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Research on elders' health behavior has largely ignored the stage between experiencing a bodily change and defining it as an illness. This paper addresses the question of what explains such definitions of bodily complaints as illness symptoms. The issue is examined in a longitudinal study with a random sample of 350 community dwelling persons aged 65 and over. Multiple regression was used to analyze the effects of external stresses, psychological factors and health attitudes as well as contextual variables, on three types of illness representations. These consisted of giving the bodily changes an illness label, initiating contact with a physician, and/or using some form of self care. These illness representations were treated as outcome variables singularly and in combination. The findings revealed that the overall frequency of a person's bodily changes was the best predictor of an illness designation. Other significant predictors at Time 4 of the study included belief in the seriousness of a complaint, the occurrence of prior illness representations and self-assessed health. This research study on the elderly is unique in that it seeks to explain, within a longitudinal design, the intermediate step between the experience of a bodily change and the definition of the change as an illness. [ABSTRACT FROM AUTHOR]

Although most older adults report one or more symptoms of a chronic health problem, little attention has been paid to the report of these symptoms over time and whether different symptom patterns affect well-being and symptom management in community-dwelling elders. Therefore, this study examined whether community-dwelling older adults in Ohio, U.S.A. who experience consistently recurring (a) arthritis or (b) cardiopulmonary symptoms report more depression and worse self-assessed health and show more symptom management than those who report inconsistent symptoms and if there are differences in well-being and symptom management over time. This secondary analysis used longitudinal data collected from a random sample of 387 older adults who reported their health complaints in four interviews over 27 months time. Subjects were included in this analysis if they reported either arthritis (n = 321) or cardiopulmonary (n = 232) symptoms at one or more times during 27 months, and then were classified as having either consistent (occurring at all four time points) or intermittent/inconsistent (occurring at three or fewer time points) symptoms. Data analysis included t-tests, chi-square tests, and Repeated Measures ANOVA. Results indicate that those with consistent symptoms reported greater depression and worse self-assessed health than those with less consistent symptoms. Specifically, those with consistent cardiopulmonary symptoms became more depressed over time. Those with consistent cardiopulmonary complaints were more likely than those with an inconsistent pattern to use an illness label to describe their symptoms. Those with consistent arthritis symptoms tended to use more self-care at all time points, to label their symptoms as an illness, and were more likely to consult a physician as their symptoms persisted. The implications of symptom recurrence on well-being, symptom management and the concept chronicity are discussed. [ABSTRACT FROM AUTHOR]

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.

This descriptive study is a secondary analysis of data that examined depressive symptoms in a random sample of 429 community-dwelling adults aged 65 years and older. Participants were classified as having consistently high (n = 20). consistently low (n = 327), or fluctuating (n = 82) levels of depressive symptoms, based on scores from the Center for Epidemiological Studies-Depression Scale (CES-D; L. S. Radloff, 1977) at three time points over the course of 18 months. Differences in stress (life events and daily hassles), health (self-assessed health and physical complaints), and biographic variables among the 3 groups were examined. One quarter of the sample reported high depressive symptoms at least once over 18 months. There were significant differences among the 3 symptom groups on each of the stress and health measures and on marital status. The findings support the relationship among stress, health, and depressive symptoms over time. Implications for clinicians and researchers are discussed.

Based on a community random sample of 406 elderly, factors that persuade an elderly person to interpret a bodily change as a symptom of illness are described. Three measures of such illness interpretation among 27 different bodily changes are used in analysis: giving an illness label to the change, consulting a physician for it, and/or using self-care for treatment. The three types of representations across all 27 bodily changes taken together, as well as among five typical complaints most commonly experienced, are reported. The findings show that the perceived seriousness of the bodily change and the general health context of the older person in which it has occurred are conducive to interpreting a bodily change as an illness symptom.

Consumerism in doctor/elderly patient relationships and physician support for the caregivers of such elderly patients are discussed as two apparently unrelated issues that affect health outcomes. The first is based on a theoretical stance that physicians' power flowing from their specialized knowledge can be countered by methods of enhancing patient power, so that an egalitarian or a negotiated approach in the relationship will ensue. The caregivers' need for support from physicians is based on the stress-support-health paradigm, and views the caregiver as a "hidden patient" of the elderly patient's own physician. The effects of cohort differences, changes in public education, the inherent uncertainties in medical practice, and the potential impact of technology are among the issues addressed. The argument that patient power and "hidden patient" support needs may constitute an oxymoron is confronted in this essay, which attempts to show how the two theoretical approaches may be consistent.

