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Introduction: Counseling is a brief psycho-educational intervention that is useful in facilitating personal growth and adaptive resolution of life stresses. With increased recognition on the psycho-emotional needs of patients with cancer, it is prudent to consider the possibility of expanding the role of nurses in the provision of counseling., Objective: This qualitative systematic review aimed to establish the best available evidence on the experiences of adult cancer patients receiving counseling provided by nurses., Inclusion Criteria: This review included studies on adult cancer patients of at least 18 years of age who were diagnosed with oncological malignancies of any type and staging. The phenomena of interest were the experiences of adult cancer patients who received nurse counseling (patient education, psycho-education and/or supportive counseling) that was conducted face-to-face or via other communication modes. The review included studies done in institutional and community settings. Qualitative data including, but not limited to, designs of phenomenology, grounded theory, ethnography, action research, feminist research and mixed methods research were considered., Search Strategy: A three-step search strategy was utilized to find both published and unpublished studies in the English language. Databases searched included CINAHL, MEDLINE, Embase, JSTOR, PsycINFO, Scopus, ScienceDirect, Wiley Online Library and ProQuest Dissertations and Theses Global. Two reviewers independently appraised the 14 included studies using the Joanna Briggs Institute (JBI) critical appraisal checklist for qualitative research. The studies were of moderate to high quality, mostly, falling short in quality due to lack of statements locating the researchers and their influence on the research. Data were extracted from included papers using the standardized JBI data extraction tool., Data Synthesis: Two reviewers independently reviewed and pooled similar findings into categories. All three reviewers then collaborated in finalizing these derived categories to generate a meta-synthesis., Results: Five synthesized findings were generated during the meta-synthesis: (1) Nurses provide tailored information and teaching to enhance patients' coping; (2) Nurses attend to patients' emotional needs; (3) Nurses assume the role of a significant person in the patients' journey; (4) Patients feel valued as a whole person and the ready availability of nursing interactions; and (5) Nursing role ambiguity and time constraints limit nurse counseling., Conclusion: Overall, cancer patients' experiences with nurse counseling are positive and beneficial to them. Despite some nursing role ambiguity and time constraints impeding nurse counseling, this review has established the diverse instrumental roles nurses have played in enhancing adaptive coping in patients across their illness trajectory. In particular, the nurses' presence and availability, a trusting nurse-patient relationship, use of psychotherapy techniques, a holistic approach, human touch and continuity of care were highlighted as key factors in enhancing healing. The role of the nurse navigator and the use of expressive writing warrant more attention when tending to patients' psycho-emotional distress.

Nature therapy has been demonstrated to induce physiological relaxation. The psychophysiological effects of nature therapy (stimulation with bonsai trees) on adult male patients with spinal cord injury (SCI) were examined. Oxyhemoglobin concentration changes in the prefrontal cortex were measured using near-infrared spectroscopy, and heart rate variability was analyzed. Psychological responses were evaluated using the modified semantic differential method and Profile of Mood States (POMS) subscale scores. Visual stimulation of adult male patients with SCI elicited significantly decreased left prefrontal cortex activity, increased parasympathetic nervous activity, decreased sympathetic nervous activity, increased positive feelings, and resulted in lower negative POMS subscale scores. Nature therapy can lead to a state of physiological and psychological relaxation in patients with SCI., Competing Interests: The authors declare no conflict of interest.

Background: Childhood adverse psychosocial factors (eg, parental divorce, long-term financial difficulties) and adult neighborhood disadvantage have both been linked to increased cardiovascular disease (CVD). However, their combined effects on disease risk are not known., Methods and Results: Participants were 37 699 adults from the Finnish Public Sector study whose data were linked to a national neighborhood disadvantage grid with the use of residential addresses between the years 2000 and 2008 and who responded to a survey on childhood psychosocial adversities and adult CVD risk behaviors in 2008 to 2009. Survey data were also linked to national registers on hospitalization, mortality, and prescriptions to assess CVD risk factors in 2008 to 2009 and to ascertain incident CVD (coronary heart disease or cerebrovascular disease) between the survey and the end of December 2011 (mean follow-up, 2.94 years; SD=0.44 years). Combined exposure to high childhood adversity and high adult disadvantage was associated with CVD risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking, heavy alcohol use, and physical inactivity) and with a 2.25-fold (95% confidence interval, 1.39-3.63) hazard of incident CVD compared with a low childhood adversity and low adult disadvantage. This hazard ratio was attenuated by 16.6% but remained statistically significant after adjustment for the CVD risk factors (1.96; 95% confidence interval, 1.22-3.16). Exposure to high childhood adversity or high adult neighborhood disadvantage alone was not significantly associated with CVD in fully adjusted models., Conclusions: These findings suggest that individuals with both childhood psychosocial adversity and adult neighborhood disadvantage are at an increased risk of CVD. In contrast, those with only 1 of these exposures have little or no excess risk after controlling for conventional risk factors., (© 2015 American Heart Association, Inc.)

