Journal of Aging and Health recent issues

The Role of Coping Resources on Change in Well-Being During Persistent Health Decline

Jonker, A. A. G. C., Comijs, H. C., Knipscheer, K. C. P. M., Deeg, D. J. H. — Fri, 06 Nov 2009 13:10:11 PST

Objectives: Research in older persons with deteriorative health shows a decrease in well-being. The aim of this study was to examine the role of psychological coping resources in the association between health decline and well-being, in a longitudinal design. Method: Data were used from the Longitudinal Aging Study Amsterdam (LASA). Health decline was defined as persistent deterioration of functioning (PDF), persistent decline in cognitive functioning and/or physical functioning, and/or increase of chronic diseases. Measurements of well-being included life satisfaction and positive affect. Measurements of coping resources included self-esteem, mastery, and self-efficacy. Results: Multivariate linear regression analyses showed that self-efficacy, mastery, and self-esteem mediated the association between PDF and change in well-being. Mastery also was a moderator of the association between PDF and life satisfaction. In older persons with a decreasing mastery, PDF was associated with a significant decrease on life satisfaction; this effect was not observed in older persons with stable or increasing mastery. Discussion: This study suggests that coping resources are of importance in explaining associations between persistent health decline and decreasing well-being. Stable or improving mastery even proves to protect older persons with PDF from decreasing well-being.Therefore, it may be of importance to develop interventions for older persons aimed at maintaining or improving psychological coping resources when health declines.

Cognition of Social Capital in Older Japanese Men and Women

Aihara, Y., Minai, J., Kikuchi, Y., Aoyama, A., Shimanouchi, S. — Fri, 06 Nov 2009 13:10:11 PST

Objective: This study explored factors related to cognition of social capital among Japanese older people. Method: Using a cross-sectional survey design, data were gathered from 940 people aged over 65 years. Cognition of social capital was compared by gender, and it was regressed on participation in community activities and health behaviors of middle age and current health status. Results: Men had higher cognitive social capital than women (p = .004). Multiple regression analysis shows that men who rested for health during middle age had high cognition of social capital. Cognition of social capital was also related to self-rated health, depression, and cognitive difficulties for both men and women. Daily activity was included among women. Discussion: Participation in community activities and health behaviors during middle age were associated factors for cognition of social capital among the older people, and encouraging cognition of social capital was important for active aging.

The Health Impact of a Hearing Disability on Older People in Australia

Hogan, A., O'Loughlin, K., Miller, P., Kendig, H. — Fri, 06 Nov 2009 13:10:11 PST

Objectives: A series of studies has proposed that hearing loss has adverse effects for other aspects of health. This article examines the health effects associated with self-reported hearing disability on older people. Methods: The study utilized the 2003 Australian Survey of Disability, Ageing, and Carers (n = 43,233), a weighted population-based survey providing data on self-reported disability and quality of life, to examine hearing disability among older Australians (55 years plus). Results: Of the estimated 654,113 people reporting hearing disability, 71% experienced limited communication and 60% used hearing aids. Compared with population norms, hearing disability at all levels was associated with poorer physical and mental health scores on the SF-12 measure, especially for people with severe or profound hearing loss, thus suggesting a threshold effect at advanced levels of disability. Discussion: Data support emerging literature suggesting a causal relationship between hearing disability and quality of life. Prospective studies to further examine this relationship are indicated.

The Adult Body: How Age, Gender, and Body Mass Index Are Related to Body Image

Fri, 06 Nov 2009 13:10:11 PST

Objectives: Body image and perceived attractiveness were examined, and the impact of age, gender, and body mass index (BMI) was analyzed and discussed from an evolutionary and a sociocultural perspective. Method: The population-based sample consisted of 11,468 Finnish men and women aged 18 to 49 years. Results: Both age-related decrease and increase in body satisfaction was detected as well as interactions between age and gender. Some effects were nonlinear. Women were generally less satisfied with their bodies than men. BMI had a stronger influence on women’s body image than men’s. Discussion: It was proposed that it is insufficient to merely study how age affects general body image because adults might become more satisfied with some aspects of their bodies as a function of age and less satisfied with other aspects. Body satisfaction might also fluctuate during different phases of the adult life, and the patterns possibly differ between men and women.

