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Recent evidence indicates that spirituality and religion are associated with both physical and psychological health. Because a belief that rewards are largely determined by external forces tends to be detrimental to mental health, the idea that God can be equated with such an external force seems contradictory to the proven benefits of religion and spirituality. The purpose of this article is to examine changes in perceived control in the context of spiritual turning points as uncovered in the narrative histories of 30 elderly people. We propose that for many people who derive benefits from religion or spirituality, God may act as a mediator, in the sense that trusting in God provides personal control. In addition to creating a model of God-media/ed control, the study's findings suggest a relationship between recall for type of control during a spiritual turning point and the interpretation of that turning point in late life.

Objectives. The purpose of this study was to evaluate predictors of change in household size and institutionalization in late life. Methods. The Duke Established Populations for Epidemiologic Studies of the Elderly cohort (n = 3730) was assessed annually (1986-1996). Independent variables included home ownership, income, cognitive and functional ability, chronic illness, mood, household size, social support, and stressful life events. Competing risk of household expansion or institutionalization was modeled using (a) hazard of either event and (b) odds of household expansion or institutionalization among elders who experienced an event. Results. Hazard of either event was associated with younger age, Black race, lower income, cognitive problems and stability, functional abilities and deterioration, low chronic illness burden, being unmarried, having more living children, and recent life events. Among those who reported either event, odds of institutionalization (vs. household expansion) were associated with older age, White race, cognitive and functional problems, high chronic illness burden, being married, having fewer living children, smaller household size, social isolation, and exits of nonspouse coresidents. Discussion. Modeling separate effects of whether there was a household expansion or institutionalization, and if so, which type of event occurred, and taking into account acute and evolving states, enabled more precise understanding of the complex mechanisms involved in determining continued community residence or institutionalization.

This is an exploratory study of the migration patterns of people older than age 70. If the life course perspective on retirement migration is correct, then this older category should be somewhat less inclined to enter the key national destination states and more likely to be moving toward the usual sending states, unlike younger retirees. The Asset and Health Dynamics Among the Oldest Old (AHEAD) Study is critical to this study goal because it contains an oversample of Florida residents older than age 70. Respondents were interviewed in 1993 and again in 1995. The older movers who were identified tend to move locally, or within the state, but those who migrate across state lines are more often leaving Florida than entering it, as suggested by the life course theory.

Objectives: Dramatic increases in living alone in late life have been associated with higher incomes and better health, obscuring the risk to subgroups living alone with diminished health and socioeconomic resources. This study describes race differences in the stability and life-course antecedents of living alone. Method: The prospective cohort study used data from the Established Populations for Epidemiologic Studies of the Elderly at Duke University (n = 4,132) to estimate 10-year prevalence, incidence, and predictors of living alone among Black and White elders. Results: New episodes of living alone were equally likely. Black elders' lower prevalence of living alone was a function of their 80 percent greater probability of a new coresident episode. Home ownership, residential tenure, and perceived good health were lower among Blacks living alone, compared to Whites, who had fewer living children. Stressful life events had similar effects on household size. Discussion: Race differences in late life household size were primarily dependent on decisions embedded in midlife.

Objectives. Although it is frequently assumed that issues of religious faith become more salient at the end of life, there is little or no population-based empirical evidence testing this assumption. Methods. Using data from the New Haven site of the Established Populations for Epidemiologic Studies of the Elderly (N = 2,812), the authors examined self-reports of attendance at services, self-ratings of religiousness, and strength and comfort felt from religion for respondents who did and did not die within 12 months following an interview. Religiousness was assessed at baseline (1982) and in follow-up interviews in 1985, 1988, and 1994. Cross-sectional comparisons of levels of religiousness were made among persons in their last 6 months of life, persons in their last 12 months of life, and persons who survived 12 months, and longitudinal comparisons were made with religiousness at the previous wave. Results. After adjusting for age, sex, education, marital status, religious affiliation, and a set of health status measures, the authors found that although attendance at religious services declined among the near-deceased, this group showed either stability or a small increase in feelings of religiousness and strength/comfort received from religion. Overall levels of attendance and religious feelings were high for this religiously diverse sample. Discussion. Community studies of respondents in their last year of life are rare. In this sample, religious involvement appears to continue throughout the last months of life.

Recent research has shown the beneficial effects of religious activity for individual health and well-being among older adults. The purpose of this article is to determine whether breaking the norms of the religious group can have deleterious consequences for individual mental health and whether this effect is exacerbated by frequent service attendance. To test these ideas, the authors used two waves of data collected from a sample of older adults (age 65 and over) living in central North Carolina. Using only sample members who reported an affiliation with a Baptist denomination, the authors tested whether attending services more often and living in rural areas were associated with a smaller likelihood of alcohol use. The authors further tested whether the use of alcohol in this sample was associated with higher counts of depressive symptoms. The results indicate that older Baptists who lived in rural areas and who attended services more often were less likely to use alcohol. It was also found that alcohol use had no effect on depressive symptoms. One exception to this latter finding was that among rural Baptists who rarely attended religious services, using alcohol was associated with more depressive symptoms.