Background: The main aim of this study was to explore the relationships between personal self-concept and satisfaction with life, with the latter as the key indicator for personal adjustment. The study tests a structural model which encompasses four dimensions of self-concept: self-fulfillment, autonomy, honesty and emotions., Method: The 801 participants in the study, all of whom were aged between 15 and 65 (M = 34.03, SD = 17.29), completed the Satisfaction with Life Scale (SWLS) and the Personal Self-Concept (APE) Questionnaire., Results: Although the four dimensions of personal self-concept differ in their weight, the results show that, taken together, they explain 46% of the differences observed in satisfaction with life. This implies a weight that is as significant as that observed for general self-esteem in previous research studies., Conclusions: This issue should be dealt with early on, during secondary education, in order to help prevent psychological distress or maladjustment.

Objectives: Although pediatric emergency departments (PEDs) generally do not care for adult patients (≥21 years old), adult patients still present to PEDs with short-term complaints. The purpose of this study was to describe trends in the prevalence, the acuity, and the causes of adult patients presenting to a PED., Methods: Patients consisted of adults (≥21 years old) seen in a large, urban PED from January 1, 2004, to December 31, 2008. Data were obtained retrospectively from the electronic medical record. Data included demographics, triage acuity, primary codes according to the International Classification of Diseases, 9th Revision, insurance status, referred status, and disposition., Results: There were 463,827 patient visits during the study period. Of these visits, 3361 (0.7%) were adult patients, with a mean (SD) age of 27.5 (9) years. During the 5-year study period, overall PED visits increased by 9% (from 85,987 to 93,753), whereas adult patient visits increased 29% (from 605 to 780). Of the adult patients seen, 1898 (55%) were white and 2100 (62%) were female. Moreover, 1465 (44%) were triaged either emergently or to the medical/trauma resuscitation room, 652 (20%) were admitted, and 677 (20%) were transferred to another facility. Of these adult patients, 712 (21%) were referred to our PED by a primary care provider or subspecialist, and 790 (29%) had no insurance., Conclusions: Adult visits to a large, urban PED have increased significantly during the past 5 years. Often, these patients have little or no insurance and present with a high acuity. Transitioning adult patients with long-term "pediatric" conditions and further training PED staff on how to care for adult patients are essential.

Misreporting characterized by the reporting of implausible energy intakes may undermine the valid estimation of diet-disease relations, but the methods to best identify and account for misreporting are unknown. The present study compared how alternate approaches affected associations between selected dietary factors and body mass index (BMI) by using data from the European Prospective Investigation Into Cancer and Nutrition-Spain. A total of 24,332 women and 15,061 men 29-65 years of age recruited from 1992 to 1996 for whom measured height and weight and validated diet history data were available were included. Misreporters were identified on the basis of disparities between reported energy intakes and estimated requirements calculated using the original Goldberg method and 2 alternatives: one that substituted basal metabolic rate equations that are more valid at higher BMIs and another that used doubly labeled water-predicted total energy expenditure equations. Compared with results obtained using the original method, underreporting was considerably lower and overreporting higher with alternative methods, which were highly concordant. Accounting for misreporters with all methods yielded diet-BMI relations that were more consistent with expectations; alternative methods often strengthened associations. For example, among women, multivariable-adjusted differences in BMI for the highest versus lowest vegetable intake tertile (β = 0.37 (standard error, 0.07)) were neutral after adjusting with the original method (β = 0.01 (standard error, 07)) and negative using the predicted total energy expenditure method with stringent cutoffs (β = -0.15 (standard error, 0.07)). Alternative methods may yield more valid associations between diet and obesity-related outcomes.