Recent social and economic trends suggest that the health and welfare of elderly persons living in urban areas may have deteriorated during the past two decades. Two representative samples of noninstitutionalized urban persons aged 65 and over were interviewed, one in 1975 (n = 1598) and the other in 1987 (n = 1491). Cohorts of "young-old" (ages 65-76), "old-old" (ages 77-88), and "oldest-old" (ages 89-100) urban residents were compared at the two time points by multivariate analysis. Over the 12 years studied, the proportion of Blacks and poor persons rose, while the educational level improved. The young-old cohort of 1987, in particular, reported more chronic illness, more psychological distress, more need for help with activities of daily living, more visits to physicians, and more need for additional medical care. We conclude that, between 1975 and 1987, a new cohort of urban residents who were more impaired, disabled, and disadvantaged than their predecessors entered the young-old age group.

A nine-year representative, longitudinal study of 1,598 urban elderly shows that two to eight times as many impaired or disabled are cared for in the community as in institutions. Younger age, male gender, better income, and living with others, especially children, favor continuing care in the home.

Experience of common symptoms and subsequent self care behaviors among older adults are compared between Japan and the United States, two industrial countries with different cultural backgrounds and health insurance systems. Based on a modification of the Health Belief Model, perceived susceptibility to illness and belief in the efficacy of physician care were selected as major explanatory concepts for the decision to use self care for a complaint. Among 900 respondents in Japan and 728 in the United States, in three communities of varying size, self evaluations of good health, an indicator of low susceptibility, were very similar. Although Japanese respondents claimed fewer experiences of physician error, they still expressed lower preference for physician care than did those in the U.S. In addition, the Japanese reported far fewer symptoms than their U.S. counterparts during a three month period, and were more likely to use self care, even for symptoms they considered more serious. Disparate effects of such variables as good health behaviors, presence of a chronic condition and desire for autonomy are discussed in terms of cultural differences in the two countries.

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.

The extent to which the erosion of professional authority observed in the United States is also occurring in the United Kingdom and the U.S.S.R. is examined in the case of the primary care physician. Informal interviews with health practitioners in these diverse societies revealed that the model of the professions which bases physicians' autonomy and authority on the occupational characteristic of a monopoly of specialized knowledge is subject to some revision. Education of the patient emerged as a critical factor in eroding physician authority in both countries, while patient age affected authority relations differentially in the two societies. Despite variations in the level of bureaucratization of health care, the role of the physician, as gatekeeper to non-medical benefits, served to counteract the erosion trend in both. The legacy of deference to the upper classes in Great Britain and in the U.S.S.R., an ideology of health as a citizen's obligation plus the "mothering' ambience of a largely female personnel are varying societal characteristics which also affect physician authority.

Two meanings of the term comprehensive care are delineated. The first refers to a wide scope of health services, the second to a humanistic approach to the patient. Findings from a sample of patients from one pediatric practice suggest that the two meanings constitute two independent variables with respect to patient expeciations. Patient responses to questions regarding their expectations of the pediatrician revealed a tendency to hold a traditional disease orientation. Comprehensive care as a broad scope of health services that include mother guidance in child rearing is not a common goal for mothers utilizing the pediatric practice under study. On the other hand, a comprehensive approach by the pediatrician is a standard shared by most respondents in the sample: high priority is accorded the pattern of the personal physician with whom a patient forms a continuous doctor-patient relationship which instills in the patient trust that the physician's recommendations are based on thorough knowledge of the patient as an individual.

A sample survey of the public in a midwestern state substantiates the existence of widespread challenges to the authority of physicians, a phenomenon previously reported only impressionistically in the media. Attitudes tending to reject physicians' right to direct their interaction with patients characterized more than half the sample and were related to younger age, higher educational level, and greater health knowledge, with a consumerist and anti-authority stance also explanatory. Actual challenging behavior occurred at least once for about half the group, but in this instance was related less to age and knowledge than to more extensive experience with the health care system, as well as a lack of trust in people in general and doctors' competence in particular. However, explained variance was modest, arguing that other variables, not identified in this study, are at work. Surprisingly, respondents' health status, race, sex, and pattern of insurance coverage had little impact on either attitude or behavior, while both knowledge and a general tendency to reject authority were influential factors. Implications for physician-patient relations in the future are discussed in light of a number of social changes, including the rising educational level of the American public.