Perceived Autonomy and Activity Choices Among Physically Disabled Older People in Nursing Home Settings: A Randomized Trial

Andresen, M., Runge, U., Hoff, M., Puggaard, L. — Fri, 06 Nov 2009 13:10:11 PST

Objectives: To evaluate the effect of individually tailored programs on perceived autonomy in institutionalized physically disabled older people and to describe participants’ activity wishes and content of the programs. Method: This blinded randomized trial with follow up included a total of nine nursing homes and 50 nursing home residents who were randomized into either a control group or an intervention group. Perceived autonomy was measured at baseline (T1), after 12 weeks (T2) of intervention and after 24 weeks (T3) Wishes for daily activities was identified at T1. Weekly reports of individual programs were drawn up. Results: Both groups perceived autonomy as average at baseline and increased their mean score at T2 to high or close to high. At T3, both groups scored average but exceeded the level of T1. Activity wishes and the content of the programs indicate incoherence. Discussion: Although the correspondence between the individual wishes for activities and the concrete content of the programs was not obvious, results indicate potential for enabling the perception of autonomy among physically disabled older nursing home residents. The clinical consequences may suggest a focus on existing traditions, methods, and tools in the nursing home practice.

The Relationship Between Obesity, Physical Activity, and Physical Function in Older Adults

Fri, 06 Nov 2009 13:10:11 PST

Objective: This study investigated the relationship between overweight and obesity, age, and gender with physical activity and physical function in community-dwelling older men and women. Method: Multivariate analysis of covariance was used to analyze differences between normal weight, overweight, and obese adults (n = 821) above the age of 60 years. Results: Obesity but not overweight was associated with lower levels of physical activity and physical function. Within BMI groups, individuals who were physically active were less likely to have abnormal physical function scores compared to those who were sedentary. Compared to men, obese women had lower physical function scores, placing them at higher risk for future disability. Aging was associated with lower levels of physical activity and physical function. Discussion: The study illustrates the importance of avoiding obesity and participating in regular physical activity to prevent or slow down the loss of functioning in older age.

The Effects of Developing a Dual Sensory Loss on Depression in Older Adults: A Longitudinal Study

Capella McDonnall, M. — Fri, 06 Nov 2009 13:10:11 PST

Objectives: To determine the effect of developing a dual sensory loss (DSL) on depression over time and evaluate the impact of preexisting single sensory loss on this effect. Method: Multilevel modeling was used to analyze data (N = 2,689) from the Health and Retirement Study. Results: A significant increase in depression at the first report of DSL occurred, and depression increased at a significantly faster rate following DSL, in a curvilinear pattern. In addition, persons who eventually developed DSL began the study with a depression score significantly higher than persons who did not experience sensory loss. A preexisting single sensory loss did not alter the effect of DSL on depression. Discussion: Two sources of disparity in depression between persons with and without DSL were identified: preexisting differences and differences that occurred due to the DSL. The relationship exhibited between depression and developing a DSL indicated an adjustment process.

Profiles of Physical and Psychological Violence in Childhood as a Risk Factor for Poorer Adult Health: Evidence From the 1995-2005 National Survey of Midlife in the United States

Greenfield, E. A., Marks, N. F. — Tue, 22 Sep 2009 18:03:28 PDT

Objectives: This study examined linkages between physical and psychological violence in childhood from parents and three dimensions of adult health (self-rated health, functional limitations, chronic conditions). Methods: Regression models were estimated using data from the 1995 and 2005 waves of the National Survey of Midlife in the U.S. Responses to an adapted version of the Conflict Tactics Scales in 1995 were used to code respondents into one of nine profiles of violence distinguished by types and frequency of violence. Results: Reports of both frequent physical and frequent psychological violence were associated with poorer health at baseline across the three dimensions of health, as well as with more severe declines in health across all three dimensions over the 10-year study period. Discussion: Results suggest that having experienced frequent physical and psychological violence in childhood is a risk factor for poorer adult health status and declining trajectories of health throughout adulthood.

