Table Of ContentBehavior,
Health,
and Aging
Edited by
Stephen B. Manuck
Richard Jennings
Bruce S. Rabin
Andrew Baum
BEHAVIOR, HEALTH,
AND AGING
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BEHAVIOR, HEALTH,
AND AGING
lidltrat by
Stephen B, Manudfc
Richard Jennings
Bruce S, Rabin
Andrew Baum
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VD Psychology Prew
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First published by Lawrence Erlbtwm Associates, ltic , Publishers
This edition published 2013 by Psychology Press
Psychology Press Psychology Press
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Copyright C'2000 by Laurence Krlbaum Associates, Inc.
All rights reserved No part of this book may be reproduced in any
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Lawrence Frlh.mm Avsod^tes, Inc,, Publishers
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Library of Congress Calalo&ing-in-Publkation Data
Behavior, health, and aging / edited by Stephen Manuck (et al.J
p. cm- — (Perspectives in behavioral medicine)
Includes bibliographical references and indes
ISBN 0-8l>W-3404-4 (doth : alk- paper),
I. Aged—Health and hygiene. 2. HeaHh behavior—Age factors
3, Aging, 4- Geriatrics,
RA564.B.B43 2000
618.97—dc2l 99-0SS82O
10 9 8 7 6 5 4 3 2 1
Contents
Preface
Genetics and Aging
Gerald E. McClearn and Debra A. Heller
Quality Adjusted Life Expectancy for Men
and Women in the United States
Robert M. Kaplan and Jennifer Erickson
Aging Women, Getting Older, Getting Better?
Elaine Leventhal
Menoupau.se as a Turning Point in Midlife
Karen A. Matthews, Rena R. Wing. Lewis H. Knller.
Elaine N. Meilahn, and Jane F. Owens
Changes in the Immune System During Aging
Bruce S. Rabin
Effect of Chronic Stress on Immune Function
and Health in the Elderly
Susan Robinson-Wlielen. Janice K. Kiecolt-Glaser.
and Ronald Glaser
Neuroimmunc Interactions: Implications for Aging
and Innnunosenescence—Rodent Models
David A. Padgett, Cathleen M. Dobbs, and John F. Sheridan
Immune Functions, Their Psychological Correlates, and Health
George F. Solomon and Donna Benton
vi CONTENTS
9 Negative Affect and the Disablement Process in Late Life:
A Life-Span Control Theory Approach
Richard Schulz, Jutta Heckhausen, and Alison O'Brien 119
10 Psychological Factors, Health, and Disease:
The Impact of Aging and the Life Cycle
Reford B. Williams 135
11 Coping with Chronic Illness Among the Elderly:
Maintaining Self-Esteem
Vicki S. Helgeson and Kristin Mickelson 153
12 Sex, Psychosocial Stress, and Atherosclerosis:
A Monkey Model
Michael R. Adams. Steven B. Manuck,./. Koudy Williams,
Jay R. Kaplan, and Carol A. Shively 179
13 Comparative Effects of Age and Blood Pressure on
Neuropsychological Test Performance: The Framingham Study
Merill F. Elias, Penelope K. Elias. Ralph B. D'Agostino,
and Philip A. Wolf 199
14 Uncertain Health Effects of Cholesterol Reduction
in the Elderly
Matthew F. Muldoon, Jay R. Kaplan, and Stephen B. Manuck 225
Author Index 245
Subject Index 263
Preface
Millennial events are peculiar for many reasons, particularly when they
occur in the context of the millions of years that preceded recorded time
keeping and history. They tend to focus attention on long-anticipated out
comes as a fitting conclusion to 1,000-year epochs (this occurs at the end
of centuries and decades too. but to a lesser extent) and on the changes
that the next epoch promises. They are useful as a way of focusing atten
tion on changes that occur independent of changes in the calendar, taking
advantage of the heightened focus on summarizing where we’ve been and
where we are going. So, as a rubric for summarizing changes that may
come to dominate our lives in the first 50 to 100 years of the new mil
lennium, they serve a useful puipose. One of the most important changes
characterizing the new era is the changing nature of our population and
its health care demands. Most prominently, our population is aging as
people live longer and remain active longer into their lives. As the popu
lation ages it becomes more diverse and our knowledge and priorities
must change as well. This book deals with aging in the context of health
and health care needs. It considers basic changes that accompany aging
and some of the more specific problems that accompany it. Several issues
are predominant. Genetics has assumed increasing importance, both in
terms of the genomic instability we associate with advancing age and in
terms of expression of heritable predispositions and exhibition of pre
dictable behaviors or disorders. Maclearn and Heller review basic tenets
of this evolving field, including some of the methods of looking at heri
table differences in health and well-being and some consideration of the
implications of discovering genes or polymorphisms that appear to be
vii
viii PREFACE
related to accelerated senescence, systemic disease, or depression.