Purpose: Autosomal dominant optic atrophy (DOA) is a major cause of visual impairment in young adults that is characterized by selective retinal ganglion cell loss. To define the prevalence and natural history of this optic nerve disorder, we performed a population-based epidemiologic and molecular study of presumed DOA cases in the north of England., Design: Case series., Participants: Seventy-six affected probands with a clinical diagnosis of DOA were identified from our neuro-ophthalmology and neurogenetics database., Methods: OPA1 genetic testing was performed using a polymerase chain reaction-based sequencing strategy. OPA1-negative cases were then screened for large-scale OPA1 rearrangements and OPA3 mutations. Additional affected family members identified through contact tracing were examined, and longitudinal visual data were analyzed., Main Outcome Measures: The prevalence and molecular characteristics of DOA in the north of England. Visual function and disease progression among patients with OPA1-positive mutations., Results: The detection rate of OPA1 mutations was 57.6% among probands with a positive family history of optic atrophy (19/33) and 14.0% among singleton cases (6/43). Approximately two thirds of our families with DOA harbored OPA1 mutations (14/22, 63.6%), and 5 novel OPA1 mutations were identified. Only 1 family carried a large-scale OPA1 rearrangement, and no OPA3 mutations were found in our optic atrophy cohort. The minimum point prevalence of DOA in the north of England was 2.87 per 100,000 (95% confidence interval [CI], 2.54-3.20), or 2.09 per 100,000 (95% CI, 1.95-2.23) when only OPA1-positive cases were considered. Snellen visual acuity varied markedly between OPA1-positive cases with a mean of 20/173 (range 20/20 to hand movements), and visual function worsened in 67.4% of patients during follow-up. The mean rate of visual loss was 0.032 logarithm of the minimum angle of resolution per year, but some patients experienced faster visual decline (range = 0-0.171 logarithm of the minimum angle of resolution/year). OPA1 missense mutations were associated with a significantly worse visual outcome compared with other mutational subtypes (P=0.0001)., Conclusions: Dominant optic atrophy causes significant visual morbidity and affects at least 1 in 35,000 of the general population., (Copyright 2010 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Background: The morbidity and mortality of anastomotic complications after esophagectomy have gradually decreased in recent years. However, swallowing difficulties and reflux continue to burden patients jeopardizing their quality of life. In the present study we performed endoscopic evaluation of the outcomes of esophagogastrostomy by analyzing the presence of anastomotic stenosis and reflux esophagitis., Methods: A retrospective analysis was carried out on 74 patients who underwent esophagogastrostomy after esophagectomy by one surgeon between January 1995 and December 2004. Fifty-three patients had an endoscopic examination during follow-up (29 +/- 23.6 months, range = 5-111 months). Reflux esophagitis and stenosis at the anastomostic site were analyzed according to the surgical technique used and the location of the esophagogastrostomy., Results: The mean age at the time of repair was 60.3 +/- 8.87 (range = 39-81) years. Cervical anastomosis was performed in 26 patients and intrathoracic anastomosis in 27 patients. No significant statistical difference in the frequency of anastomotic stenosis was observed between the two groups (p = 0.829); reflux esophagitis was noted in three patients in the cervical anastomosis group and in 14 patients in the intrathoracic anastomosis group (p = 0.041). For all patients, 23 received a hand-sewn esophagogastric anastomosis and 30 a circular stapled one. There was no significant statistical difference in anastomotic stenosis (p = 0.689) and reflux esophagitis (p = 0.879) in comparisons between the two groups., Conclusion: Cervical anastomosis resulted in a better outcome for esophagogastrostomy by lowering the risk of reflux esophagitis; this outcome might improve the patient's quality of life.

