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Hearing loss is associated with multiple physical, cognitive, and psychosocial co-morbidities. Achievement of safe healthcare in the context of these complex co-morbidities necessitates accurate hearing and coordination across specialties. This paper discusses the potentials for and barriers to an interprofessional approach to integrating hearing screening and treatment across all healthcare settings.The paper reviews the relationship between hearing loss and other health care concerns to emphasise the need for an inclusive, coordinated, interprofessional approach; discusses interprofessional and patient/family centred coordinated care as essential to achieving quality care; and introduces the Age Friendly Health System initiative as a framework that could be leveraged to move towards comprehensive hearing healthcare.The literature highlights prior work identifying gaps in quality care and the need for new and innovative approaches to evolve interdisciplinary and interprofessional collaborations to achieve comprehensive healthcare. The literature also provides support for using the Age-Friendly initiative as a point of leverage.Bringing together thought leaders from the health care provider community, World Health Organisation, age-friendly cities movement, and field of architecture to coordinate the integration of hearing healthcare into Age Friendly Health Systems initiatives has potential to achieve comprehensive hearing healthcare across healthcare settings. (198).

Hearing loss, common in older adults, is associated with negative health outcomes but screening rates in primary care clinics are low and individuals screened or referred often do not follow-through. To address these problems, we worked with 2 primary care clinics to design a simple screening and education protocol for integration into a standard office visit. To assess the effectiveness on the education brochure that was developed, we assessed its impact on individuals age 60 or older who screened positive for possible hearing loss. Ninety-four of 125 screened positive. Seventy-one agreed to participate and were given a brochure along with a brief review of the materials it contained. Of 67 completing follow-up, 23 (34%) sought further testing and 47 (70%) had used the information to enhance communication. A simple educational brochure accompanied by a brief review of its contents may enhance effective use of hearing healthcare services. (147).

Objectives To compare hearing loss screening results of four simple tests with those of hand-held audiometry. Design Cross-sectional study of individuals screened during intake for physicals and other routine procedures. Setting Two primary care clinics in the San Francisco Bay area. Participants Older adults not wearing hearing aids (N = 125, mean age 72.9, 63% female). Measurements Direct question about hearing loss, indirect question, finger-rub test, whisper test, and audiometric results using a hand-held audiometer. Results Sensitivity was 91% for the finger-rub test compared with 89% for the direct question, 85% for the indirect question, and 79% for the whisper test. For specificity, the whisper test was highest, followed by the finger rub, indirect, and direct. Conclusion Simple screening procedures can be used to identify older adults with hearing loss in primary care and facilitate early referral for additional testing and treatment.

Sleep in older adults with Alzheimer's disease can often be extremely fragmented, thus disturbing normal sleep-wake rhythms. This poor-quality sleep is challenging for caregivers and frequently results in admitting older adults to long-term care institutions. Many variables, such as genes, medications, depression, and environmental factors, influence sleep in persons with Alzheimer's disease. Interventions, such as exposure to light, melatonin therapy, sleep hygiene, and physical activity, are commonly used to treat or to prevent sleep problems. Neuroscience nurses can play an important role in assessing sleep characteristics and related factors, educating caregivers and staff, providing family members with emotional support, and conducting research.

Background: Problems with cognitive function are common among older adults, yet there is little research assessing the extent to which the cognitive problems of older husbands and wives are related to those of their partners and whether any observed relationships are moderated by gender or marital quality. Objectives: Our purpose was to analyze longitudinal relationships between older spouses’ cognitive function and the cognitive function of their partners 5 years later, as well as to assess moderating roles of gender and marital quality. Methods: The subjects were 378 community-dwelling couples aged 46–89 years at baseline who were followed for 5 years. Cognitive function was measured with a scale assessing problems remembering names, finding the right word, misplacing things and paying attention. Marital quality was assessed by comparing those reporting marital problems often or sometimes with those reporting marital problems rarely or never. All data were collected by self-report. Statistical models adjusted for paired data where appropriate and included partner cognitive function, age, chronic conditions and financial hardship. Stratified models assessed moderating roles of gender and marital problems. Results: We found a negative relationship between husbands’ baseline lower cognitive function and wives’ subsequent cognitive function but only for the wives reporting marital problems. We found no comparable relationship between wives’ baseline lower cognitive function and their husbands’ subsequent cognitive function. Conclusions: Our gender-specific finding for wives is consistent with the gender differences noted in 2 previous studies. The limitation to wives with problems in their marriages is a new finding and might follow increased stress and depression responding to changes in their husbands’ cognitive functioning.

