Journal of Aging and Health

Objectives: To further explain the relationship of education to health by a prospective examination of positive psychological states as mediators. Furthermore, to examine the resources of desirable events, self-esteem, and social support as possible mediators between positive psychological states and subsequent health and vitality. Methods: Four in-home interviews were conducted at 6-month intervals with a probability sample of 1,277 older adults (aged 55 and older); multiple regression was used to estimate mediating effects. Results: Positive states mediated the education relationship to both symptoms and vitality, independent of negative states; the resource measures did not mediate the positive state-health relationship. Discussion: Higher education level appears to increase the likelihood of being serene and happy, and healthy and vital, in later years; positive psychological states appeared to have both a promotion function (for vitality) and protective function (against health symptoms); self-esteem showed promise as a possible mediator of the effects of psychological states on health.

Objectives: Assess the effects of social relationships on physical and mental health among the elderly in Taiwan. Methods: Using 4 waves of a survey of the elderly, we examine the relationship between social ties and perceived support and four health outcomes—mortality, functional status, self-assessed health, and depression. Results:Perceived support and social ties are related to health, but many of the apparent effects are attenuated in the presence of controls for prior health. However, positive perceptions about support are protective of mental (but not physical) health. Discussion: If baseline health is ignored, estimates of the effects of social relationships on health at a given stage of life are likely to be inflated by reverse causality or by effects occurring prior to baseline. Inclusion of controls for initial health reveals that, in general, the relationship between social support and health at the older ages in Taiwan is relatively modest.

Objectives: The ε4 allele of apolipoprotein E (APOE) has been associated with health-related outcomes that may adversely affect quality of life (QOL) in older adults. In the absence of published information, we sought to determine whether the ε4 allele was associated with subjective QOL across 5 parameters in a community sample of older adults. Design: Prospective cohort study. Setting: Community-based sample of older adults in North Carolina (Duke site of the Established Populations for Epidemiologic Studies of the Elderly [Duke EPESE]). Participants: Self-responding genotyped sample members (n = 1,880) of whom 1,254 provided longitudinal data. Measurements: APOE genotype and five newly constructed, reliable, and valid measures of subjective QOL derived from the Duke EPESE questionnaire. The 5 parameters measured were social, economic, mental and physical health, and functional status. Control variables included age, gender, race (African American or White), education and urban/rural residence. Results: Among those with good baseline QOL, there was no significant association between the ε4 allele and any of the parameters of subjective QOL in longitudinal analyses. In controlled longitudinal analysis, older age women predicted poorer functional status; being African American, and reporting lower education predicted poorer subjective economic well-being; and being African American predicted better self-assessed mental health. Conclusions: This study is among the first to explore the association of the ε4 allele with overall QOL. Considered from a public health perspective, these findings challenge the uncritical assumption that the presence of this susceptibility gene in the population implies an excess burden of poor QOL. The findings do not contradict the previous association of ε4 with Alzheimer's disease (AD) and other conditions. Such conditions continue to merit full attention.

Objectives: National surveys of older Americans routinely have included functional limitation items using either a leading approach (“how much difficulty do you have...”) or a neutral approach (“do you have any difficulty...”). This article evaluates the performance of scales based on these two approaches. Methods: Using responses from 595 randomly selected participants to the 1994 Health and Retirement Study, the authors compared prevalences and evaluated scales based on each approach with respect to the extent of missing data, face validity, reliability, predictive validity, convergent validity, and robustness of odds ratios in predictive models. Results: The authors found that leading questions provided higher estimates of functional limitations than neutral questions, but both approaches yielded scales with similar validity and reliability. However, for both approaches, scales incorporating degree of difficulty had better validity and reliability than those based on counts of tasks. All four approaches yielded substantially similar coefficients in a model predicting disability onset. Discussion: The authors conclude that, because they minimize survey time without compromising validity and reliability, items that explicitly capture degree of difficulty by asking “How much difficulty do you have...” may be the optimal approach for survey designers.

Objective: Research indicates that caregivers of persons with cognitive impairment are at elevated risk for clinical depression. The current study examines the association between physical illness and depressive symptoms among caregivers over a 5-year interval. Methods: Participants were recruited as part of a longitudinal study of dementia prevalence in Canada (N = 382). Persons with cognitive loss and their primary caregivers were randomly identified from each Canadian province. Results:Subsequent to control for sociodemographic variables, patient illness characteristics and initial depressive symptomatology, baseline health of caregivers contributed significantly to the prediction of depressive symptoms five years later. In contrast, depressive symptomatology was not a significant predictor of physical health over this same interval (again controlling for sociodemographic variables, patient illness characteristics, and caregivers' health at baseline). Discussion: These analyses pro-vided partial support for reciprocal effects between physical illness and depression. Findings are discussed in terms of the applicability of a model of reciprocal effects to older adults.

Research on the rationing of care to older patients in Britain and America typically focuses on acute care here I consider `chronic care'as illustrated by `community care' in Britain. Adopting a critical sociological approach to dependency and to the construction of `later life,'I argue that chronic care users constitute a class, and that clinical need has played a pivotal role in its development. As this reflects the allocative rationing of care I call into question, the claim made by the current British government that need can provide a benchmark of age justice.