages and disadvantages of each approach. In particular, the analysis seeks to determine if statistical power is adequate for the binary variable approach. METHODS: Morbidity measures from adults in 2 large national surveys were used in both cross-sectional and longitudinal analyses. RESULTS: Although differences across the approaches are modest, the binary variable approach offers greater explanatory power and slightly higher R2 values. Despite these advantages, statistical power is insufficient in some cases, especially for conditions that are relatively rare and/or that manifest modest differences on the outcome variable. DISCUSSION: Statistical power estimates are advisable when using the binary variable approach, especially if the list of diseases and health conditions is extensive. Although a simple count of diseases may be useful in some research applications, separate counts for serious and nonserious conditions should be more useful in many research projects while avoiding the risk of inadequate statistical power.

Financial strain, social relations, and psychological distress among older people: a cross-cultural analysis.

OBJECTIVES: This article examines how financial strain and social relations may independently and jointly influence psychological distress among older people in four nations. METHODS: Data from four Western Pacific nations (N = 3,277) are used to test additive and multiplicative models of the relationships between financial strain, social relations, and psychological distress. RESULTS: Financial strain is associated with higher levels of psychological distress in three of the four nations. Interactive models of the effects of financial strain and social relations on distress were uncovered in three of the four nations, but the type of social relation influencing the strain-distress relationship varied. Subjective-health and IADLs were significant predictors of psychological distress in all four nations. DISCUSSION: Findings suggest that although financial strain is quite likely to lead to psychological distress among elders, this can be mitigated, at least in part, by social relationships. Modernization was not associated with higher psychological distress.

Age, body mass index, and functional illness.

OBJECTIVES: This study examines the relationship between body mass index (BMI) and selected measures of functional illness and whether the relationship between BMI and these outcomes is stronger in advanced ages. METHODS: Four measures of functional illness were examined in national, longitudinal survey of noninstitutionalized adults. Tobit and Poisson models were used to estimate cross-sectional and longitudinal specifications. RESULTS: BMI was related to functional illness but not in a linear form: Both obese and underweight persons manifested higher levels of functional illness on most outcomes during the baseline survey. Results from the change analyses, however, revealed that obesity was associated with more days hospitalized or ill in bed and an increase in functional limitations. DISCUSSION: Obesity is associated with functional illness, but there is no evidence from these data that this relationship is stronger for older adults. Rather, the effect of obesity on some measures of functional illness is greater in the younger and middle ages.

Distress and perceived health: mechanisms of health decline.

Stress is a common experience in modern society, and it can affect both physical and mental health. Recognizing that not all stress is detrimental to health, this research examines the relationship between perceptions of distress and perceived health within a longitudinal framework. Using two waves of a nationally representative panel study, the National Health and Nutrition Examination Survey I (NHANES I), structural equation modeling revealed that distress leads to more negative health perceptions. In addition, perceived health was found to impact distress levels at the following wave suggesting a cycle of decline between distress and perceived health. Finally, perceived health was found to have predictive validity in determining future functional disability even when considering distress.

Health trajectories: long-term dynamics among black and white adults.

Disability has long been identified as a predictor of self-assessed health, but some studies suggest the opposite causal direction. The aim of this study is to examine the dynamic relationships between physical disability and assessments of health among Black and White adults while simultaneously considering changing morbidity. Research questions include: Do more negative health assessments lead to greater morbidity and physical disability? Do negative health assessments lead to a cycle of health decline over time? These questions were addressed for Black and White respondents over 15 years using data from three waves of the National Health and Nutrition Examination Survey I: Epidemiologic Follow-Up Study. Results from structural equation modeling reveal that self-assessed health predicts subsequent change in health, suggesting a cycle between health problems and negative health assessments for both White and Black adults. In addition, self-assessed health among African Americans declined at a faster rate than was the case for White adults.

Social relations and health assessments among older people: do the effects of integration and social contributions vary cross-culturally?