This pilot study examined rest-activity patterns and related factors in institutionalized older adults with dementia in Korea. Twelve individuals, residing in either a nursing home or an assisted living facility, participated in the study. Actigraphic measurements were collected for seven consecutive 24-hour periods to assess rest-activity patterns. The participants’ demographic characteristics, cognitive function, problematic behaviors, and light exposure were also assessed. The results indicated the participants experienced sleep disturbances, including multiple awakenings at night and excessive daytime napping. Those in the nursing home had significantly more interdaily stability and less intradaily variability, with higher relative amplitude in their rest-activity rhythms, indicating more stable and stronger rest-activity rhythms than those in the assisted living facility. These findings emphasize the importance of the institutional environment in care planning to improve sleep and rest-activity rhythm for older adults with dementia.

Maximizing patients'cognitive functioning and quality of life is a key concern for nurses. Some data suggest that hearing loss may be associated with cognitive decline. To further assess this association, a 5-year longitudinal study was conducted using a community sample of 2,002 men and women ages 50 to 94. A relatively strong relationship between baseline hearing impairment and subsequent poorer cognitive function was found in both existing and new cases of cognitive impairment. These findings raise questions for nursing practice and support the need for increased dialogue and collaborative studies across specialties to both refine the understanding of the factors involved and develop clinical strategies to minimize sensory and cognitive loss.

The purpose of this study was to compare independent impacts of two levels of self-reported hearing and vision impairment on subsequent disability, physical functioning, mental health, and social functioning.A 1-year prospective cohort study.San Francisco Bay Area, California.Two thousand four hundred forty-two community-dwelling men and women age 50 to 102 from the Alameda County Study (California).Hearing and vision impairment were assessed in 1994. Outcomes, measured in 1995, included physical disability (activities of daily living, instrumental activities of daily living, physical performance, mobility, and lack of participation in activities), mental health (self-assessed, major depressive episode), and social functioning (feeling left out, feeling lonely, hard to feel close to others, inability to pay attention). All 1995 outcomes were adjusted for baseline 1994 values.Both impairments had strong independent impacts on subsequent functioning. Vision impairment exerted a more wide-ranging impact on functional status, ranging from physical disability to social functioning. However, the results also highlighted the importance of hearing impairment, even when mild.These impairments can be partially ameliorated through prevention, assessment, and treatment strategies. Greater attention to sensory impairments by clinicians, patients, public health advocates, and researchers is needed to enhance functioning in older adults.

Two waves of data from a community-based study (Alameda County Study, 1994-1995) were used to investigate the association between obesity and depression. Depression was measured with 12 items covering Diagnostic and Statistical Manual of Mental Disorders: DSM-IV diagnostic criteria for major depressive episode. Following US Public Health Service criteria, obese subjects were defined as those with body mass index scores at the 85th percentile or higher. Covariates were age, sex, education, marital status, social isolation and social support, chronic medical conditions, functional impairment, life events, and financial strain. Results were mixed. In cross-sectional analyses, greater odds for depression in 1994 were observed for the obese, with and without adjustment for covariates. When obesity and depression were examined prospectively, controlling for other variables, obesity in 1994 predicted depression in 1995 (odds ratio (OR) = 1.73, 95% confidence interval (CI): 1.04, 2.87). When the data were analyzed with obesity defined as a body mass index of > or = 30, cross-sectional results were the same. However, the prospective multivariate analyses were not significant (OR = 1.43, 95% CI: 0.85, 2.43). Although these data do not resolve the role of obesity as a risk factor for depression, overall the results suggest an association between obesity and depression. The authors found no support for the "jolly fat" hypothesis (obesity reduces risk of depression). However, there has been sufficient disparity of results thus far to justify continued research.

To determine whether functional and psychosocial outcomes associated with hearing impairment are a direct result or stem from prevalent comorbidity, we analyzed the impact of two levels of reported hearing impairment on health and psychosocial functioning one year later with adjustments for baseline chronic conditions. Physical functioning, mental health, and social functioning decreased in a dose-response pattern for those with progressive levels of hearing impairment compared with those reporting no impairment. Our results demonstrate an independent impact of hearing impairment on functional outcomes, reveal increasing problems with higher levels of impairment, and support the importance of preventing and treating this highly prevalent condition.

