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Objectives: This study addresses the following question: What characteristics of urban, noninstitutionalized elders predict which individuals are most likely to remain independent of personal assistance during a 2-year observation period?, Methods: A population-based sample of 602 noninstitutionalized urban residents aged 70 and older was followed for 2 years., Results: Ninety-eight of the 487 survivors remained independent. Factors associated with sustained independence were relatively younger age, male gender, fewer medical conditions, good physical function, and nonsmoking. The attitudes "favors family or self over agency assistance" and "does not expect filial obligation" were also independently associated., Discussion: The results are consistent with previous studies of successful aging and show that attitudes expressed at baseline favoring personal independence are associated with sustained autonomy during a period of at least 2 years.

Objective: To test the hypothesis that there is an inverse relationship between smoking and cognitive impairment by examining the prevalence and incidence of such impairment in a representative cohort of older urban residents., Design: Survey follow-up with three interviews over a 4-year period., Setting: City of Cleveland, Ohio., Participants: Six hundred forty-seven survivors of a population-based, multi-stage probability sample of urban residents, aged 74 years and older in 1984., Measurements: Past and present cigarette smoking was measured in 1984 by direct questioning. Cognitive impairment was measured in 1984, 1987, and 1988 by the 10-item Short Portable Mental Status Questionnaire. Mortality was determined at each interview date, and death certificates were obtained. Data were analyzed by univariate analysis, stratified analysis, and multivariate logistic regression., Results: There were 99 cases of cognitive impairment at baseline among 628 individuals for whom complete data were available. Crude data suggest that the prevalence of cognitive impairment was lower among smokers than among non-smokers, but logistic regression, adjusted for age, income, and gender, showed this difference to be non-significant, OR 0.73; 95% CI (0.42, 1.29). Fifty-one new cases of cognitive impairment occurred during the 4-year observation period. Neither the crude data nor logistic regression showed any significant relationship between smoking and the incidence of cognitive impairment, OR 1.03; 95% CI (0.54, 1.99). Four-year mortality did not differ significantly between these older smokers and non-smokers, but smokers died at a relatively younger age and were more likely to die of diseases associated with smoking.

Objective: To describe the 3-year incidence of acute respiratory illness in a population of noninstitutionalized elderly persons., Design: Cohort analytic study with an observation period of 3 years., Setting: Large midwestern urban community., Subjects: 574 noninstitutionalized persons aged 65 years and older, of whom 349 were living independently, 110 were in congregate settings, and 115 were living independently and regularly caring for small children., Methods: Subjects were interviewed and examined by nurse practitioners at intake and every 4 months. Acute illness and convalescent visits were made when illnesses were reported by participants., Main Outcome Measures: The incidence of acute respiratory illness was used to test the hypothesis that elderly persons taking care of children have the highest incidence, congregate-dwellers intermediate incidence, and those living independently the lowest incidence., Results: The average incidence of acute respiratory illness was 2.5 per 100 person months, comparable to rates reported in the National Health Survey. The incidence of respiratory illness was significantly greater in subjects living in congregate settings or regularly caring for young children. Similarly, greater proportions of persons in the congregate and child-care groups reported at least one episode of illness (P < .05). A more detailed analysis of exposure shows that acute respiratory illness was significantly more common in subjects who had contact with children (P < .05). This risk was definitely present during the months November through February, and probably also during July through October, but was not observed for March through June., Conclusions: Elderly persons living in the community experience low rates of acute upper respiratory illness. Contact with children increases their risk of developing such illnesses during certain seasons of the year.

A population-based cohort of 1,598 urban residents, aged 65 years and over, was studied in 1975, and 645 survivors were re-interviewed in their places of residence in 1984. Since 25.6 percent of the subjects were Black, it was possible to examine race-related changes in health, function, and socioeconomic status over nine years, as well as differences in rates of institutionalization and mortality. Aging urban Blacks continue to experience major social disadvantages, especially in education and income. After age 74, although Blacks probably experience more favorable mortality rates and less institutionalization, they consider themselves less healthy and are more likely to develop diabetes, hypertension, and glaucoma. Although Blacks rate their own mental health lower, this difference is not supported by other measures. Functionally, elderly Whites are more likely to be dependent in certain activities of daily living. The findings are consistent with the previously observed mortality crossover; predictors of mortality are identified but do not differ by race. Lower institutionalization rates among older Blacks may be partly explained by different living patterns, poverty, and a higher proportion of males among surviving Blacks.

Analysis of homicide patterns in Cuyahoga County, Ohio (metropolitan Cleveland), for 1958-1974 discloses the following major trends: a dramatic rise in overall homicide rates in the city (320 per cent) and suburbs (200 per cent); an increase in justifiable homicide; a doubling of the percentage of homicides incident to other felonies; a markedly increased incidence of homicide among younger persons; a conspicuous rise in firearm killings (now 81 per cent of all homicides); and a continued preponderance of intraracial homicide, with the highest rates among nonwhite males in the city. The trends in Cuyahoga County are consistent with those in other United States metropolitan counties. Homicide is responsible for a major part of the decreased life expectancy among young, urban, non-white men. The factor most consistently associated with these trends is the increased use of handguns.

Age adjusted mortality rates for the 1969-1971 adult population in the United States reveal a consistent pattern of 13% excess cancer mortality in the metropolitan counties with central cities compared to non-metropolitan counties. Only 14% of all cancer death exhibit a different pattern. A detailed analysis of cancer mortality in Cuyahoga County, (Cleveland), Ohio, during the years 1969-1971, shows that apart from cancer mortality of the respiratory tract, general air pollution characteristics correlate secondarily with mortality, compared with socioeconomic factors.

