Inbrief: Jul/Aug 2000

Special Issue: Health Promotion Among the Elderly
Lester Breslow David Reuben Steven Wallace	Introduction: Health Promotion Among the Elderly
Intervention Focus
	Medical Self Care
Nallini Gnanadesigan Susan H. Hirsch David B. Reuben	Preventive Health Behaviors and Mammography Use Among Urban Older Women A cross-sectional survey of 610 low income women between the ages of 60 and 84 who attended community meal sites in Los Angeles was conducted to determine health behaviors associated with mammography use among urban community dwellers. Preventive practices that require women to take an active role and recurrent participation were positively associated with a current mammography, while services that are clinician-initiated were associated with ever having a mammography.
	Nutrition
Kathleen M. Hall Russell V. Luepker	Is Hypercholesterolemia a Risk Factor and Should It Be Treated in the Elderly? A MEDLINE search and bibliography review on treatment of hypercholesterolemia on older adults yielded 1360 abstracts. After all subject inclusion criteria were applied, 40 remained. After methodology inclusion criteria were applied, five long term randomized trials of lipid-lowering therapy for older adults remained. The subjects who received lipid-lowering therapy had reductions in CHD deaths ranging from 26% to 43%, all cause mortality of 34%, coronary events 15% to 32%, and stroke 26% to 40%. The authors conclude that lipid screening and treatment is warranted for older adults.
	Smoking Control
David M. Burns	Cigarette Smoking Among the Elderly: Disease Consequences and the Benefits of Cessation Older smokers are less likely to attempt to quit smoking than younger smokers, but when they do try to quit, they are more likely to use formal assistance and to be successful in quitting. The excess death rate for smokers vs non-smokers increases with age for lung cancer, chronic obstructive pulmonary disease, heart disease, and other smoking-related causes of death. Of the three diseases, the excess death rate is highest for heart disease before age 50 but is overtaken by lung cancer by age 55; the impact on chronic obstructive pulmonary diseases becomes most evident by age 65. Death rates from all causes drop by the first year after quitting after controlling for disease status at the time of quitting.
	Social Health
Teresa E. Seeman	Health Promoting Effects of Friends and Family on Health Outcomes in Older Adults This non-systematic review of the literature concluded that there is strong support for the claim that higher levels of social integration among older adults is associated with lower mortality rates. Less extensive evidence suggests that higher levels of social integration provide protective effects against physical and mental illnesses and facilitate recovery from disease. A small but growing literature suggests potential negative effects from relationships characterized by conflicts and excessive demands, especially in stimulating angina and depression.
Applications
	Underserved Populations
Meredith Minkler Helen Schauffler Kristen Clements-Nolle	Health Promotion for Older Americans in the 21st Century A review of the literature was conducted on the behavioral and environmental contributors and barriers to health promotion for Americans over 65. Creative health promotion interventions sensitive to the needs of older adults were described to develop a recommended health promotion strategy for this group. Health promotion programs have the potential to improve the current health and quality of life of older adults. Programs that promote individual risk reduction as well as targeting the broader social or physical environment are likely to have the greatest impact.
Thomas R. Prohaska Karen Peters Jan S. Warren	Sources of Attrition in a Church-based Exercise Program for Older African-Americans Among 123 older African Americans recruited into a church-based exercise program, 43% had dropped out within four months. Compared to those who did not drop out, drop outs had lower levels of education, energy to do activities, energy to exercise, and self-ratings of health, all based on measures taken before the class. Over half of those who dropped out cited non-exercise related health problems, and 17% caregiver responsibilities. Of those who dropped out, half said they would continue to exercise and 32% said they intended to start within the next six months.

Abstracts	31 abstracts are featured from a variety of publications.
DataBase: Research and Evaluation Results	Four new studies are critiqued and are added to the DataBase chart.