OBJECTIVES: The purpose of this study was to assess the justification, on the basis of mortality, of the new National Heart, Lung, and Blood Institute (NHLBI) guidelines on obesity and overweight and to discuss the health implications of declaring all adults with a body mass index of 25 through 29 "overweight." METHODS: The relationships between NHLBI body mass index categories and mortality for individuals older than 31 years were analyzed for 6253 Alameda County Study respondents aged 21 through 75 years. Time-dependent proportional hazards models were used to adjust for changes in risk factors and weight during follow-up. RESULTS: Adjusted relative risks of mortality for 4 NHLBI categories compared with the category "normal" indicated that only being underweight or moderately/extremely obese were associated with higher mortality. Specific risk varied significantly by sex. CONCLUSIONS: Our results are consistent with other studies and fail to justify lowering the overweight threshold on the basis of mortality. Current interpretations of the revised guidelines stigmatize too many people as overweight; fail to account for sex, race/ethnicity, age, and other differences; and ignore the serious health risks associated with low weight and efforts to maintain an unrealistically lean body mass.

Most research on the association between sleep disturbances and depression has looked at cross-sectional data. The authors used two waves of data from a panel study of community residents aged 50 years or more to investigate this issue prospectively.Data on symptoms of major depressive episodes and sleep problems were examined for a subgroup of the 1994 and 1995 surveys of the Alameda County (California) Study (N=2,370). The authors examined the effects of age, gender, education, marital status, social isolation, functional impairment, financial strain, and alcohol use. Depression was measured with 12 items that covered the DSM-IV diagnostic criteria for major depressive episodes, including insomnia and hypersomnia.The prevalences were 23. 1% for insomnia and 6.7% for hypersomnia in 1994. Sleep was a significant correlate of depression, as were being female, older age, social isolation, low education, financial strain, and functional impairment. When sleep problems and depression were examined prospectively, with controls for the effects of the other variables, sleep problems in 1994 predicted depression in 1995. However, other symptoms of major depressive episodes-anhedonia, feelings of worthlessness, psychomotor agitation/retardation, mood disturbance, thoughts of death-were much stronger predictors of future major depression.Sleep disturbance and other symptoms that are diagnostic for major depression are strongly associated with the risk of future depression. Sleep disturbance appears to be a less important predictor of depression. More epidemiologic research is needed on the relative contributions of the range of depressive symptoms to the risk of clinical depression.

Previous longitudinal studies assessing relative mortality risks associated with fair or poor self-rated health have differed in the extent to which observed relative risks are explained by disease burden and health risk factors. Gender and ethnic differences have rarely been assessed. The authors used proportional hazards models with time-dependent covariates to examine associations between fair or poor self-rated health and mortality over 28 years for 5,976 Alameda County Study respondents age 21 to 94 at baseline. Adjustments for a number of demographic variables, chronic conditions, mobility impairment, and health risk factors accounted for about half of the unadjusted relative risk. No gender or ethnicity differences in relative risk comparisons were found, but consistent with other studies, lower relative risks associated with increasing age were found. The authors conclude that self-rated health is a deceptively simple variable that likely measures a great deal more than disease burden.

Objective: Most research examining age as a risk factor for depression has been based on cross-sectional data. To investigate the effect of aging on rates of depression prospectively, the authors used two waves of data from a panel study of community residents 50 years old and older. Method: Data on symptoms of major depressive episodes were examined for the 1994 and 1995 cohorts of the Alameda County Study. The authors examined age, gender, marital status, education, financial strain, chronic medical conditions, functional impairment, cognitive problems, life events, neighborhood problems, social isolation, and social support. Depression was measured with 12 items covering DSM-IV diagnostic criteria for major depressive episodes. Results: Point prevalence of major depressive episodes was 8.7% in 1994 and 9.0% in 1995. Among the subjects 60 years old and older, there was a tendency toward higher prevalence in 1995. The highest prevalence rates in 1994 and in 1995 were among those 80 years old and older. Subjects who were depressed in 1994 were at greater risk for depression in 1995. When the effects of age and other psychosocial risk factors in 1994 were controlled, there were no significant age effects on depression in 1995. Multivariate analyses demonstrated that the initial age effects were due mainly to chronic health problems and functional impairment. Gender, chronic health conditions, problems with activities of daily living, cognitive problems, neighborhood problems, and social isolation in 1994 all were significant predictors of depression in 1995. Conclusions: Healthy, normally functioning older adults are at no greater risk for depression than younger adults. What seem to be age-related effects on depression are attributable to physical health problems and related disability. (Am J Psychiatry 1997; 154:1384‐1390)