Distance is the major factor determining the frequency of social interaction with family and friends for elderly whites. Age, sex, marital status, length of residence, and income also affect the number of social contacts. These relationships have not been studied for elderly blacks. Utilizing data from a survey of 655 black urban residents 60 years old and older, this study investigated contacts with family and friends. The major finding was that the neighborhood is an important place for socializing with both family and friends for this population as is the case for working-class white elderly adults. A surprising finding is that, whereas social contacts increase with higher income for working-class elderly whites, for these black elderly adults who are of the working class and poor, social contacts decrease with higher income.

Etiological theories of suicide are reviewed from epidemiological, individual (both biological and psychological), and psychosocial perspectives. Cohort and population-model approaches as explanations for the two- to three-fold increase in completed suicide rates observed in adolescents and young adults over the past 25 years are presented. The results of the authors' study of suicides in adolescents and young adults in Cuyahoga County, Ohio, to test these hypotheses are summarized. This study revealed marked cohort differences in suicide rates and provided partial support for the "population-model" approach. Differences between suicide rates in adolescents and other age groups are discussed, as are data from some minority groups. The role of depression in adolescents and various studies of diagnostic approaches (e.g., structured diagnostic assessments, biological markers, clues during intensive psychotherapy or psychoanalysis, studies of high-risk diagnostic groups) are reviewed. Lastly, treatment employing individual, family, and group approaches to classical psychoanalytic or cognitive psychotherapy as well as the role of pharmacological treatments are considered.

To increase the competence of physicians to practice and teach geriatric medicine, the Office of Geriatric Medicine at Case Western Reserve University School of Medicine in Cleveland, Ohio, offered an 11-week course to interested physicians on the faculty. This course, "Medical Management of the Aged--A State of the Art Symposium for Medical Faculty," was conducted as part of an overall plan of the Office to enhance faculty and curriculum development in geriatrics within the School. The weekly sessions consisted of clinical and research information presented by recognized experts in the field of geriatric medicine. Of the 52 formal registrants, 79 per cent were physicians and were from such fields of specialization as internal medicine, family medicine, and psychiatry. The mean attendance was 37. An overview and evaluation of the geriatric faculty development program is given.

A study of accidental firearm fatalities in Cuyahoga Count, Ohio, (Metropolitan Cleveland) from 1958-1973, inclusive, has shown a threefold increase in the rate of such deaths since1967. They are more frequent in the central city than in the suburbs, show a male preponderance, are more common in nonwhites, have a peak prevalence in the 25-34-year age range and usually happen in the home. Approximately half of the adult victims had been drinking alcoholic beverages when shot. It is hypothesized that the frequency of accidental firearm fatalities is primarily related to the number of guns, particulary handguns, in civilian possession. The data indicate that a loaded firearm in the home is more likely to cause an accidental death than to be used as a lethal weapon against and intruder.

Examinations of 427 prisoners at the time of the admission to a large urban county jail showed that more than a quarter were, or had been, users of potentially addictive drugs. Except for their drug problems, the drug users did not present any more of different health problems than the nonusers. The treatment for drug abuse recommended by the examining physicians was, for the most part, not available in the facility. Evidence of continued drug use in the jail by less than 10 per cent of the prisoners was obtained at 4-week and 8-week followup examinations. Detection of drug use by means of questionnaires and urine testing was shown to be feasible among persons admitted to such a jail.

Suicide rates in Cuyahoga County (metropolitan Cleveland) rose from 10.2 in 1958 to 12.5 per 100,000 populations in 1974 (23 per cent increase) with the greatest rise among nonwhite males (from 5.9 to 13.1, or 122 per cent). Increased rates were observed in both the city (19 per cent increase) and suburbs (35 per cent increase). Rates increased among young non-white and white adults of both sexes aged 15--34 years, but decreased slightly among adults aged 65 years and older. These findings are consistent with national trends. Alcohol was present in the blood of one-fourth of the individuals who were "dead on arrival," and at intoxicating levels in 20 per cent. There were increasing percentages of victims with positive blood alcohol and with intoxicating levels during the study period. White male victims in the city had significantly higher frequencies of such findings than their counterparts in the suburbs. The rates of suicide committed by firearms rose among all race-sex groups, with the greatest increase among city nonwhite males (2.1 to 7.7, or 267 per cent). Suicide by chemical agents (roughly one-half being barbiturates) increased in all groups except city nonwhite males, with the greatest increase among white males and suburban white females. Firearms among males and poisoning among females displaced asphyxia as the leading modes of suicide.

The usefulness of household composition in characterizing the functional status of the elderly was examined in a random sample of 1,598 noninstitutionalized urban persons aged 65 years and older. Subjects were interviewed twice, one year apart. Five areas of well-being were assessed, including: physical and mental health, social and economic functioning, and ability to perform daily tasks. Living arrangements were categorized as follows: living alone, never married; living alone, ever married; living with spouse; living with spouse and children; living with children, but without spouse; and living with others, not spouse or children. Profiles for those living with children but without spouses and those living with spouses provided the most extreme contrasts. Persons living alone and never married consistently had better outcomes than those living alone but ever married. After one year, changes in living arrangements were most likely to occur for those living with spouse/children and those living with others. For the elderly, "Who lives with you?", is an important question.