End-of-Life Communication: Ethnic Differences Between Korean American and Non-Hispanic White Older Adults

Ko, E., Lee, J. — Tue, 22 Sep 2009 18:03:28 PDT

Objective: This study examined ethnic differences in end-of-life communication between Korean American and non-Hispanic White older adults using the Health Belief Model as a conceptual framework. Method: A cross-sectional design was employed to survey 217 community-dwelling older adults (112 Korean Americans and 105 Non-Hispanic Whites). Results: Half of the participants had never held end-of-life discussions with significant others. Non-Hispanic Whites were more likely to engage in end-of-life communication than Korean Americans, but the ethnicity effect was not evident in a multivariate analysis. Only participants’ knowledge, perceived barriers, perceived severity, and experience of illness significantly predicted the likelihood of the end-of-life communication. Higher knowledge, stronger beliefs about the perceived severity and barriers, and greater experience of illness were related to having end-of-life communication. Discussion: Knowledge and health beliefs play an important role in end-of-life communication which differs by ethnicity. Culturally competent health care practitioners need to consider ethnic variation in advance care planning.

Determinants of Adult Day Center Attendance Among Older Adults With Functional Limitations

Savard, J., Leduc, N., Lebel, P., Beland, F., Bergman, H. — Tue, 22 Sep 2009 18:03:28 PDT

Objective: To examine factors related to regularity of adult day center (ADC) attendance among seniors with functional limitations. Methods: Using data collected as part of a larger study, we identified the proportion of scheduled days attended among 101 ADC users in Montréal and identified determinants of this attendance. Results: More regular attendance was associated with previous profession of ADC participant or spouse in a sector other than health care, receiving formal help for activities of daily living or instrumental activities of daily living on days of expected ADC participation, participating for the whole day rather than half a day, lower participation in prevention and health-promotion activities, and lower caregiver burden among persons with cognitive impairments and higher caregiver burden among persons without cognitive impairments. Discussion: To enhance ADC intervention effects, levels of participation should be maximized. Study findings suggest ways to promote more regular attendance.

Examining the Social Context in the Caregiving Experience: Correlates of Global Self-Esteem Among Adult Daughter Caregivers to an Older Parent With Cancer

Bachner, Y. G., Karus, D. G., Raveis, V. H. — Tue, 22 Sep 2009 18:03:28 PDT

Objectives: To examine the associations between various patient, disease, situation, and caregiver characteristics (organized by five conceptual domains) and global self-esteem among caregiver daughters to parents with cancer. Method: Dyads comprised of 237 cancer outpatients and their adult caregiving daughter completed structured telephone interviews. Results: Two of the five domains of potential correlates significantly predicted caregiving daughters’ global self-esteem—daughters’ sociodemographics and constraints on/facilitators of caregiving. Daughters’ overall sense of self-worth was directly correlated with their household income and inversely correlated with greater depressive affect and the number of patient needs for which someone else provided assistance. It was also correlated with the daughters’ other role obligations. A higher sense of self-worth was associated with either being employed or having to care for a child/grandchild; a lower sense of self-worth was associated with having a spouse/partner. Discussion: The present analysis documents the complexity of social connectedness, demonstrating that various role obligations contribute to caregiving daughters’ global self-esteem in different ways. In the context of assuming cancer careprovision, daughters’ existing repertoire of social roles may possibly mediate the stress associated with their care involvement or serve as a buffer against the strain of the caregiving experience.

