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EDITORIALS |
School of Rural Public Health Texas, A&M University System, College Station, Texas
Department of Medicine, UCSF, San Francisco, California
The major goal for this special issue is to focus attention on emergent research that investigates how biological, behavioral, and social factors influence aging and health outcomes over the life-course. This will be accomplished by presenting new research findings that 1) explore the impact of health behaviors and social circumstances on the health and longevity of middle-aged and older adults; 2) elaborate the role of behavioral and social factors in the onset and course of illnesses, with special attention to the basic mechanisms linking stress, coping, and health outcomes among aging populations; and 3) examine the effectiveness of different intervention approaches for maintaining health and preventing disease/disability. This issue also provides a venue to demonstrate innovations in research methods, assessments, and analyses that are advancing knowledge in this field.
The articles reflect the emphasis on multifaceted and multidisciplinary research advocated at the turn of the twentieth century (1). Included among the authors are clinicians, epidemiologists, psychologists, sociologists, engineers, statisticians, etc. The focus on aging reveals the wide range of biological, clinical, behavioral, and social determinants and consequences impinging on health and functioning of an aging society. In addition, the articles also reflect the life-long process that characterizes aging with some investigators targeting midlife as well as older groups and others examining the link between earlier life histories and future health and functional outcomes (2). Finally, the articles demonstrate the malleability of aging processes and how intervention efforts can avoid or delay the onset and progression of certain age-related conditions and enhance the capacity of older adults to manage their daily lives and health situations (3).
We are learning also about the iterative and evolving process of research. What we think we know may be limited by the previous methodological and measurement problems leading to faulty conclusions. Thus, articles demonstrating new measurement or analytic approaches are important for advancing this field of study.
The first section of this issue links social circumstances and health behaviors to health outcomes. Longitudinal studies of working lives shed light on how changes and stabilities in the nature of work can impact on health outcomes. Examining the relationship between life course work exposures and all-cause mortality, Amick and colleagues (4) point to the importance of job control with the finding that working in low control jobs for a working life is associated with a 43% increase in the likelihood of death. Kahana et al. (5) draw attention to the need to evaluate interventions, not in terms of impact on mortality but rather to investigate effects on functioning and quality of life. Exploring the long-term health quality of life benefits of engaging in proactive preventive behaviors, these investigators reveal that physically active and smoke-free lifestyles continue to make a difference for the quality of life of the old-old residing in retirement communities.
The second section includes studies exploring biobehavioral pathways to health and illness. Using a new concept of cumulative biological risk known as allostatic load, Seeman and colleagues (6) address the biological pathways through which social integration and support affect morbidity and mortality risks in both midlife and later life. Exploring different mechanisms by which loneliness has deleterious effects on health in both college students and older adults, Cacioppo et al. (7) reveal the importance of cardiovascular activation and sleep dysfunction as two critical predisease mechanisms. Vitaliano and colleagues (8) examine gender differences in the relationships of chronic stress, pathophysiology, and coronary disease documenting biological bases for the deleterious effects of stress on caregivers and reporting significant differences between men and women in stress responses. Testing the common sense model of self regulation, Mora and colleagues (9) examine the differential effects that negative affect has on symptom reporting, illness episodes, and care seeking among older adults.
Intervening to promote health and manage chronic illnesses/disabilities is the focus of the third section of papers. Intervention effectiveness is dependent on adherence to treatment protocols and Kearney and colleagues (10) shed light on the major behavioral influences on older women’s adherence to a dietary modification protocol. The next set of papers address different aspects of caring for loved ones with dementia. Castro and colleagues (11) demonstrate the feasibility and benefit of providing a home-based health promotion counseling program for increasing caregivers’ physical activity levels. Examining the feasibility of technological interventions for meeting the care needs of an older population, Czaja and Rupert (12) describe how emergent telecommunication technology can assist caregivers and improve their quality of life. Combining pathophysical and intervention research approaches, Grant and colleagues (13) show that placement or death of a spouse does not result in immediate improvement in physiological functions, indicating the persistence of physiological altercations with chronic stress associated with age-related diseases.
The final section of articles presents new insights from enhanced research methods, measurements, and analytical techniques. The first two articles deal with cutting edge neuroscience research. As shown by Mega and colleagues (14) new high-resolution three-dimensional brain magnetic resonance imaging techniques reveal the identification of the right hippocampal area as an early site of atrophy in early memory impairment. Comparing neuropsychological evaluations with post mortem brain studies of centenarians, Silver and colleagues (15) show that a divergence sometimes occurs between cognitive functioning and brain pathology suggesting the presence of a functional reserve to delay the functional expression of pathological changes. The next three articles deal with different aspects of assessments, with the overriding goal being the enhancement of the sensitivity and usefulness of assessment tools in different populations. There has also been a need to develop easily administered physiological markers into large scale, epidemiologic studies of aging. Testing several different markers, Powell and colleagues (16) identify evening salivary cortisol and urinary testosterone from a first morning void as promising markers of marital upheaval. The assessment of quality of life in older adults with cognitive impairment has been challenging. Lodgdon and colleagues (17) describe the theoretical, psychometric, and practical considerations of a new quality of life assessment called the QOL-AD. In response to the dearth of measurement assessment tools to assess adaptive strategies used by minorities to cope with subclinical disease, Hazuda et al. (18) have combined qualitative and quantitative measurement approaches to develop a new reliable and valid instrument called ADAPT.
The final article in this section addresses statistical issues common to the analysis of longitudinal studies focused on older chronic care populations. Comparing traditional approaches with modern methods for the analysis of repeated measures of hierarchical multicenter data, Petkova and Teresi (19) show how newer more appropriate statistical analyses can reveal significant differences in institutional care research that may have been masked by less powerful statistical techniques.
With this special issue, we hope to interest Psychosomatic Medicine readers in research on aging and the life-course. Psychosomatic research has a long tradition of elucidating the complex interactions among biological, behavioral, and social factors that influence health outcomes. The articles included here demonstrate the challenges and the opportunities that await scientists and practitioners who decide to focus their efforts on understanding the aging process or intervening to enhance the health and quality of life of Americans as they age. The importance, and indeed, urgency, of such efforts will only increase in the coming years as the advances in medicine, public health, and technology being unveiled every day converge with unprecedented growth of the aging population (20–24).
REFERENCES
This article has been cited by other articles:
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  P. P. Vitaliano, R. Persson, A. Kiyak, H. Saini, and D. Echeverria Caregiving and Gingival Symptom Reports: Psychophysiologic Mediators Psychosom Med, November 1, 2005; 67(6): 930 - 938. [Abstract] [Full Text] [PDF]
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