Aim: The aim of the study is the analysis of diagnostic procedures performed by general practitioners (GPs) leading to the detection of prostate cancer (PCA)., Patients and Methods: A retrospective evaluation was performed on all 406 patients who underwent ultrasound-supported transrectal multibiopsy of the prostate in our department between January 2004 and August 2005. The GPs were interviewed by use of standardised questionnaires concerning the indication for specific examinations, referrals to the specialist, the clinical findings and results, and the GPs own urological qualification. The rate of returned questionnaires was 72.9 % (105 of 144 GPs), therefore a study group (SG) of 295 patients (72.7 %) was formed. The mean age was 67.2 (40 - 90) years., Results: In 190 patients (64.4 %) primary diagnostic measures were performed by the GP herself/himself. All the other patients had already been in urological specialist treatment (n = 43), were either referred directly to an urologist for primary diagnostics (n = 42) or were diagnosed during a hospital stay (n = 3). The reasons for the performed diagnostic measures were not to be found in 17 cases. In 50.8 % of all cases the initiation of preventive medical check-ups or determination of PSA levels was done at the patient's own request. 91 of 176 digital rectal examinations (DRE) performed by GPs showed suspect findings, leading to referral to the urologist in 62 cases. PSA levels of 105 patients measured by the GPs ranged between 0.0 and 1662 ng/mL with a mean level of 29.81 and a median of 6.20 ng/mL. In 75 cases the PSA level led to a referral to the urologist. In the case of 27 patients the referral was decided because of clinical symptoms. In 39.0 % (n = 115) of the SG a PCA was detected by biopsy. In 43.0 % (n = 64) of the patients originally examined by the GPs the suspected diagnosis of a PCA based on a pathological PSA level and/or DRE proved to be correct. The GPs stated in 35.2 % (n = 37) that they had spent a certain period of time in a urological department during their medical training. Concerning referrals and the positive predictive value of DRE, there was no statistically significant different to be found in GPs without urological training., Conclusion: Every fifth patient in the study group showed a histologically proven PCA that had initially been suspected by a GP based on a pathological PSA level and/or DRE. This underlines the value of preventive exams in the hands of GPs. In addition, the correct and sensible use of PSA levels controls by GPs as well as a pronounced desire for preventive medical check-ups on the patient's side was shown.

Loss of bone strength is the main determinant of bone fragility. Bone strength is directly dependent on bone size (BS). A substantial portion of BS variation is attributable to genetic effects. However, the list of genes and allelic variants involved in the determination of BS variation is far from being complete. Polymorphisms in the ANKH gene have been shown to be associated with radiographic hand BS-related phenotypes. The present study examined the possible association of the ANKH gene with skeletal size and shape in order to test the universality of the ANKH effect on BS traits. Our sample consisted of a total of 212 ethnically homogeneous nuclear families (743 individuals) of European origin. Each individual was measured for body height, weight, and several other anthropometrical measurements, and genotyped for nine polymorphic markers (the average heterozygosity level was 0.4). We observed significant associations with practically all the anthropometrical phenotypes studied. More specifically, we found associations with body weight and height, limb length (P

This paper examines (for the first time) young adult American, Ghanaian, and Black South Africans' perceptions of communication and aging. Irrespective of cultural background, as age of target increased, so did trait attributions of benevolence, norms of politeness and deference, and communicative respect and avoidance; however, attributions of personal vitality and communication satisfaction decreased linearly. Young adults' reported avoidant communication with older people negatively predicted their conversational satisfaction and enjoyment of it. In addition, communicative respect was more strongly predictive of Africans' satisfaction while certain age stereotypes had contrastive effects for the Ghanaian and South Africans' enjoyment of intergenerational communication.

Research has shown that the prevalence of deliberate self-harm (DSH) is higher in adolescents than in adults, but little is known about other differences. In this study we compare adolescent and adult DSH-patients regarding factors contributing to the suicidal act. In two regions in Norway, 98 persons under 20 years of age and 83 older persons were interviewed following an act of DSH. They were compared regarding intentions involved in the DSH, precipitating circumstances, level of suicidal intent, medical seriousness of the act, depression, hopelessness, and self-esteem. Few differences were found. The adults more often wanted to escape from unbearable thoughts or situations, or to receive care and attention. Adults also reported a slightly higher level of medical seriousness of the DSH act, more psychiatric problems, and substance abuse. The similarities between young and adult DSH-patients are striking. The differences found are most likely related to factors of age itself, such as cognitive immaturity, impulsivity, and lack of experience in enduring problems.

