Health psychology and late life. The differentiation of health and illness for the study of health-related behaviors

Literature pertinent to understanding the health psychology and health behaviors of older adults is reviewed. It is proposed that judgments of health and illness status be viewed as separate domains of personal health psychology rather than as endpoints of a single continuum. A process is described in which individuals collect and evaluate information about their "healthiness" and "unhealthiness," that in turn influences health behavior decision making. Emphasis is placed on the process of health behavior, on the need to view health behaviors from a noncrisis perspective, and on the importance of recognizing that ambiguity and uncertainty can legitimately reflect one's situation.

Methodological considerations for research on late life future temporal perspective

Several complications may be encountered by the investigator who wishes simply to "plug a future time perspective measure or two" into highly quantitative analyses. Difficulties in data collection appear to arise both from the complex nature of time perspective and from characteristics sometimes associated with older respondents themselves. Although an accompanying data base for empirically determining the most appropriate procedures is currently absent, it appears that an awareness of certain basic points can enhance the quality and accuracy of data collection. A number of these generic methodological considerations are discussed, and various suggestions are offered. Time perspective should not be considered a universal solution for every researchable issue in gerontology. Its strong face validity and literature to date should, however, encourage our addressing the methodological difficulties that exist.

Dental hygiene students' future orientation and perceptions of old age and of older persons

The future orientation that health care providers have toward old age has been proposed as one factor that contributes to unfavorable perceptions of older patients. Two samples of students from a dental hygiene program (n1 = 145; n2 = 100) were questioned about their general attitudes toward older people, older people as patients, their own future, the future for older adults, and about their social/familial contact with the elderly. Discriminant function analysis supported the importance of both views of the future and social/familial background for general attitudes and perceptions of patients.

[Areas of urbanization in Poland]

Current urbanization trends in Poland are analyzed. "In the first part of the article the author presents the changes in the settlement network in 1945-1980 together with the process of concentration of population. In the second part he describes the influence exerted by the big and average towns." (SUMMARY IN ENG AND RUS)

Sodium transport across isolated epithelial structures in vitro--Ledakrin in the liposomes as a moderator of the bioelectric activity of frog skin

The effect of Ledakrin (an acridine derivative with antineoplastic action), free or liposome-bound, on the bioelectric activity of frog skin was studied by the method of Ussing and it was shown that this activity (being a function of sodium transport) depended on the chemical composition of the liposomes as well as on the calcium content of the experimental medium. Two conclusions have been drawn: 1) the first phase of the response triggered by Ledakrin is due to its action on the cell membrane, 2) the second phase depends on an intracellular mechanism due, probably, to Ledakrin effect on the cytoskeleton.

Comparability and reliability of techniques to assess personal future extension

The diversity of existing procedures for assessing personal future time perspective requires that we establish whether the techniques used to operationalize even any one dimension are in fact comparable. A sample of 83 older women (mean age = 74.1 years) responded to a questionnaire containing four different techniques commonly employed for determining personal future extension--how far into the future a person is thinking: (a) open-ended thinking and planning; (b) line-marking; (c) line-drawing; and, (d) life-event listing. Results showed a pattern of correlations suggesting only borderline comparability. Same-session retesting of (a), (b), and (c) revealed relatively high correlations, with the exception of open-ended future planning. Based on these data, caution is advised when selecting a procedure to assess future extension.

Temporal context and the perceptions of geriatric patients

The prevalence in later life of long-term, chronic conditions requires that researchers and clinical professionals become sensitive to the temporal context of older persons' personal and health-related perceptions. A sample of patients at a geriatric ambulatory clinic responded to a questionnaire sent prior to their appointment. The present report focuses on expectations regarding future health and treatment, general personal future projection, and perceptions of current health. Present self-rated health status and future projection were significant associates both of anticipated future health and treatment expectations. However, questions directed toward when treatment benefits were expected to begin and for how long treatment might last were characterized by few predictors. Indications of optimism and uncertainty about future health and treatment were both represented, although neither general optimism nor general uncertainty appeared in a large segment of the sample. Results suggest the salience of future perspective for older adults in the health care setting, and the complexity which may be encountered as treatment progresses.

A brief life-graft technique for work with geriatric patients

Patients aged over 60 or older from the practice of a private physician (n = 32) and from a geriatric outpatient clinic (n = 132) responded to a questionnaire designed to assess perceived present and future health, treatment expectations, and general future projection. Of interest was the extent to which present health, as measured by a brief life-graft technique, might be predictive of perceptions in these other areas. Results from two samples were consistent in suggesting that present health ratings were related to anticipated future health, general future projection, and certain treatment expectations. However, expectations of when benefits from treatment would begin, and of the probable duration of treatment, were not predicted in either sample. The life-graft technique seems useful for practitioners' interactions with older patients and for understanding these patients' extended view of their health.

Consistency in patients' health and treatment expectations at a geriatric clinic

This study focused on predictors of consistency and inconsistency in health and treatment expectations among 77 new patients (mean age, 73) at a geriatric outpatient clinic. Just before their first appointment, and again one week afterward, the patients were asked about their overall health status, their specific illness complaints, their reasons for visiting the clinic, and their expectations regarding treatment and the future outlook. Few predictors of consistency were found for such outcome measures as the number of health problems reported, present and future health status, and the duration, difficulty and benefits of treatment. Inconsistency and uncertainty were more evident in these geriatric outpatients' perceptions, especially among those with self-rated poor health and mobility. This study emphasizes: 1) the importance to the treatment context of geriatric patients' inconsistencies about their health, and 2) the additional burden clinicians must bear in dealing with such discrepancies.