Association Between Health Education Needs and Stroke Caregiver Injury

Hinojosa, M. S., Rittman, M. — Tue, 22 Sep 2009 18:03:28 PDT

Objectives: Many stroke caregivers are inadequately informed about stroke and its sequelae and have little preparation for the physical demands of moving, lifting, and handling often required. Our objectives are to examine the association between health education needs and physical injury sustained as a result of activities related to the caregiving role. Method: A total of 276 caregivers of veterans who suffered an acute stroke event were surveyed about their information needs and injury status.We used multivariate logistic regression analysis to calculate adjusted and unadjusted odds ratios for injury status. Results: Results indicate that in the adjusted model, caregivers who had increased educational needs were almost twice as likely (OR: 1.80; 95% CI: 1.74-1.94) to have incurred an injury related to caregiving activities. Conclusions: Health education interventions that provide stroke caregivers with educational materials may help reduce caregiver injuries.

The Effects of Church Attendance and Marital Status on the Longitudinal Trajectories of Depressed Mood Among Older Adults

Law, R. W., Sbarra, D. A. — Tue, 18 Aug 2009 11:52:00 PDT

Objective: The present study investigated the potential effects of church attendance and marital status on mood trajectories among older adults and whether these effects varied by gender. Method: Data from the Australian Longitudinal Study of Aging were used to examine the effects of church attendance and marital status on changes in depressed mood. Participants included 791 older adults (42.4% men; mean age at study entry = 75.62) who were interviewed at three time points over 8 years. Results: Using multilevel modeling to assess change, church attendance was found to have a protective effect against the emergence of mood problems among older adults. Also, although becoming married was associated with a decrease in depressed mood, becoming nonmarried was associated with an increase in depressed mood. Discussion: A sense of purpose as a potential explanation for the association between church attendance and changes in depressed mood in old age was discussed.

Alcohol Consumption and Health Status in Older Adults: A Longitudinal Analysis

Chen, L. Y., Hardy, C. L. — Tue, 18 Aug 2009 11:52:00 PDT

Objective: This longitudinal study examines the relationship of alcohol consumption to mortality and changes in mental and functional health in older adults. Method: In a national population health survey, 4,187 participants aged 50 and older at baseline provided information on alcohol consumption, potential confounders, and follow-up vital status. Logistic regression estimated the odds ratio for mortality, increase in psychological distress, and decline in functional health 10 years later. Results: Compared with lifelong abstainers, light and moderate drinkers were at nonsignificantly lower risk of mortality. Among survivors, alcohol consumption showed no consistent relationship with increases in psychological distress. Occasional and light drinkers had significantly reduced risk of a substantial functional health decline, whereas moderate drinkers had nonsignificantly reduced risk. Discussion: Findings suggest that light-to-moderate alcohol consumption reduces the risk of substantial functional health decline in older middle-aged drinkers.

Problems Meeting Basic Needs Predict Cognitive Decline in Community-Dwelling Hispanic Older Adults

Sachs-Ericsson, N., Corsentino, E., Cougle, J. R. — Tue, 18 Aug 2009 11:52:00 PDT

Objectives: Indices of low socioeconomic status (SES) have been found to predict negative health outcomes. However, problems meeting basic needs (e.g., not having enough money for health care, adequate food, etc.) may be a more potent measure of negative health outcomes than other more typically assessed indices of SES, such as income. This article examined the association between problems meeting basic needs and cognitive decline in a sample of community-dwelling Hispanic older adults (N = 1,964). Method: The authors used a prospective design to study the influence of problems meeting basic needs on cognitive functioning. Analyses controlled for demographics, health problems, and depressive symptoms. Results: The authors found problems meeting basic needs to be a more potent predictor of cognitive decline than income. Discussion: Interventions focused on providing older adults with resources for meeting basic needs, such as adequate food and health care, may substantially reduce the subsequent level of stress and health problems in this population.