Data on symptoms of major depressive episodes were examined for the 1994 cohort (n = 2,417) of the Alameda County Study (mean age = 65). In addition to age, we examined gender, education, marital status, social isolation and social support, perceived physical and mental health, chronic medical conditions, functional impairment, life events, financial strain, and neighborhood quality. The point prevalence of symptoms of major depressive episodes was 6.6 percent for men and 10.1 percent for women, with a trend for prevalence to increase with age. When the effects of the other psychosocial risk factors were controlled, there were no significant age effects. Multivariate analyses demonstrated that apparent initial age effects were due almost entirely to chronic health problems and functional impairment. The implications are clear: Healthy, normal-functioning older adults are at no greater risk of depression than younger adults. Apparent age-related effects on depression are attributable to physical health problems and related disability.

The association between leisure-time physical activity and 28-year (1965-1993) risk of death from all causes and cardiovascular disease was studied in 6,131 adults who participated in the Alameda County Study in Northern California. Because study participants were interviewed on a number of occasions, it was possible to include in the analyses information on changes over time in levels of leisure-time physical activity as well as changes in a wide variety of other risk factors. There were 47,616 person-years of observation for males (639 deaths from all causes and 321 from cardiovascular disease) and 57,666 person-years of observation for females (587 deaths from all causes and 388 from cardiovascular disease). In analyses in which only the baseline values of all covariates were included, a four-point increase on the leisure-time physical activity scale, the interquartile range, was associated with reduced risk of death from all causes (relative risk (RR) = 0.90, 95% confidence interval (CI) 0.83-0.99) and cardiovascular disease (RR = 0.85, 95% CI 0.75-0.97). When time-varying information on leisure-time physical activity and all other covariates was included, there was still a protective effect for all-cause and cardiovascular disease mortality (RR = 0.84, 95% CI 0.77-0.92 and RR = 0.81, 95% CI 0.71-0.93, respectively). The association between leisure-time physical activity and risk of death was not altered when information on variations over time in leisure-time physical activity and many determinants and consequences of physical activity were explicitly included in survival models.

We studied 100 adult child caregivers providing care to dependent parents and found that although the vast majority supported family care for older persons in general and their own parent in particular, 46% did not want family care for themselves if they became dependent. For many the contrast between their general statements supporting care of parents and eschewing it for themselves was quite sharp. Caregiver variables significantly associated with not wanting family care for self included age, conflict with relatives over caring, caregiving burden, number of caregiving tasks performed, poorer mental health, and number of years has provided care. Caregivers not wanting family care for self were also more likely to consider placing their parent in a nursing home. Our data reveal contrasting themes in caregiving that may affect caregiver well-being and burden, and that may have implications for the future care of dependent older persons.

The authors studied the relationships between physical functioning and cumulative measures of behavioral and psychosocial risk factors collected over two decades for 91 persons 80 years old and older at follow-up. They found that consistency of physical activity and absence of depression were associated with better functioning as were race (non-Blacks), education, and marital status. A health practices index that combined consistency of moderate alcohol use, moderate weight, and physical activity was also associated with better functioning. Controlling for the persistence of chronic conditions generally reduced but did not eliminate the observed relationships. The association between social contacts and functioning became stronger in the presence of controls. Risk factors after age 60 appear to influence physical functioning for those who survive into their 80s and consistency appears to make a difference.

