Stanislav V. Kasl

Longevity Increased by Positive Self-Perceptions of Aging

This research found that older individuals with more positive self-perceptions of aging, measured up to 23 years earlier, lived 7.5 years longer than those with less positive self-perceptions of aging. This advantage remained after age, gender, socioeconomic status, loneliness, and functional health were included as covariates. It was also found that this effect is partially mediated by will to live. The sample consisted of 660 individuals aged 50 and older who participated in a community-based survey, the Ohio Longitudinal Study of Aging and Retirement (OLSAR). By matching the OLSAR to mortality data recently obtained from the National Death Index, the authors were able to conduct survival analyses. The findings suggest that the self-perceptions of stigmatized groups can influence longevity.

Health Behavior, Illness Behavior and Sick Role behavior: I. Health and Illness Behavior

Health Behavior, Illness Behavior and Sick Role behavior Stanislav V. Kasl PhD & Sidney Cobb MD To cite this article: Stanislav V. Kasl PhD & Sidney Cobb MD (1966) Health Behavior, Illness Behavior and Sick Role behavior, Archives of Environmental Health: An International Journal, 12:2, 246-266, DOI: 10.1080/00039896.1966.10664365 To link to this article: http://dx.doi.org/10.1080/00039896.1966.10664365

Selected Psychosocial Models and Correlates of Individual Health-Related Behaviors

RELATIVELY LOW LEVELS of public participation in screening, immunization, and other preventive health programs have been extensively documented,21 50 55, 91 as have the generally poor rates of individual compliance with prescribed medical therapies.42, 52, 81, 86 Over the past two decades, hundreds of research reports and review articles have been published reflecting the desire to both discover and better under-

Days of Delirium Are Associated with 1-Year Mortality in an Older Intensive Care Unit Population

RATIONALE Delirium is a frequent occurrence in older intensive care unit (ICU) patients, but the importance of the duration of delirium in contributing to adverse long-term outcomes is unclear. OBJECTIVES To examine the association of the number of days of ICU delirium with mortality in an older patient population. METHODS We performed a prospective cohort study in a 14-bed ICU in an urban acute care hospital. The patient population comprised 304 consecutive admissions 60 years of age and older. MEASUREMENTS AND MAIN RESULTS The main outcome was 1-year mortality after ICU admission. Patients were assessed daily for delirium with the Confusion Assessment Method for the ICU and a validated chart review method. The median duration of ICU delirium was 3 days (range, 1-46 d). During the follow-up period, 153 (50%) patients died. After adjusting for relevant covariates, including age, severity of illness, comorbid conditions, psychoactive medication use, and baseline cognitive and functional status, the number of days of ICU delirium was significantly associated with time to death within 1 year post-ICU admission (hazard ratio, 1.10; 95% confidence interval, 1.02-1.18). CONCLUSIONS Number of days of ICU delirium was associated with higher 1-year mortality after adjustment for relevant covariates in an older ICU population. Investigations should be undertaken to reduce the number of days of ICU delirium and to study the impact of this reduction on important health outcomes, including mortality and functional and cognitive status.

Religion, Disability, Depression, and the Timing of Death'

Despite its importance in Durkheims work, the subject of religions influence on health and well-being is rarely addressed in contemporary sociological research. This study of elderly persons in New Haven, Connecticut, examines the prospective relationship between religious involvement and several aspects of health status. Results show significant protective effects of public religious in volvement against disability among men and women and of private religious involvement against depression among recently disabled men over a three-year period. Religious group membership also protected Christians and Jews against mortality in the month before their respective religious holidays during a six-year period. The article concludes that religious involvement exerts a strong positive effect on the health of the elderly; that this effect varies by religious group and by sex; that the health behaviors, social contacts, and optimistic attitudes of religious group members may explain part but not all of this association; and that several aspects of religious experience, such as participation in ritual and religions provision of meaning play a role.

Prognostic Importance of Emotional Support for Elderly Patients Hospitalized With Heart Failure

BACKGROUND Several studies have indicated that a variety of social relationships are important predictors of morbidity and mortality in patients with coronary artery disease, but little attention has been focused on the prognostic importance of these factors in the growing population of elderly patients with heart failure. To address this issue, we sought to determine whether emotional support is associated with fatal and nonfatal cardiovascular events in elderly patients hospitalized with heart failure. METHODS AND RESULTS We reviewed the medical records of 292 subjects aged > or =65 years who were hospitalized with clinical heart failure and were part of the New Haven, Conn, cohort of the Established Population for the Epidemiologic Study of the Elderly, a longitudinal, community-based study of aging that included a comprehensive assessment of psychosocial support. In the unadjusted analysis, lack of emotional support was significantly associated with the 1-year risk of fatal and nonfatal cardiovascular outcomes [odds ratio, 2.4; 95% confidence interval, 1.1 to 4.9]. After adjustment for demographic factors, clinical severity, comorbidity and functional status, social ties, and instrumental support, the absence of emotional support remained associated with a significantly higher risk (odds ratio, 3.2; 95% confidence interval, 1.4 to 7.8). The test for interaction between emotional support and sex was significant (P=.01). In the fully adjusted model, the odds ratio for women was 8.2 (95% confidence interval, 2.5 to 27.2) compared with 1.0 (95% confidence interval, 0.3 to 3.3) for men. CONCLUSIONS Among elderly patients hospitalized with clinical heart failure, the absence of emotional support, measured before admission, is a strong, independent predictor of the occurrence of fatal and nonfatal cardiovascular events in the year after admission. In this cohort, the association is restricted to women.