Long-Term Fish Intake Is Associated With Less Severe Depressive Symptoms Among Elderly Men and Women: The MEDIS (MEDiterranean ISlands Elderly) Epidemiological Study

Tue, 18 Aug 2009 11:52:00 PDT

Objective: This work aims at exploring the association between fish intake and depressive symptoms, in older adults. Method: During 2005-2007, 1,190 men and women (>65 years) free living in various Greek islands and in Cyprus participated in the study. Depressive symptoms were assessed using the validated Geriatric Depression Scale (GDS), and foods intake through a Food Frequency Questionnaire. Results: Almost 70% of the participants scored above the depressive cutoff (i.e., GDS score > 5), with women having higher values. People classified under the 1st tertile of GDS score (i.e., GDS ≤ 5) were more educated, physically active, and report higher fish consumption. One portion increase of fish consumption per week was associated with 0.58 times (95% confidence interval: 0.45-0.73) lower likelihood of having GDS score above the clinical threshold, after various adjustments were made. Discussion: These findings may assist public health policy makers in better preventing emotional disorders among the elderly by promoting healthier eating habits.

An Exploratory Study of Individual and Environmental Correlates of Fear of Falling Among Community-Dwelling Seniors

Filiatrault, J., Desrosiers, J., Trottier, L. — Tue, 18 Aug 2009 11:52:00 PDT

Objective: The objective of this study was to identify individual and environmental correlates of fear of falling among community-dwelling seniors. Method: The study sample involved 288 community-dwelling adults aged 65 years or older going through the normal aging process. Fear of falling and a series of individual and environmental characteristics were measured with a questionnaire during home interviews. Results: Multivariate logistic regression procedures showed that the strongest correlates of fear of falling are gender, support from a spouse or partner, and residential area. Being a female as well as living in a smaller city or rural area were shown to be risk factors for fear of falling, whereas the availability of support from a spouse or partner was a protective factor. Discussion: Findings from this study suggest that researchers should adopt an ecological perspective to understanding the phenomenon of fear of falling among seniors and collect data on a broader range of individual and environmental factors.

Conflict Between Nursing Home Staff and Residents' Families: Does It Increase Burnout?

Abrahamson, K., Jill Suitor, J., Pillemer, K. — Tue, 18 Aug 2009 11:52:00 PDT

Objective: In this study, the authors examine the influence of conflict between nursing home staff and family members of residents on staff burnout. Method: Data were collected from interviews with a representative sample of 655 nursing home nurses and nursing assistants. Hypotheses were tested using structural equation modeling. Results: Results indicate that conflict with family members increases staff burnout and decreases staff satisfaction. Staff and family conflict increases when staff members feel they do not have enough time to complete required tasks. Level of conflict decreases when staff perceive that family members have care expectations that are similar to their own. Interestingly, staff who have personal experience as family caregivers are more likely to report conflict with family members of residents, a result that necessitates further study. Discussion: Staff burnout and dissatisfaction affects both individuals and organizations. Policy that addresses staff and family interaction can have an important place in the design and delivery of long-term care.

Social Inequalities in Grip Strength, Physical Function, and Falls Among Community Dwelling Older Men and Women: Findings From the Hertfordshire Cohort Study

Syddall, H., Evandrou, M., Cooper, C., Aihie Sayer, A. — Tue, 18 Aug 2009 11:52:00 PDT

Objectives: To explore social inequalities in grip strength, SF-36 physical functioning (PF), and falls among older people. Methods: We analyzed data from 3,225 men and women (age 59-73 years) who participated in the Hertfordshire Cohort Study, United Kingdom. Car availability and home ownership were used as markers of material deprivation. Results: A total of 6.4% of men (17.7% women) had no car and 19.3% of men (23.1% women) did not own their home. Having fewer cars was associated with lower grip and poorer PF among men and women (p < .001), and increased falls among men (p < .001). Not owning one’s home was associated with lower grip in men and women (p < .001) and poorer PF in men (p < .001). Lower social class was associated with falls among women only (p = .01). Discussion: There are social inequalities in grip strength, PF, and falls among older people. Interventions should consider the contribution of social inequalities to the problem.