Aging opinion survey: a report on instrument development

Attitude instrument development remains a necessary task in aging research, for the eventual explication of attitude-behavior relationships. The present report describes initial development of the Aging Opinion Survey, an instrument based upon a multidimensional view of attitudes towards aging and the elderly. After identifying substantive attitudinal content areas, an initial 120-item pool was constructed, balanced across referent groups and direction of wording. Pilot analysis eliminated sixty items with minimal variances. Administration of the reduced item set to a subsequent sample of 200 gerontological practitioners and students produced four meaningful factors. Poor items were again eliminated and replacements constructed. Another administration (n=226) again produced four meaningful factors, three of which met the criterion of reliability: (1) Stereotypic age decrement, (2) Personal anxiety toward aging, and (3) Social value of the elderly. These scales appeared to reflect peer, personal, and generalized-elderly referents, respectively. Development and refinements of attitudes scales such as the Aging Opinion Survey are necessary elements for proceeding beyond the current theoretical and empirical difficulties in gerontological attitude literature.

Response format and coding procedures in research on time perspective: a methodological commentary

The dimension of time perspective for extension of personal future was examined as it may be affected by response format and coding procedures. A total of 75 undergraduate students responded to a questionnaire containing one of three formats for reporting anticipated future life-events, varying in the structure imposed on responding. Temporal estimates of life-event occurrence were coded using two procedures, each of which permitted a near and a far value. Analyses suggest that the greatest degree of caution should occur in considering the representativeness of far estimates of extension provided under an open-event format. While coding procedures each produced a significant near/far difference, cross-procedure comparisons were not as impressive, despite also being significant. Questions can therefore be raised regarding techniques for obtaining time perspective data and preparing them for analysis.

Attitude instrument analysis: an examination of factor consistency across two samples

The factor analytic model of the practitioner-oriented opinions about people (OAP) was tested with a population of gerontological practitioners (N =558). A confirmatory factor analysis was performed to ascertain the degree-of-fit between these data and the published OAP factor model. After results supported the hypothesis that the two samples differed, a second factor analysis was designed to yield estimates of communalities by a least squares multiple regression technique. This analysis eliminated nine items not warranting inclusion in the instrument, redistributed the factors, and brought out a completely new factor. Finally, to test the hypothesis that attitudes toward aging and the aged are uncorrelated, a third analysis was performed in which the six scales of the oblique solution were refactored. The resulting higher order dimensions tended to support this hypothesis.

Future time perspective in later adulthood: review and research directions

The degree of experimental and quantitative detail which can be imposed on older adults' temporal experiences remains a significant area for investigation. This paper surveys material related to this general area of study, taking primarily a psychological focus. Review of this literature suggests that while a basic future time orientation is not significantly affected in later life, older adults are at-risk of developing a less extended and less full personal future. However, research has been almost exclusively cross-sectional,, and our empirical knowledge concerning the functional impact of such changes, should they occur, is minimal. In addition, although several correlates of older adults' future time perspective have been reported, normative directions of causal relationship have not been determined. Consequently, while much of our data are varied, interesting, and insightful, they are at present difficult to organize or apply. Research should be pursued on several fronts, including prospective designs, the use of time perspective as a predictor and outcome variable, model development, and close association with temporal concepts in social gerontology.

Attitudes toward aging as a function of in-service training and practitioner age

Age differences in attitudes toward aging were investigated as a function of a 3-hour training program with 322 women (18-74 years) from various geriatric health care and social service contexts. Using a quasi-experimental pre- and posttest design, sites were randomly divided into initial experimental and control groups, with all control participants receiving training following the research program. Results indicated few instances of unfavorable attitudes toward aging in any age group, with younger women evidencing less cynicism toward aging, less social distance from the aged, and slightly less stereotyping. Training appeared to result in less cynicism, stronger endorsements of family and public responsibility, and slightly greater anxiety. No Age X Pretest/Posttest interactions were found. The results are discussed in terms of their implications for service provider-client interaction, the correspondence of attitudinal and behavioral change, and appropriate instruments for assessing program impact.

Assessing motivational readiness and decision making for exercise

Motivational and cognitive processes of behavior change with respect to the area of exercise adoption were investigated. A total of 778 men and women, recruited from four worksites, answered a 40-item questionnaire consisting of statements based on constructs from the trans-theoretical model of behavior change. Principal-components analysis identified two factors--one a 6-item component representing avoidance of exercise (Cons), the other a 10-item component representing positive perceptions of exercise (Pros). Analysis of variance showed that the Pros, Cons, and a Decisional Balance measure (Pros minus Cons) were significantly associated with stage of exercise adoption. Results are consistent with applications of the model to smoking cessation and other areas of behavior change. Distinctions between exercise adoption and behaviors such as smoking cessation, weight loss, and alcoholism are discussed.

Assessing elements of women's decisions about mammography

We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.