This study analyzes risk factors associated with 6-year change in physical functioning for 356 members of the Alameda County Study aged 65 and over. Statistically significant associations were found for baseline age, family income, perceived health, number of chronic conditions, prevalent stroke, prevalent heart attack, exercise, going out, marital status, social networks, depression, and internal health locus of control. Relatively strong (but not statistically significant) associations were found for ethnicity, smoking, and weight. Incident conditions during follow-up that had statistically significant associations with change in function included hip fracture, stroke, serious fall, and heart attack. Controls for prevalent and incident conditions attenuated the associations for only ethnicity, smoking, weight, and marital status. Interventions directed at the risk factors identified here may hold promise for extending independent physical functioning in old age

Objective To examine changes in functional status over time by age, gender, and ethnicity in a representative sample of older persons. Design Six-year prospective cohort study. Setting Alameda County, California. Participants 508 persons 65 years old and older at baseline in 1984. Main Outcome Measures Activities of daily living (ADL) dependence, mobility impairment, and functioning on an 18-item scale. Results The prevalence of ADL dependence and mobility impairment at baseline increased with age, while function decreased. Particularly striking differences occurred for those 80 and older. Changes in function over the 6-year follow-up showed a similar pattern. While death rates for males were higher, females had poorer initial functioning, and surviving females declined more than surviving males. The incidence of ADL dependence and mobility impairment during follow-up was similar for males and females, although females survived longer with incident disability than did males. Blacks had poorer baseline functioning, more ADL dependence and mobility impairment, and declined more than non-Blacks during follow-up. Some of the baseline difference in function between Blacks and non-Blacks was due to higher rates of chronic illness and co-morbidity. In spite of the general downward trend in functioning over the 6 years, 13% of the males and 20% of the females improved. Conclusion Age-related changes in function for older persons are complex and result in much heterogeneity. Clarifying the reasons for such heterogeneity is an important and challenging area of research.

While important, family care for frail elders is not always appropriate and should be but one option in long-term care. The present focus on expanding family care includes unsupported assumptions-that long-term care costs will be decreased, that family relationships are the main source of elderly psychological support, that all family members want to care for one another, and that family care invariably has a higher quality than institutional care. Strongly promoting family care has unintended negative consequences; it can impede efforts to promote income and employment equality for women, delay needed quality improvements in institutional care, and increase the guilt felt by relatives of institutionalized family members. Rather than a single focus on family care, we need to work for parallel improvements in the quality and acceptability of institutional care. Families could then arrange the type of care that would be most efficacious for all concerned.

To analyze longitudinal relationships between older spouses' lower cognitive function and the health and well-being of their partners five years later and to assess the moderating roles of gender and marital problems.Subjects were 404 community-dwelling older couples from the Alameda County Study. Baseline cognitive function was measured with a scale assessing problems remembering names, finding the right word, misplacing things and paying attention. Follow-up measures included five health and well-being outcomes. Statistical models adjusted for paired data and included spouse and partner cognitive function as well as partner baseline values for each outcome. Interaction terms assessed gender differences; stratified models assessed the moderating roles of marital problems.Husbands' lower cognitive function was associated with subsequent poorer health and well-being for their wives; however, these associations were significant only for the 52% reporting few or no marital problems. Wives' lower cognitive function was not associated with any outcomes for their husbands.Our findings support early identification of cognitive decline and development of assistive strategies for wives dealing with relationship changes associated with lower cognitive function in their husbands. Although our finding that associations were limited to wives in marriages with few or no problems is consistent with a communication framework, further research is necessary to better understand this strong gender difference.

Family conflict is an overlooked yet potentially critical component of the caregiving experience. In a study of 100 adult child caregivers, 40% were experiencing relatively serious conflict with another family member, usually a sibling. Most conflict arose because the relative failed to provide sufficient help. Path analysis revealed that caregivers experiencing family conflict had significantly higher perceived burden and poorer mental health than did caregivers without conflict, even when quality of the caregiver's relationship with the parent, extent of caregiver tasks, income, gender, and age were taken into account.

Objectives. The purpose of this study was to assess the impact of older spouses’ vision impairment on the health and well-being of their partners and to test for gender differences. Methods. Participants were 418 older couples from the Alameda County Study. Vision impairment was assessed in 1994 with a 9-point scale assessing difficulty seeing in everyday situations; outcomes were assessed in 1999. Longitudinal analyses included multivariate statistical models adjusting for paired data and partners’ own vision impairment, age, gender, chronic conditions, and financial problems. We include results on outcomes for partners’ own vision impairment for comparative purposes. We assessed gender differences with interaction tests. Results. Spouse vision impairment negatively impacted partner depression, physical functioning, well-being, social involvement, and marital quality; these effects were not greatly different in magnitude from those associated with partners’ own vision impairment. Three of four outcomes with significant gender differences evidenced stronger impacts of husbands’ vision impairment on wives’ well-being and marital quality than the reverse. Discussion. Spouses do not live in isolation; characteristics of one impact the other. Both treatment and rehabilitation programs should include spouses and other family members of visually impaired patients. Why wives appear more sensitive to their husbands’ vision impairment is unclear and warrants further study.