Fall Risk in Older Adults: Roles of Self-Rated Vision, Home Modifications, and Limb Function

Steinman, B. A., Pynoos, J., Nguyen, A. Q. D. — Tue, 07 Jul 2009 18:01:41 PDT

Objectives: To assess direct effects of self-rated vision, home modifications, and limb functioning, and moderating effects of self-rated vision on change in functioning of upper and lower limbs on fall risk in older adults. Method: Logistic regression was used to analyze 2004 and 2006 waves of the Health and Retirement Study. Results: Effects of self-rated vision and home modifications in predicting falls decreased after controlling functioning in upper and lower extremities. Declines/gains in functioning across short periods of time superseded self-rated vision in predicting falls. No evidence was found for a moderating effect of vision status on limb functioning. Discussion: Poor self-rated vision may not be a good indicator of fall risk in older adults. Thus, for older adults with visual impairments, preserving residual limb functioning through exercise and activity has the important potential to reduce fall risk in addition to improving muscle and bone strength as well as improving balance and gait.

Black--White Disparities in Disability Among Older Americans: Further Untangling the Role of Race and Socioeconomic Status

Fuller-Thomson, E., Nuru-Jeter, A., Minkler, M., Guralnik, J. M. — Tue, 07 Jul 2009 18:01:41 PDT

Objectives: To explore the impact of adjusting for income and education on disparities in functional limitations and limitations in activities of daily living (ADLs) between Black and White older Americans. Method: Data from the 2003 American Community Survey were used to examine the associations of education and income, stratified by race and gender, with functional limitations and ADLs, in a sample of 16,870 non-Hispanic Blacks and 186,086 non-Hispanic Whites aged 55 to 74. Sequential logistic regressions were used to examine the relative contribution of income and education to racial disparities. Results: Ninety percent of the Black—White difference in disability rates for men and 75% of the difference for women aged 55 to 64 were explained by income and education. Discussion: The greatly elevated risk of disability among Blacks aged 55 to 74 is largely explained by differences in socioeconomic status. Reductions in Black—White health disparities require a better understanding of the mechanisms whereby lower income and education are associated with functional outcomes in older persons.

The Vote of Acute Medical Inpatients: A Prospective Study

Bosquet, A., Medjkane, A., Voitel-Warneke, D., Vinceneux, P., Mahe, I. — Tue, 07 Jul 2009 18:01:41 PDT

Objective: There may be ethical issues associated with allowing certain inpatients to vote as some may be cognitively impaired. During the 2007 elections in France, we conducted a prospective observational study on voting among hospitalized patients. Method: Patients hospitalized in an Internal Medicine and Geriatric Department on election day were included. The primary outcome was the turnout among registered inpatients, and secondary outcomes were Mini-Mental State Examination (MMSE) scores and reasons for abstention. Results: Of 142 inpatients (mean age 73 years), 84 were eligible to vote, and 22 actually voted (turnout 25.2%). Among the voters, 23% had an MMSE score of less than 12; 58% of abstentions were procedure-related. Discussion: In our study, some inpatients did not vote as a result of procedural issues. When patients with severe cognitive impairment vote, there is a potential risk of vote diversion. Voting procedures should be improved to give inpatients easier access to the ballot while protecting them from the risk of fraud.

