Self-care among older adults: an analysis of the objective and subjective illness contexts.

OBJECTIVES: The authors hypothesize that older adults diagnosed with arthritis show a greater reliance on objective factors in their self-care behaviors, whereas those diagnosed with heart problems or hypertension demonstrate a greater reliance on more general belief-laden factors. METHODS: A total of 794 older adults (mean age = 69.3) who were professionally diagnosed with arthritis, heart problems, or hypertension completed a telephone survey about a number of aspects of their illness condition and their general well-being. RESULTS: The results from the hierarchical regression analyses indicate that objective factors and illness-specific beliefs are better predictors of self-care behavior in the arthritis group, whereas general beliefs (e.g., self-efficacy and general well-being) are better predictors of such behavior in the heart problems and hypertension groups. DISCUSSION: The analyses support the authors' hypothesis. The results are discussed in the context of expanding the Health Belief Model of self-care.

The effects of socioeconomic status on exercise and smoking: age-related differences.

The aim of this article is to examine the effects of socioeconomic status (as measured by education, income, and labor force status) on patterns of exercise and smoking for three age groups: persons aged 25 to 44, 45 to 64, and 65 and over. Two hypotheses drawn from the literature are tested: (a) that socioeconomic status is associated with risky lifestyle behaviors and (b) that the effect of socioeconomic status is greater for younger and middle-aged groups than for older age groups. Logistic regression analyses are performed on the 1990 Canadian Health Promotion Survey. Our results indicate that socioeconomic status affects health behaviors in relatively important ways, but this depends on the measure, the specific behavior, and the age group. The findings are discussed in relation to controversies about the existence of a culture of poverty and its impact on health behaviors, as well as to several age pattern hypotheses.

Homeleaving age norms: conflict or consensus?

While research attention has been directed to the normative timing aspects of some family transitions, little work on homeleaving has been undertaken. Drawing upon in-depth interviews with one child and one parent in 218 families in which the adult child has/had returned home (boomerang families) and 202 families in which the adult child has remained independently "launched," this article examines a number of aspects of norms regarding the appropriate timing of homeleaving. The following issues are examined: the degree of overall consensus regarding homeleaving age norms; variations by generation and by family type; factors viewed as conditioning the normative age at homeleaving; and perceptions regarding social approval/disapproval of young adults living at home. Results are discussed in terms of theoretical issues in the life course perspective regarding age norms.

Age at death due to ischemic heart disease: gender differences.

This paper investigates gender differences in the timing of ischemic heart disease (IHD) mortality among white Americans. Three age-at-death groupings are examined, using a model incorporating three types of independent variables: lifestyle, socioeconomic status, and biology/heredity. Logistic regression techniques are used to analyze National Mortality Follow-back Survey data. Three hypotheses drawn from the literature are tested: (1) that IHD mortality risks will vary by gender and across the life course; (2) that the independent variables will exert a lower mortality risk for women than for men at all ages of death; and (3) that differential risks by gender will be larger for younger age-at-death groups. Findings support the first and third hypotheses. The importance of research on gender differentials in age at IHD mortality in relation to parental heart-attack mortality, smoking and spousal smoking, occupation, and fertility is highlighted.

Staff attitudes: monitoring technology in long-term care.

1. Overall, care staff members displayed positive attitudes toward resident monitoring technologies, especially staff members working in facilities with more of this technology. 2. It is necessary to place nurses and other front-line health care workers in the center of the policymaking process that determines the technological versus human composition of any long-term care facility. 3. The ethnicity of the health care worker, and to a lesser extent their age and education, are more important than the job status in determining attitudes toward monitoring technology. 4. Comprehensive evaluations of technology used in care facilities should include the overall value of the technology, its impact on a facility's liability, its effect on the quality of care on residents, and whether use of the devices in question is ethical.

Residential attitudes and knowledge, use, and future use of home support agencies.

Critical review of the health and social service use literature reveals a need to elaborate on the dynamics of factors identified in the behavioral models applied to this field. In particular, research has tended to omit direct measures of attitudes and awareness of social services, including their interrelationships. This study examines determinants of knowledge, use, and future use of local home support agencies among a sample of community-dwelling elderly over the age of 74 living in Kitchener-Waterloo, Ontario. Measures of domestic self-reliance, independent living and perceptions of futurity are incorporated into the analysis. Logistic regression is used to test the models. The results show that attitudes regarding domestic self-reliance and independent living influence use of home support agencies largely through their impact on service awareness. Interestingly, these relationships are opposite to those hypothesized. Education is also found to be a predictor of knowledge of home support, and living arrangement, health status measures, and knowledge arise as important predictors of use and future use. The findings are discussed in terms of their implications for the underlying behavioral models, and for service providers and policymakers.

The etiology of nonpsychotic emotional illness.

Two hundred and fifty couples in the general population completed self-report questionnaires which measured life events, personality, marital intimacy, and symptoms of nonpsychotic emotional illness. Path analysis was utilized to explain the development of symptoms of nonpsychotic emotional illness. Personality traits of neuroticism and extroversion explained most of the variance of symptoms of nonpsychotic emotional illness. Life events played a much smaller but significant role and marital intimacy was a nonsignificant factor. The data support a proneness model for the etiology of nonpsychotic emotional illness.

Environmental adaptation by persons in their later life.

In an attempt to delay institutionalization among elders while supporting their widespread desire for privacy and independence in living style, it has been deemed necessary to adapt the physical and social milieu to fit declining competence. The theoretical rationale underlying current housing policy can be identified in person-environment theories of aging. The aims of this article are to (1) assess critically and expand Lawton's ecological model of aging as it pertains to environmental decisions among the elderly, and (2) test a series of hypotheses derived from the theoretical discussion using a 1987 study of environmental adaptation among 280 elderly, 74 years of age and over, living in the community. The most striking finding is the tendency for older elderly to engage in psychological processes of adaptation to a greater extent than altering the physical or social characteristics of the home environment. The findings suggest extending the Lawton model to include a wider range of subjective attributes of the individual.