OBJECTIVES: This study assessed changes in the prevalence of hearing impairment in persons aged 50 years and older over the past 30 years and identified risk factors. METHODS: Age-adjusted hearing impairment prevalence rates at four time intervals were calculated from the Alameda County Study (n = 5108). Logistic regression models analyzed risk factors from 1974 for 1994 incident hearing impairment. RESULTS: The prevalence of hearing impairment nearly doubled between 1965 and 1994. The increase was significantly greater for men. The higher incidence was associated with potentially high-noise-exposure occupations for men and with symptoms and conditions associated with ototoxic drug use for both men and women. Exercise was protective. CONCLUSIONS: Given the serious health and social consequences of hearing impairment, its increasing prevalence is cause for concern.

Study objectives To analyze relationships between spouses' sleep problems and their partners' physical health, mental health, well-being, social involvement, and marital quality in a sample of older persons. Design The Alameda County Study is a population-based longitudinal study focusing on behavioral factors associated with health and mortality. Setting Participants completed questionnaires for the sixth wave of data collection (1999). Participants 405 couples (810 husbands and wives aged 51 to 94 years). Measurements and results Participants were asked how often they had experienced difficulty falling asleep, waking up in the middle of the night, and waking up very early in the morning over the past month. Response sets ranged from "never" to "often." Scores were summed. Analyses included multivariate statistical models using generalized estimating equations to adjust for paired data as well as partner age, sex, chronic conditions, financial problems, and own sleep problems. Although partners' associations with negative outcomes were stronger for their own sleep problems, spouses' sleep problems were associated with partners' poor health, depressed mood, poor mental health, unhappiness, low optimism, feeling left out, not satisfied with relationships, and unhappy marriage, even after adjusting for the partners' sleep problems. We found no sex differences in associations between spouses' sleep problems and partners' outcomes. Conclusions Although data are cross-sectional, findings suggest that spouses' sleep problems negatively impact partners' health and well-being. Our analyses emphasize the importance of treating sleep problems to promote the health and well-being of both affected individuals and their partners.

Objectives Hearing loss is increasingly common among older persons and is negatively associated with health and well-being. Its impact on spouses, however, is poorly researched. This study analyzed the relationship between a spouse's self-assessed hearing loss and his or her partner's physical, psychological, and social well-being 5 years later. Methods Subjects were 418 older married couples from the Alameda County Study. Hearing loss and adjustment variables were assessed in 1994 and outcomes in 1999. Longitudinal analyses included multivariate statistical models using generalized estimating equations to adjust for paired data and partners' hearing loss, age, gender, chronic conditions, and financial problems. Results Spouse hearing loss increased the likelihood of subsequent poorer physical, psychological, and social well-being in partners. The negative impact of husbands' hearing loss on wives' well-being appears stronger than the reverse. Discussion Findings suggest that early diagnosis and treatment of hearing loss constitute important clinical strategies to enhance the well-being of both hearing-impaired individuals and their spouses and support policy change to cover hearing devices by insurance. Further research incorporating theoretical perspectives from communication theory and qualitative methodology would enhance understanding of how hearing loss impacts older couples and support refinement of interventions to promote quality of life.

OBJECTIVE: To examine the temporal relation between obesity and depression to determine if each constitutes a risk factor for the other. DESIGN: A two-wave, 5-y-observational study with all measures at both times. SUBJECTS: A total of 2123 subjects, 50 y of age and older, who participated in the 1994 and 1999 waves of the Alameda County Study. MEASUREMENTS: Obesity defined as body mass index (BMI)⩽30. Depression assessed using DSM-IV symptom criteria for major depressive episodes. Covariates include indicators of age, gender, education, marital status, social support, life events, physical health problems, and functional limitations. RESULTS: Obesity at baseline was associated with increased risk of depression 5 y later, even after controlling for depression at baseline and an array of covariates. The reverse was not true; depression did not increase the risk of future obesity. CONCLUSION: These results, the first ever on reciprocal effects between obesity and depression, add to a growing body of evidence concerning the adverse effects of obesity on mental health. More studies are needed on the relation between obesity and mental health and implications for prevention and treatment.