Introduction: Prostatic abscess (PA) is a very uncommon disorder. The value of transrectal ultrasound (TRUS) guided aspiration in the treatment of PA has not been clearly defined. We present our experience with six such patients., Materials and Methods: Between July 1997 and December 2002, six patients with PA were diagnosed by TRUS and treated by TRUS guided needle aspiration in our department. PA was defined as hypoechoic, inhomogeneous, thick walled fluid collection. TRUS guided needle aspiration of the abscess was performed transrectally in all patients with a 20-cm long 18 gauge Chiba needle. Successful treatment criteria were defined as clinical improvement in symptoms and decrease of more than half of the estimated abscess volume on follow up TRUS control. Patients with continuing clinical symptoms were defined as treatment failures., Results: The most common TRUS finding was detection of a hypoechoic area with inhomogeneous structures, which was determined in all patients (100%). In some patients irregular contour and heterogeneous areas were additionally described. TRUS guided needle aspiration treatment of PA was successful in five of six patients (83.3%). In one patient treatment failed and the abscess recurred 3 weeks after the procedure. As this patient had additionally a bladder outflow obstruction, transurethral resection of the prostate was performed instead of a repeat procedure. There were no complications associated with the procedure., Conclusions: In conclusion, TRUS has an important value in diagnosis and treatment of PA. TRUS guided aspiration is an effective and minimally invasive treatment modality for PA which causes no serious complications.

In two normative studies, we examined daily scripted activities from the perspective that scripts are frequency-based knowledge structures. In Study 1 individuals recorded their daily activities for 7 consecutive days. Fifteen activities that were reported with low, moderate, and high frequency were selected for Study 2, in which individuals generated a script for each activity. The 18 most frequently generated events from each script are reported, along with their centrality and distinctiveness rankings and the number of individuals reporting each event. Overall, the mean number of events generated increased with increasing script frequency, suggesting that script representations are subject to frequency effects. Also, we found a high level of consistency across the three age groups in the events generated in each script and in their corresponding rankings of centrality and distinctiveness. Finally, we found no evidence of age or gender bias in the frequency or recency of engaging in each of the scripted activities.

As a step towards the identification of the neuronal populations responsive to glial cell line-derived neurotrophic factor (GDNF) in the human nervous system and their changes with age, this study reports on the immunohistochemical localization of the protein GDNF in the autoptic normal human brain stem of pre- and full-term newborns and adult subjects. Two different anti-GDNF polyclonal antibodies were used. Western blot analysis on homogenates of human and rat brain and recombinant human GDNF resulted in differential detection of monomeric and dimeric forms of the proteins. The ABC immunohistochemical technique on cryostat tissue sections showed an uneven distribution of GDNF-like immunoreactive nerve fibers and terminals and neuronal cell bodies. Immunoreactive elements were mainly localized to the spinal trigeminal, cuneate, solitary, vestibular, and cochlear sensory nuclei, dorsal motor nucleus of the vagus nerve, ventral grey column, hypoglossal nucleus, dorsal and ventrolateral medullary reticular formation, pontine subventricular grey and locus coeruleus, lateral regions of the rostral pontine tegmentum, tectal plate, trochlear nucleus, dorsal and median raphe nuclei, caudal and rostral linear nuclei, cuneiform nucleus, and substantia nigra. Comparison between pre- and full-term newborns and adult subjects revealed changes with age in density of positive innervation and frequency of immunoreactive perikarya. The results obtained provide detailed information on the occurrence of GDNF-like immunoreactive neurons in the human brain stem and suggest that the protein is present in a variety of neuronal systems, which subserve different functional activities, at developmental ages and in adult brains.