The experience of losing a job: reported changes in health, symptoms and illness behavior.

&NA; Changes in health and in behavior related to health‐illness were described in men whose jobs were abolished because of a permanent plant closing. Fluctuations in several measures based on a 2 week health diary (Days Complaint, Days Disability, Percent Days Complaint That Are Also Days Disability, Days Saw Doctor, Days Used Drugs), as well as in other indicators (Symptoms, Depression, Dissatisfaction with Social Support) were analyzed as the men went through the various phases of anticipation, plant closing, unemployment and re‐employment. Differences in the objective and subjective severity of the experience, in the social setting of the plant closing (urban vs. rural) and in selected personal characteristics were also examined for their influence on the changes in the various health‐related measures.

Fatigue and psychological distress in the working population: Psychometrics, prevalence, and correlates

OBJECTIVE The purposes of this study were: (1) to explore the relationship between fatigue and psychological distress in the working population; (2) to examine associations with demographic and health factors; and (3) to determine the prevalence of fatigue and psychological distress. METHODS Data were taken from 12,095 employees. Fatigue was measured with the Checklist Individual Strength, and the General Health Questionnaire (GHQ) was used to measure psychological distress. RESULTS Fatigue was fairly well associated with psychological distress. A separation between fatigue items and GHQ items was shown. No clear, distinct pattern of associations was found for fatigue vs. psychological distress with respect to demographic factors. The prevalence was 22% for fatigue and 23% for psychological distress. Of the employees reporting fatigue, 43% had fatigue only, whereas 57% had fatigue and psychological distress. CONCLUSIONS The results indicate that fatigue and psychological distress are common in the working population. Although closely associated, there is some evidence suggesting that fatigue and psychological distress are different conditions, which can be measured independently.

Blood pressure changes in men undergoing job loss: a preliminary report.

&NA; A longitudinal study was made of blood pressure (BP) changes in married, stably employed men who lose their jobs because of a permanent plant shutdown. Some 150 men, including controls, were seen and followed up to 2 years. Major findings were as follows: (1) The controls showed no significant long‐term trends, (2) BP levels during anticipation of job loss and unemployment or probationary re‐employment were clearly higher than during later stabilization on new jobs, (3) Men whose BP levels remained high longer: (a) had more severe unemployment, (b) were lower on Ego Resilience, (c) reported longer‐lasting subjective stress, and (d) failed to show much improvement in reported well‐being, (4) Within the period of anticipation, there was a clear rise in BP which was correlated with subjective ratings of felt stress, and (5) These major BP changes were replicated in preliminary results from a second company.

Patients With Depressive Symptoms Have Lower Health Status Benefits After Coronary Artery Bypass Surgery

Background—Depression is an established independent prognostic factor for mortality, readmission, and cardiac events after CABG surgery. However, limited data exist on whether depression influences functional outcomes after CABG. Methods and Results—We followed 963 patients who underwent first CABG between February 1999 and February 2001. At baseline and at 6 months after CABG, we interviewed patients to assess depressive symptoms using the Geriatric Depression Scale (GDS) and physical function using the Short Form-36 Physical Component Scale (PCS). The patient’s physical function was considered improved if the PCS score increased ≥5 points at 6 months. Patients with high GDS scores were younger, were more often female, and had worse physical function and higher comorbidity than patients with low GDS scores. Rates of improvement in physical function were 60.1% for a GDS score <5 (below 75th percentile), 49.8% for a GDS score between 5 and 9 (75th to 90th percentile), and 39.7% for a GDS score ≥10 (≥90th percentile; P=0.002 for the trend). Depressive symptoms remained a significant independent predictor of lack of functional improvement after adjustment for severity of coronary artery disease, angina class, baseline PCS score, and medical history. A GDS score ≥10 was a stronger inverse risk factor for functional improvement after CABG than such traditional measures of disease severity as previous myocardial infarction, heart failure on admission, history of diabetes, and left ventricular ejection fraction. Conclusions—Higher levels of depressive symptoms at the time of CABG are a strong risk factor for lack of functional benefits 6 months after CABG.