Behavioral and lifestyle factors have a profound impact on health throughout the life span. Older adults can help to prevent disease and disability and improve their quality of life through healthy behaviors such as proper nutrition, exercise, use of preventive health care, and avoiding smoking and alcohol abuse. Several particularly encouraging studies have shown that disability rates are declining, and NIA research is focusing on ways to sustain and even accelerate the decline in disability, including the use of behavioral interventions and the health care system by older people. In addition, important research efforts, such as the national Health and Retirement Study, continue to collect and analyze demographic data that inform public policy and planning for the health, economic, and social needs of a growing older population.
Potential Impact of Attitudes on Health and Behavior
Emotional state has been associated with health and functional status in old age. Both positive and negative attitudes or emotions can influence health and physical and cognitive function.
Personality and Risky Behaviors. A recent study examined relationships between a comprehensive measure of personality, the Revised NEO Personality Inventory, and condom use and other HIV risk behaviors. Participants consisted of 201 disadvantaged, primarily African-American participants of an HIV risk reduction program. Participants were divided into three risk groups (high, medium, and low risk) based on their self-reported sexual history, sexual behaviors, and intravenous drug use with shared needles. Results indicated that high-risk behavior was associated with emotional distress, poor self-control, and hostile and antagonistic attitudes and behaviors. The high-risk group demonstrated less ability to resist cravings and urges than the medium- and low-risk groups. The high-risk group also scored lower on measures of feelings of self-efficacy, motivation to carry tasks through to completion, and aspiration levels. All participants, regardless of risk classification, scored within the average range on measures of excitement-seeking. These results suggest that individuals who engage in high-risk sexual behaviors are motivated less from a desire for "thrills" than for temporary relief from psychological suffering. Successful intervention in these AIDS-related behaviors may require interventions tailored to at-risk individuals' basic tendencies.
Story of Discovery: Disability Rates Continue To Decline Among American Elders
When scientists assess disability in the population, they may look at a number of factors. One is the extent to which individuals can conduct basic activities of daily living such as eating, dressing, or bathing or participate in routine care activities such as everyday household chores or managing money. Scientists also track the extent to which cognitive disabilities such as memory loss are present in the population.
The 1999 National Long Term Care Survey (NLTCS), the latest of a series of surveys of the elderly population (particularly those who are functionally impaired), continues to document a dramatic decline in the overall prevalence of physical disability among older Americans over the past two decades. While 26.2 percent of the elderly were assessed as disabled in 1982, this figure dropped to 19.7 percent in 1999. Of particularly note is the reduction in disability rates among African Americans during the 1990s, reversing trends from the 80s.
Results from the 1999 NLTCS also indicate the possibility that rates of severe cognitive impairments may also be declining, with 900,000 fewer cases in 1999 than expected based on the 1982 rates - a decline in prevalence from 5.2 to 2.7 percent. The finding that cognitive disability may be declining is supported by evidence from the Health and Retirement Study, a major national study of the lives of older Americans. In this study, declines were especially large among those with less than a high school education and those ages 80 and older.
These findings are potentially of great significance in identifying and addressing causes of disability, as well as informing national health care policy. Declining rates of chronic disability may also moderate the burden of caregiving, including the informal care provided within families, the care provided through home health services, and the care provided in long-term care institutions. Most importantly, they indicate that elderly Americans are more likely than ever to enjoy the robust health and independence that characterize a life free of chronic physical or cognitive disability.