Geriatric rehabilitation is a prolonged and expensive process. There is a need to evaluate the rehabilitation potential because of the increasing number of elderly in the population and limited resources. Cognition is one of the components of occupational performance and its evaluation is a crucial part of comprehensive geriatric assessment. Cognitive evaluation is one of the predictors of function among elderly in the community and also assists in predicting their rehabilitation potential during hospitalization. High prevalence of cognitive decline with aging and the difficulties in its early assessment during hospitalization emphasizes the utmost importance of this evaluation in predicting the functional prognosis of the patient. This article reviews the main common tools for cognitive evaluation, which are in use clinically, and also used in research, for geriatric rehabilitation in Israel. These were compared with the principles of dynamic cognitive assessment. We aim to assess the need to add dynamic diagnostic tools to supplement those in common use. This will assist in providing an optimal mechanism for cognitive evaluation during geriatric rehabilitation.

Unobserved differences in individual's susceptibility to death are an important aspect in the analysis of contemporary mortality patterns. However, observed mortality rates at adult ages, which are usually well described by a Gompertz curve, are often perceived inconsistent with frailty models of mortality. The authors therefore propose a modified DeMoivre hazard function that is suitable for the application of frailty models to adult and old ages. The proposed hazard increases faster than exponential, and when combined with unobserved frailty it can capture a broad range of patterns encountered in the analysis of adult mortality. The authors' application to Bulgaria during 1992-93 suggests that the stronger selection process in the male population, caused by an overall higher level of mortality, may constitute a primary mechanism leading to the convergence of male and female mortality at higher ages. Hence, the convergence between male and female mortality is not necessarily caused by differential process of aging across sexes, but is merely a consequence of the different levels of mortality at adult ages.

Data on heights and weights of Indian males and females of various ages are presented. The weights of specific organs obtained from post-mortem records of accident cases of Indian adults and children are also presented to provide some inputs towards formulation of an Indian Reference Man for radiation protection purposes. An intercomparison of the present data with the data available from other sources including those for ICRP Reference Man, Woman, and Child has been made. The daily intakes of air, water, and dietary constituents of an average Indian adult are also given.

... We can therefore conclude that either we should go for equality; and in that case QALYs are unfair because they haven't got enough of an ageist bias. Or we should accept consequentialism; and in that case QALYs have just the right sort of ageist bias. No plausible case can, however, be made for the claim that QALYs have an unfair bias against old people. Other things being equal we ought when distributing resources essential for survival favour the young. This ethical claim can be supported both by reference to equality (the life-time-view) and by reference to consequentialism (and the premises that resources generally will be more useful when given to young people).

Interview data gathered during 2 surveys in Anhui and Shejiang Provinces in 1986 and 1987 are used to depict changes in the social status and life situation of rural women in China in 3 age groups, 18-36, 37-55, and 56 and over. For the younger women, marriage increasingly is a result of discussion with parents, not arrangement, but 3rd-party introductions are increasing. They are active in household and township enterprises and aspire to more education and economic independence. The middle-aged group experienced war and revolution and now work nonstop under the responsibility system of household production, aspiring to university education for sons and enterprise work for daughters. The older women, while supported by their sons, live a frugal existence. In general, preference for sons is still prevalent and deep-seated. At the same time, the bride price and costs of marriage are increasing and of widespread concern. Rural socioeconomic growth is required before Confucian traditions are overcome.

"Distinctive types of mobility are identified for the [U.S.] elderly, many of whom also move for traditional reasons. Using a longitudinal data set from adult residents in Rhode Island, univariate, chi square, and logit analyses indicate associations between sociodemographic characteristics of the elderly and their mobility behavior. Mobility for assistance reasons is associated with older age, unmarried status, higher previous mobility, and renter status. Mobility in preparation for aging (e.g., to an elderly complex) is more likely for unmarried, previously mobile residents. Out-of-state mobility to amenity destinations is not limited to the elderly, but younger, married, more affluent elderly were more likely to make such moves.", (excerpt)

Male and female undergraduates and older community volunteers were asked their opinions as to the age of onset of young man- and womanhood, middle-age man- and womanhood, and old man- and womanhood. Data indicated that older respondents generally judged onsets of both middle and old age to occur significantly later than did young respondents and that women retarded middle- and old-age onsets, compared with men respondents. Men were generally seen as reaching transition points at a somewhat later age than women. Both sex and age of perceiver, as well as sex of the perceived, are variables in the perception of onsets of middle and old age, with onset of young adulthood a relatively fixed age for all respondents. The results were not considered compatible with interpretation of sex differences in stage onsets based upon sex-related occupational-role discontinuities.