This research evaluates the utility of two different definitions of successful aging in predicting well-being.We assessed the definitions of (a) self-rating and (b) Rowe and Kahn's criteria of absence of disease, disability, and risk factors; maintaining physical and mental functioning; and active engagement with life. We made associations with well-being for each definition using data from 867 Alameda County Study participants aged 65-99 years.The percentage of those rating themselves as aging successfully was 50.3% compared with 18.8% classified according to Rowe and Kahn's criteria. Although absence of chronic conditions and maintaining functioning were positively associated with successful aging for both definitions, many participants with chronic conditions and with functional difficulties still rated themselves as aging successfully; none were so classified according to Rowe and Kahn's criteria. On 14 of 15 measures, self-rated successful aging resulted in sharper contrasts for well-being.Understanding criteria used by older persons to assess their own successful aging should enhance the conceptualization and measurement of this elusive concept.

Previous studies assessing protective effects of physical activity on depression have had conflicting results; one recent study argued that excluding disabled subjects attenuated any observed effects. The authors' objective was to compare the effects of higher levels of physical activity on prevalent and incident depression with and without exclusion of disabled subjects. Participants were 1,947 community-dwelling adults from the Alameda County Study aged 50-94 years at baseline in 1994 with 5 years of follow-up. Depression was measured using criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (Washington, DC: American Psychiatric Association, 1994). Physical activity was measured with an eight-point scale; odds ratios are based upon a one-point increase on the scale. Even with adjustments for age, sex, ethnicity, financial strain, chronic conditions, disability, body mass index, alcohol consumption, smoking, and social relations, greater physical activity was protective for both prevalent depression (adjusted odds ratio (OR) = 0.90, 95% confidence interval (CI): 0.79, 1.01) and incident depression (adjusted OR = 0.83, 95% CI: 0.73, 0.96) over 5 years. Exclusion of disabled subjects did not attenuate the incidence results (adjusted OR = 0.79, 95% CI: 0.67, 0.92). Findings support the protective effects of physical activity on depression for older adults and argue against excluding disabled subjects from similar studies.

Objective: Analyze effects on long-term survival of frequent religious attendance compared with four widely-accepted beneficial health behaviors. Method: Calculate gender-specific associations with mortality over 29 years for religious attendance, cigarette smoking, physical activity, alcohol consumption, and non-religious social involvement. Subjects were 5,894 participants in the Alameda County Study age 21–75. Analyses use proportional hazards modeling with time-dependent measures to adjust for subsequent changes in attendance and each health behavior over the follow-up period. All statistical models adjust for the same variables. Results: For women, the protective effect of weekly religious attendance was of the same order of magnitude as the four other health behaviors. For men, the protective effect of weekly religious attendance was less than for any of the other health behaviors. Conclusions: The protective effect of religious attendance for women is comparable to those observed for several commonly recommended health behaviors: for men the protective effect of religious attendance is more modest. This strong gender difference may be a key to understanding how religious attendance exerts its effects.

Several recent prospective analyses involving community-based populations have demonstrated a protective effect on survival for frequent attendance at religious services. How such involvement increases survival are unclear. To test the hypothesis that religious attendance might serve to improve and maintain good health behaviors, mental health, and social relationships, changes and consistencies in these variables were studied between 1965 and 1994 for 2,676 Alameda County Study participants, from 17 to 65 years of age in 1965, who survived to 1994. Measures included smoking, physical activity, alcohol consumption, medical checkups, depression, social interactions, and marital status. Those reporting weekly religious attendance in 1965 were more likely to both improve poor health behaviors and maintain good ones by 1994 than were those whose attendance was less or none. Weekly attendance was also associated with improving and maintaining good mental health, increased social relationships, and marital stability. Results were stronger for women in improving poor health behaviors and mental health, consistent with known gender differences in associations between religious attendance and survival. Further understanding the mechanisms involved could aid health promotion and intervention efforts.