Background. The purpose of the study was to examine religious attendance as a predictor of survival in older adults. Methods. A probability sample of 3,968 community-dwelling adults aged 64-101 years residing in the Piedmont of North Carolina was surveyed in 1986 as part of the Established Populations for the Epidemiologic Studies of the Elderly (EPESE) program of the National Institutes of Health. Attendance at religious services and a wide variety of sociodemographic and health variables were assessed at baseline. Vital status of members was then determined prospectively over the next 6 years (1986-1992). Time (days) to death or censoring in days was analyzed using a Cox proportional hazards regression model. Results. During a median 6.3-year follow-up period, 1,777 subjects (29.7%) died. Of the subjects who attended religious services once a week or more in 1986 (frequent attenders), 22.9% died compared to 37.4% of those attending services less than once a week (infrequent attenders). The relative hazard (RH) of dying for frequent attenders was 46% less than for infrequent attenders (RH: 0.54, 95% CI 0.48-.0.61), an effect that was strongest in women (RH 0.51, CI 0.43-0.59) but also present in men (RH 0.63, 95% CI 0.52-0.75). When demographics, health conditions, social connections, and health practices were controlled, this effect remained significant for the entire sample (RH 0.72, 95% CI 0.64-.81), and for both women (RH 0.65, 95% CI 0.55-0.76, p < .0001) and men (RH 0.83, 95% CI 0.69-1.00, p = .05). Conclusions. Older adults, particularly women, who attend religious services at least once a week appear to have a survival advantage over those attending services less frequently.

Background. The objective of this study was to examine the relationship between religious activities and cigarette smoking in community-dwelling older adults. Methods. Cigarette smoking and religious activities were assessed in a probability sample of 3968 persons age 65 years or older participating in the Duke Populations for Epidemiologic Studies of the Elderly (EPESE) survey. Participants were asked if they currently smoked, if they ever smoked, and how many cigarettes per day they smoked. Attendance at religious services, participation in private religious activities (prayer or Bible study), and use of religious media (religious TV or radio) were also assessed. Data were available for Waves I-III of the survey (1986, 1989, and 1992). Analyses were controlled for age, race, sex, education, alcohol use, physical health, and in the longitudinal analyses, smoking status at prior waves. Results. Cross-sectional analyses revealed that participants who frequently attended religious services were significantly less likely to smoke cigarettes at all three waves. Likewise, elders frequently involved in private religious activity were less likely to smoke (Waves II and III). Total number of pack-years smoked was also inversely related to both attendance at religious services and private religious activities. Watching religious TV or listening to religious radio, on the other hand, was not related to smoking at Waves I and II nor to total pack-years smoked, but was positively related to current smoking at Wave III. Among those who smoked, number of cigarettes smoked was inversely related to frequency of attendance at religious services (Wave I), private religious activities (Wave III), and religious TV/radio (Waves II and III). Retrospective and prospective analyses revealed that religiously active persons were less likely to ever start smoking, not more likely to quit smoking. Conclusions. Religiously active persons are less likely to smoke cigarettes, and if they do smoke, smoke fewer cigarettes. Given the association between smoking and disease, and the widespread prevalence of both smoking and religious activity, this finding has implications for public health.

Few investigations of the social correlates of depressive symptomatology have addressed variation in the correlates across multiple dimensions of depression scales. We examined the relationships of selected social clinical and demographic correlates with four dimensions of the Center for Epidemiologic Studies - Depression (CES-D) scale in 3,401 community-dwelling elders in the Piedmont area of North Carolina. These correlates explained significant variation in somatic complaints and depressed affect; effects of chronic disability and recent negative events were particularly robust. Having a confidant explained reduced symptomatology for all four dimensions, but particularly for low positive affect and interpersonal problems. Positive affect was also buttressed by helping others. These patterns have particular relevance where treatment for depression is divorced from considerations of the social environment of the elderly patient.

Elders are more likely to confront the death of a sibling than any other kinship bereavement. Yet we know almost nothing about the impact of sibling deaths on older adults. We used attachment theory to generate hypotheses about the impact of this life event on physical health, mood, social support, and economic outcomes in late life. At the Duke University site of a large multi-center epidemiologic study (EPESE), 3173 elderly community-dwellers provided data on bereavements experienced in the past year as well as on demographic, health-related, and socioeconomic characteristics. Bereaved siblings were more functionally and cognitively impaired than bereaved friends and rated their overall health as worse than bereaved spouses or bereaved friends who were similarly impaired. Brothers and sisters bereaved of a brother reported excess financial hardship and mood impairment, respectively. Terminal care programs should screen for excess risk among surviving siblings and plan for assisting these survivors in adaptation to this loss.

The dynamic nature of household composition in a population of elderly persons, with particular focus on Black-White and urban-rural differences, is described in this study. The Duke EPESE is a stratified, random household sample (N = 4,162) of elderly persons in a five-county mixed urban-rural area of North Carolina with respondents contacted annually to report on health and social factors. Between 1986 and 1990, 35 percent of the households underwent some change in composition, with 14-percent contracting and/or expanding more than once. Where elders lived alone and where married elders lived with the spouse and/or others, Black elders were significantly more likely to experience a net expansion of their household than were White elders of the same age, gender, socioeconomic, and functional status. Elderly residents of rural areas who lived alone were slightly more likely to add one or more persons to their households than were comparable elderly urban residents. No additional risk of household instability was noted in sociodemographic or health-related subgroups by race or residence. Future analyses should examine the outcomes of instability.

Background. Sleep complaints have been reported in epidemiologic studies to be more frequent in late life, among females, among the physically impaired, and among persons experiencing psychiatric disorders. To date, however, no studies have reported a racial difference in sleep complaints among older persons in the United States. Method. The Duke EPESE (Established Populations for Epidemiologic Studies of the Elderly) assessed 3,976 community-dwelling elders age 65 + for sleep complaints and relevant control variables. Results. In bivariate analyses, sleep complaints were associated with female gender, White race, older age, cognitive impairment, lower education, presence of chronic health conditions, poor self-rated health, and higher scores on a selfrated depression scale (the CES-D). In logistic regression analysis, the association of White race and more sleep complaints persisted (p < .001) when the above variables were simultaneously controlled. Conclusions. Fewer reported sleep complaints in community-dwelling Black elders compared to White elders remains unexplained, though it may be secondary to a higher threshold for Black elders reporting complaints.