Research on health assessments has shown the importance of social relations as a factor influencing health, especially among older people. Drawing upon sociological theories of social integration and social exchange, this research examines two domains of social relations which are expected to influence assessed health. In addition, the study uses a cross-national sample (N = 3,407) of noninstitutionalized older people from the Republic of Korea, Fiji, Malaysia, and the Philippines to determine if modernization conditions the relationships between social relations and health. Results indicate that social integration has a positive effect on subjective health assessments in all nations, whereas social contributions are significant only in Korea. Findings suggest that health assessments by elders in the most modernized nations appear to be much more influenced by the contributions they make to the social order than is the case in nations which are less modernized.

Double jeopardy, aging as leveler, or persistent health inequality? A longitudinal analysis of white and black Americans.

Longitudinal data from a 15-year national survey of adults are used to test the double jeopardy to health hypothesis as well as the alternative hypotheses that aging levels ethnic differences and that health inequalities persist across the life course. Findings show that African Americans began the study in poorer health and manifested higher mortality. Among survivors, young and middle-aged Black adults developed more serious illness and their subjective health declined more rapidly than their Whites counterparts during the first 10 years of the study. Among subjects with heart failure, Black people were also more likely than Whites to become more disabled over time. Depending upon the health measure considered and the analytic strategy applied, there was evidence for all three processes, but the weight of the evidence shows persistent health inequality over the life course. Indeed, evidence for the age-as-leveler thesis was eliminated by accounting for mortality during the study.

Double jeopardy to health hypothesis for African Americans: analysis and critique.

Considerable research on minority health has examined whether members of a minority group experience more rapid health declines than the White majority when both groups reach later life. Researchers have sought to determine if being both old and a member of a minority creates a double disadvantage to health. The primary purpose of this research is to test the double jeopardy to health hypothesis among Black and White Americans using data from a 15-year panel study of adults: National Health and Nutrition Examination Survey I: Epidemiological Follow-up Study (NHEFS). African Americans have poorer health at all three times on a variety of health status measures, but no evidence for double jeopardy was uncovered. There were important racial differences for change in health status but Black Americans of all ages -- including Black older adults -- suffered from growing disability and more negative ratings of health. Black adults are more likely to develop serious illness, and their ratings of health decline more rapidly than is the case for White respondents. While there is little support for the double jeopardy hypothesis as originally stated, there is overwhelming evidence to show that the health of Black Americans of all ages declines at a faster rate. The formulation of the double jeopardy hypothesis is critiqued on several points: ontogenetic fallacy, attribution of discrimination, and selective mortality.

Body weight and self-ratings of health.

Does body weight affect self ratings of health? If yes, are health ratings affected by being overweight, underweight, or both? These questions are examined in this research note with data from a national sample of adults surveyed in 1986 (N = 3, 497). Obesity is associated with lower ratings of health among persons with similar levels of morbidity and functional limitation; being underweight does not independently influence health ratings. The effect of being overweight is similar for Black and White adults as well as for men and women. Finally, health ratings for older people were more positive than anticipated regardless of body weight.

Are black older adults health-pessimistic?

African Americans generally have more health problems than Whites, as manifested on most indicators of morbidity and mortality. The question pursued in this research is whether the more extensive health problems of minority older adults lead to a more pessimistic outlook on health. Previous research suggests that Black older adults who may be more pessimistic in their health orientations are thereby deterred from expecting health improvements from medical interventions. Using data from the Supplement on Aging to the Health Interview Survey conducted in 1984, a structural model is developed to examine the influence of functional morbidity and race on health promotion efforts and health assessments. Analysis of data from 3,237 respondents indicates that Black older adults report significantly more functional morbidity and more negative health assessments that White older adults. No direct racial differences were observed on health promotion efforts, but total effects show that Black persons are less likely to report promoting their health. When considering the four categories defined by race and sex, older Black women report the highest levels of functional morbidity and the most negative assessments of health.

Are older people most afraid of crime? Reconsidering age differences in fear of victimization.