Although religiosity is protective for mortality and morbidity, its relationship with depression is unclear. We used the 1994 Alameda County Study survey of 2,537 subjects aged 50-102 to analyze associations between two forms of religiosity and depression as well as the extent to which religiosity buffers relationships between stressors and depression. Non-organizational religiosity included prayer and importance of religious and spiritual beliefs; organizational religiosity included attendance at services and other activities. Non-organizational religiosity had no association with depression; organizational religiosity had a negative relationship that weakened slightly with the addition of health controls. Both forms of religiosity buffered associations with depression for non-family stressors, such as financial and health problems. However, non-organizational religiosity exacerbated associations with depression for child problems, and organizational religiosity exacerbated associations with depression for marital problems, abuse, and caregiving. Religiosity may help those experiencing non-family stressors, but may worsen matters for those facing family crises.

Studies of disability in old age have focused on gross measures of physical functioning. More useful results for prevention might be gleaned from examining risk factors associated with frailty, a concept implying a broader range of more subtle problems in multiple domains. This study conceptualized frailty as involving problems or difficulties in two or more functional domains (physical, nutritive, cognitive, and sensory) and analyzed prospective predictors. Subjects were 574 Alameda County Study respondents age 65-102. One-fourth scored as frail; there was no gender difference. Frail persons reported reduced activities, poorer mental health, and lower life satisfaction. Cumulative predictors over the previous three decades included heavy drinking, cigarette smoking, physical inactivity, depression, social isolation, fair or poor perceived health, prevalence of chronic symptoms, and prevalence of chronic conditions. By modifying these risk factors, it may be possible to postpone the onset of frailty or ameliorate its further development.

This study compares the health of 42 grandparent, 44 spouse, and 130 adult-child caregivers with 1,669 noncaregivers in 1994 and 1974. In 1994, all three caregiver groups had poorer mental health than the noncaregivers; grandparent caregivers also had poorer physical health and greater activity limitations. Spouse and adult-child caregivers had not differed from the noncaregivers 20 years prior, but grandparent caregivers had experienced poorer health than the noncaregivers and more stressful life events than the other caregivers. Caregiving appears to add new burdens to otherwise normal lives for spouse and adult-child caregivers, while being yet another aspect of a difficult life course for grandparent caregivers.

Six-year predictors of successful aging were analyzed for 356 Alameda County Study men and women aged 65-95 years measured prospectively in 1984 and followed to 1990. Successful aging was defined as needing no assistance nor having difficulty on any of 13 activity/mobility measures plus little or no difficulty on five physical performance measures. After adjusting for baseline successful aging, sex, and age, the authors found that 1984 predictors of 1990 successful aging included income above the lowest quintile (odds ratio (OR) = 2.01, 95% confidence interval (CI) 0.99-4.11), > or = 12 years of education (OR = 1.67, 95% CI 0.98-2.84), white ethnicity (OR = 2.12, 95% CI 0.93-4.86), diabetes (OR = 0.10, 95% CI 0.01-0.79), chronic obstructive pulmonary disease (OR = 0.41, 95% CI 0.17-0.97), arthritis (OR = 0.43, 95% CI 0.26-0.71), and hearing problems (OR = 0.48, 95% CI 0.25-0.89). Adjusting for all variables, the authors found that behavioral and psychosocial predictors included the absence of depression (OR = 1.94, 95% CI 1.10-3.42), having close personal contacts (OR = 1.82, 95% CI 1.05-3.18), and often walks for exercise (OR = 1.77, 95% CI 1.00-3.12). Cross-sectional comparisons at follow-up revealed significantly higher community involvement, physical activity, and mental health for those aging successfully.

We investigated the relationship between baseline internal health locus of control (IHLC) and 6-year change in physical functioning in 356 older adults. IHLC was strongly related to change in physical functioning for women at all levels of baseline functioning, but only affected men with lower baseline functioning. Cross-sectional analyses indicated no relationship between IHLC and health seeking activities except changing eating patterns when sick. Other findings were that IHLC was related to depression and not having childhood illness for men and to number of negative life events for women. For both genders IHLC was related to the importance placed on good health.

We compared 356 older men and women and found that income, education, and marital status had significantly stronger associations with 6-year change in functioning for men; internal health locus of control was stronger for women. Large but not significant differences occurred for age, perceived health, and days going out per week (stronger for women) plus exercise and smoking (stronger for men). We found no difference for ethnicity, chronic conditions, and social contacts. Gender specific models incorporating factors amenable to change predicted significantly higher follow-up functioning for those with positive health behaviors, supporting the value of preventive interventions.