Analysis of longitudinal data (1975-1984) from the Cleveland GAO study shows that physical health and social support emerge as major coping resources for forestalling decline in mental health among the elderly over a nine-year period. However, social resources and poorer self-assessed physical health, which are significant predictors of decline in emotional health, have no effect in loss of cognitive ability, suggesting a biological component in such loss. However mortality over the nine-year time span is related to poorer initial mental health and cognitive ability, thus revealing that selective survival masks the extent to which mental conditions decline over time, with impaired White males the least likely to survive. Although measures of mental health and cognitive skills play a major role in predicting mortality, taken together they are less significant in explanatory power than the availability of social resources.

The effects of the reorganization of a medical practice on continuity of care were investigated in a case study of a changing pediatric practice. Continuity, which has often been conceptualized as one indicator of quality of care, was measured by an index of which the numerator was the number of visits with own pediatrician and the denominator was the total number of pediatric visits for the year. Increased number of pediatricians and incorporation of the practice into an academic setting resulted in a decline of continuity of care accompanied by a rise in the number of doctor visits for acute illness care. Patient satisfaction, although related in some of its aspects to continuity, was by and large unaffected by the change. The consequences of changes in practice size and goal complexity for interpersonal aspects of patient care and quality of care are discussed.

Physician utilization patterns of older as compared to younger persons are investigated in a national random sample. Those 60 and over were more likely than younger groups to contact physicians for routine checkups in the absence of symptoms, and to over-utilize for a list of five common "non-serious" complaints. However there were no differences by age in the pattern of under utilization for a series of five common ailments which were serious enough to require a physician's attention. The effects on these use patterns of various controls such as sex, health knowledge and attitude toward physician authority are analyzed singly and in combination. Implications of the findings for future health care requirements of an aging population are discussed.

Previous studies of the geographical maldistribution of physicians suggest that choice of practice location follows from specialty selection and residency location, although it is plausible that the causal order is reversed. To aid in disentangling the causal order, the locational preferences of entering medical students are analyzed. The findings show that the majority of students prefer a small town or mid-size city for practice and about 70 percent prefer primary care--general practice, internal medicine, or pediatrics. Moreover, nearly 60 percent desire a solo or small-group practice of no more than five physicians. Unexpectedly, the factor which best predicts preference for practice locale is not specialty but form of practice organization, which explains 13 percent of the variance in selected geographic location when other factors are controlled. The relationship between preferences for solo or small-group practice and small or mid-size communities may be explained by a common underlying disposition to independence, autonomy, and freedom from bureaucratic control.

Defining self-care as treatment for a perceived symptom, this paper posits that explanations for such illness behavior will differ depending on whether symptoms experienced are perceived as not serious and most amenable to self-treatment or more serious and less likely to respond to self-care. Borrowing from the Health Belief Model, two major concepts, a health set (consisting of five measures of perceived physical and mental health) and an attitude set (comprising four indicators of belief in physician efficacy) are included to explain rates of self-care across all reported symptoms. Self-care rate, calculated as the percentage of experienced symptoms self-treated without professional advice, was slightly higher for persons whose symptoms were seen as less serious. Measures of self-assessed health were related to self-care for those less severe symptoms, while lower faith in doctors as well as health were more closely related to the ailments perceived as more serious. Implications of the results for further studies are discussed.

If professions are characterized by their monopolization of esoteric knowledge, autonomy in work performance, and authority over clients, then "deprofessionalization" is measured by the degree to which these characteristics are diminished or lacking for the members of a profession. Physicians' monopoly of knowledge has been recently challenged by computer technology and the public's rising educational level; their authority has eroded as patients adopt a more questioning attitude toward medicine; and their autonomy has lessened with the growth of group practices, peer review and cost-containment measures. Current evidence is insufficient either to retain or reject the physician deprofessionalization hypothesis; more time is needed before the erosion of medicine's authority can be assessed.

Prior work on early retirement has given inadequate attention to differences by gender and race in the influences of health and pension on the decision to leave the labor force before 65. A study of previously or currently employed black and white men and women aged 60 to 64 reveals that white males were most likely to be retired and black women the least. Bivariate analysis showed that activity limitations and the presence of chronic health conditions were related to early retirement for men, but not for women. Analysis of women by race showed that while white women who assessed their health as poor were likely to be retired, black women in poor health were apt to be still working. Pension coverage was unrelated to early retirement for both genders. Logistic regression was used to analyze the simultaneous effects of health, pension and race on men's and women's decisions to leave the labor force early, with other variables controlled. The results led to the conclusion that different motivations toward early retirement apply to women and men, and blacks as compared to whites.