What Works Better for Community-Dwelling Older People at Risk to Fall?: A Meta-Analysis of Multifactorial Versus Physical Exercise-Alone Interventions

Petridou, E. Th., Manti, E. G., Ntinapogias, A. G., Negri, E., Szczerbinska, K. — Tue, 07 Jul 2009 18:01:41 PDT

Objective: To compare and quantify the effectiveness of multifactorial versus exercise-alone interventions in reducing recurrent falls among community-dwelling older people. Method : A meta-analysis of recently published studies on fall prevention interventions was conducted. Measure of the overall effectiveness was the combined risk ratio for recurrent falls, whereas heterogeneity was explored via metaregression analyses. Results: Ten of the 52 identified studies met the preset criteria and were included in the analysis. The exercise-alone interventions were about 5 times more effective compared to multifactorial ones. Short-term interventions, smaller samples, and younger age related to better outcomes. Discussion: From cost-efficiency and public health perspectives, exercise-alone interventions can be considered valuable, as they are more likely to be implemented in countries with less resources. Further qualitative research is needed, however, to explore determinants of willingness to participate and comply with interventions aiming to prevent recurrent falls among older people.

Differentials by Socioeconomic Status and Institutional Characteristics in Preventive Service Utilization by Older Persons in Costa Rica

Brenes-Camacho, G., Rosero-Bixby, L. — Tue, 07 Jul 2009 18:01:41 PDT

Objective: The goals of this article are to assess the level of preventive service utilization by older persons in Costa Rica and to determine whether there are differentials in utilization across socioeconomic status (SES) and institutional characteristics. Method: Using data from the Costa Rican Study on Longevity and Healthy Aging (CRELES) project, a study of healthy aging in Costa Rica, the authors use self-reported information on preventive service utilization. The SES differentials are studied using logistic regressions. Results: Preventive services linked to cardiovascular disease prevention are frequently utilized; preventive services linked to cancer screening, vaccination, and sense impairments are not so widely used. Higher SES people are more likely to utilize most preventive services. Utilization rates among uninsured seniors are lower than among their insured peers. Home visits by community health workers are positively associated with higher utilization rates. Discussion: The SES disparities in preventive service utilization exist in Costa Rica, and institutional characteristics are positively associated with increasing utilization.

Health Behavior Risk Factors Across Age as Predictors of Cardiovascular Disease Diagnosis

Cardi, M., Munk, N., Zanjani, F., Kruger, T., Schaie, K. W., Willis, S. L. — Tue, 07 Jul 2009 18:01:41 PDT

Objectives: The current study examines the prevalence of health risk behaviors and their cumulative effects on cardiovascular disease (CVD) among a sample of adults. Age cohort is also examined to determine the role of age in predicting CVD and risky health behaviors. Method: Medical records of a sample of adults from the Seattle Longitudinal Study categorized into one of four age-group cohorts were examined. Data regarding participants' health risk behaviors were examined individually and cumulatively for predicting later CVD diagnosis. Results: The prevalence of CVD increases with age, obesity, and risky medical checkups. Female risky sleepers are more likely to receive a CVD diagnosis than men who report risky sleep patterns (p < .05). Discussion: A high risk of CVD appears to exist for adults across the life span, and several risky health behaviors also seem to place individuals more at risk for being diagnosed with CVD.

Differences in Accessibility, Affordability, and Availability (AAA) of Medical Specialists Among Three Age-Groups of Elderly People in Israel

Iecovich, E., Carmel, S. — Tue, 07 Jul 2009 18:01:41 PDT

Objectives: Older people use more health services due to health problems, but various reasons impede their ability to use health services. The purpose of this study is to examine difficulties in accessing and affording specialist services and to explore the factors that explain these difficulties among elderly people. Methods: The sample included 1,255 respondents in three age-groups: 65-75, 76-89, and 90+ years who were interviewed face-to-face in their homes. Results: The findings showed that between 21% and 41% of the respondents encountered difficulties in visiting specialists. Those aged 90+ encountered more accessibility problems and fewer affordability problems compared to their younger counterparts, and those aged 76-89 encountered more availability problems compared to the other two age-groups. Enabling and need factors were the most significant factors in explaining problems in accessing and affording specialist services. Discussion: Recommendations for policy and practice are discussed.