The older population in the US has grown twice as fast as the rest of the population in the last 20 years. This growth is expected to accelerate early in the next century as the large baby boom cohorts move through middle age and become elderly. Today, about 1 in 8 Americans is 65 years of age or older. By 2030, 1 out of every 4 persons will be in older person. Substantial improvements in life expectancy at all ages, particularly at extreme old age, mean that not only will there be a greater proportion of elderly in the population, but the more will be the "oldest-old," over 85. By 2050, they will be more than 1/4 of the population. As people live longer, many are active and healthy well past retirement. However, many individuals living into their 80s have to cope with chronic disabilities affecting their capacity to perform day-to-day activities. Modern medicine has made great inroads against mortality from such illnesses as heart disease and stroke, but has not eliminated all the effects of these diseases. As the population ages, the issues of health care funding and availability, particularly long-term care, increase in importance. Contrary to widespread belief, the elderly are not abandoned by their families to nursing home care. The vast majority--95%--live in the community. Those needing assistance generally receive help from family and friends. This has created a tremendous demand for federal subsidies to support community-based long-term care services. 1/4 of the federal budget is now spent on the elderly--$270 billion in 1986. Medicaid and Medicare are among the government's success stories, but these programs are threatened by their very success. Economists estimate that government expenditures are 3 times greater for the elderly than for children, raising the issue of "intergenerational equity"--how to balance the amount of care society provides to those who have already contributed with what is provided to those who will contribute in the future. The view that the young and old simply compete for fixed resources is misleading. It ignores the interdependence among generations, and the burdens and benefits of intergenerational transfers at all stages of the life course.

This paper attempts to gauge the effect of constantly declining fertility on population aging in India through the application of an analytical model proposed by Ansley Coale (1972), which employs stable population theory. The author has assumed a linearly constant fertility decline in India to obtain a net reproduction rate equals 1 by the year 2001. The projected age distribution in 2001 shows that the proportions of males and females aged 65+ will be 3.66% and 3.98% respectively. This means that there would be an increase of 7.3% in the proportion of males (65+) from 1971 to 2001. The corresponding increase for females is more, 17.4%. The median age of males increases from 16.59 to 22.92 years during the same period. For females, the increase is from 16.64 to 22.75 years. Although the proportional increase of the aged is not very substantial, the absolute magnitude it implies is very large. It has far reaching implications in the development process in India.

"Vital registration data together with 1980 census data [are] used for assessing the mortality level among the Kuwaiti male and female population in 1980. Under the eclectic approach adopted in this paper, mortality estimates for different sections of age-spans are derived through various indirect techniques. For early childhood mortality estimates, the method developed by Brass...has been employed, whereas, for old age, mortality estimates are derived through Coale's method.... The results show that, as in the developed societies, Kuwaiti females have lower mortality compared with Kuwaiti males.", (excerpt)

Senior citizens, particularly those aged 75 or older, are the fastest growing group in the US today. 25 million strong, the elderly make up 11% of the total population, the proportion ranging from 18.1% in Florida to 2.6% in Alaska. 1/4 of the federal budget, $155 billion in 1980, now goes to their support yet many face difficulty in gaining access to the programs designed to benefit them. The elderly, especially those who rely solely on Social Security, comprise a disproportionate share of all poor households. The retirement system itself is facing financing challenges that promise to grow as the baby boom generation swells the number of senior citizens to 55 million in 2030. Plans to coordinate government programs and improve the method of financing the retirement system are receiving increasing attention. Financing Social Security from revenue funds, or with actuarial reserves, are 2 alternatives to the present pay-as-you-go system. Another area of concern to policymakers is America's health care system, which is now crisis oriented and heavily biased toward institutionalization. Health care must be made more responsive to the long-term needs of the oldest segment of the population, many of whom suffer from chronic illnesses. Impaired elderly receive most of their care from family or friends, and private organizations, but this natural support network largely has been ignored by government. New program initiatives might emphasize homemaker services, geriatric day care, compensation for families that provide for the needs of an elderly relative, and the strengthening of the informal partnership between the elderly themselves, their families and friends, community groups, private organizations, and government at the state and local as well as the federal level.