The reasons why previous studies of fear of crime yield different conclusions regarding age differences are examined. Data from a national survey of adults are used to assess whether older adults manifest the highest levels of fear of crime. No significant relationship was found between age and the commonly used indicators of fear of crime in many previous studies when controlling for relevant factors. Using an alternative strategy for measuring fear of crime--based upon rating fear for 10 different victimizations--reveals that younger persons are more likely than older persons to be afraid of most types of crime. Women score higher on fear for all victimizations considered. A LISREL analysis indicates that the 10 victimizations are best characterized as either personal or property crime and that older adults' scores on these dimensions are below the grand mean; persons 75 years or older have the lowest scores on fear of property crime. These results question the existence of the "victimization/fear paradox."

Cohort change in images of older adults, 1974-1981.

This study examines images of older people held by adults of all ages at two points in time. The two surveys, 7 years apart (1974 and 1981), permit the examination of cohort changes in such perceptions over time. Multivariate analysis indicated that social class and health status evaluations of older adults declined between the two surveys, principally because of the assessments by more recent cohorts. With regard to media portrayals of older adults, more recent cohorts felt that the media portrayals of older adults were distorted by presenting a more positive picture than what older people actually experienced.

Self and older-people referents in evaluating life problems.

This study examined the severity of common life problems among "older people" as reported in national survey data along with similar evaluations of such problems among the respondents themselves. The two surveys, seven years apart (1974-1981), permit the examination of cohort changes in such perceptions over time. People of all ages, including older adults, evaluate the problems of "older people" as being more substantial than such problems among the respondents themselves. More recent cohorts (younger people) were more likely than earlier cohorts to report serious personal problems during the first survey and even more so by the second survey. The more recent cohorts also felt that the seriousness of problems among older people increased over time, whereas earlier cohorts reported just the opposite in assessing the problems of their age peers. It appears that younger people believe older persons' problems are more serious than do the older people themselves, and this difference in perceptions did not disappear over time.

Assessing the impacts of community-based health care policies and programs for older adults.

This article presents a framework for evaluating long-term care policies and programs to determine how well community-based programs benefit the older adult population. Equity, accessibility, quality, and efficiency are identified as core criteria for implementing and evaluating long-term care policy. Special problems with conducting process and/or outcome evaluation of community-based programs are noted, and findings of evaluation research on community-based health care programs are reviewed. Most previous research indicates that community-based health programs for older adults are not a substitute for institutional care and do not reduce either informal caregiving or ambulatory medical services. The article concludes with policy implications.

Group benefit orientation toward older adults at work? A comparison of cohort analytic methods.

The group benefit orientation for explaining generational beliefs on policy issues is considered in light of debate regarding emerging conflict between younger and older people in America. Using data from two national surveys conducted seven years apart, beliefs about older adults' labor force participation are analyzed by conventional cohort analysis and an alternative method of replacing age in similar models with a theoretically meaningful variable. Neither method offers support for the group benefit orientation. Both methods indicate that more recent cohorts show the highest levels of support for older workers' privileges and opportunities, reflecting social change in the direction of increasing tolerance of and support for the rights of older people. A period effect of increasing support for older workers was also observed on two of the indicators. The findings have implications for both the substantive issues raised and the analysis of cohort data.

Cohort analysis of retirement preparation, 1974-1981.

Extending Easterlin's (1987) thesis regarding cohort size and personal welfare, this study was designed to examine cohort differences and changes in preparation for retirement. The data on which the study is based came from two cross-sectional surveys commissioned by the National Council on the Aging and conducted in 1974 and 1981. Major research questions included: (a) Which cohorts are most active in taking steps to prepare for retirement? and (b) Did Americans increase their retirement preparation activities during the time period studied? Results indicate that retirement preparation is influenced by cohort effects, especially among the more recent cohorts, and that earlier cohorts generally prepare more. Most respondents, especially the earlier cohorts, experienced a decrease in retirement preparation between 1974 and 1981 (i.e., a period effect). Analysis of the separate indicators of a retirement preparation index show that most activities, for instance, savings, decreased during this time while others either increased (will preparation) or remained stable (home ownership). The findings suggest that retirement preparation is influenced by economic climate and provide partial support for this application of Easterlin's thesis. Retirement preparation is also strongly related to education and race.