Overall, the genetic bases of differences in how quickly people age and/or
lose functional competence are of considerable interest as are the envi
ronmental conditions that affect the shape such predispositions assume.
The second chapter considers another development that has important
implications for health care in the next epoch, adjustment of life
expectancy for quality of life. Most of us are aware of changes in the
recognition of and emphasis on quality of life in planning therapeutic
interventions for disease or disability and most of us can recognize the
importance of factoring such concerns into decision-making and research.
Kaplan and Erickson discuss the wisdom and value of quality-adjusted
survival analysis and describe the findings of a study of such analyses in a
large sample of men and women, reporting differences between men and
women in overall quality of life. More significantly, quality adjustments
had greater impact on life expectancy among women, negating much of
the life expectancy advantages typically afforded them. In contrast to mor
tality-based measures of health outcomes that show women with a clear
survival advantage, quality-of-life measures suggest advantages for men.
Issues associated with gender are also a prominent theme of the third
chapter. Here, Leventhal argues that gender differences in symptoms,
behaviors, and outcomes affect the physical and psychosocial impact of
interventions among the elderly, influencing the emergence of frailty or
loss of function and, ultimately, use of the health care system. The impli
cations of a view of aging emphasizing multiple systems are considered,
and the notion that aging and life span development are really a series of
partially independent biological clocks that run at different rates and wind
down at different times is discussed. Of necessity, longevity is associated
with greater heterogeneity as a variety of factors combine to determine
how well people deal with the growth and decline of each of these sys
tems. Gender appears to affect many or most of these systems and impli
cations for behavior, survival, and psychosocial aging are examined.
Chapter 4 continues this focus on gender, focusing on a major life tran
sition among aging women. Matthews, Wing, Kuller, Meilahn, and
Owens attack the anecdotal nature of reports of menopause, suggesting
that despite negative expectations among premenopausal women,
menopause is a complex and potentially positive transition for women
that does not necessarily unfold as cultural stereotypes would indicate.
The chapter comprehensively reviews the biological bases of menopause,
its role in increasing risk for cardiovascular disease, and the emotional
and biological changes that accompany it. Importantly, Matthews and her
PREFACE ix
colleagues report evidence that suggests that non-pharmacologic lifestyle
interventions may modify risk factors during the menopausal period that
reduce potential consequences or health problems later on.
The next four chapters deal with various aspects of aging and the
immune system. Some of the primary health-related consequences of
aging appear to be mediated by the immune system, and the greater vul
nerability of older people to infectious illnesses provides prima facia evi
dence of declines in immune defenses with age. In chapter 5, Rabin sum
marizes our knowledge of immune system changes that occur with aging,
including autoimmune responses, T-cell function, cytokine activity, and
the role of nutrition in aging of immune defenses. This is followed by
Robinson-Whelan, Kiecolt-Glaser, and Glaser’s chapter on chronic stress
as an important immunmodulator in the elderly. This discussion is cen
tered on chronic stress associated with caregiving and its impact on immu
nity, suggesting health implications and possibilities for intervention in
this rapidly growing group of older adults. Chapter 7, by Padgett, Dobbs,
and Sheridan, explores the concept of immune senescence from a differ
ent perspective, using rodent models to evaluate the immune changes
thought to accompany aging. These authors offer a very comprehensive
review of findings bearing on clear trends toward the progressive decline
of immune functions and corresponding increases in vulnerability to infec
tious agents. Finally, Solomon and Benton provide a different challenge to
the traditional view of immunosenescence. Focusing on healthy behaviors
among people doing relatively well in the face of potentially debilitating
disease, they found little evidence of substantial immune system decline in
a group of healthy older men and women who coped well and maintained
good mental health. The implications of this and related findings described
in these four chapters are important components of an overall model of
health, disease, and outcomes of aging.
The last six chapters evaluate some of the psychosocial implications of
aging for health and illness, with emphasis on the contributions of these
factors to cardiovascular disease. In chapter 9, Schulz, Heckhausen, and
O’Brien address the relations between negative emotional experience and
disablement and disability in late life, suggesting that adjustment to limita
tions on prevailing modes of controlling one's environment is a significant
component of the gradual decline many experience. Interventions may
address these limitations, facilitating adjustment to them, or may focus on
the effects of the disablement process and on secondary prevention. In
chapter 10, Williams addresses the dynamic interplay of psychosocial
risk factors, biobehavioral mechanisms underlying pathophysiology, and
