Knowledge about the practice of health habits by elderly women is needed by healthcare providers who seek to facilitate self-regulatory health behavior among older women.1 There is as yet little documentation in the literature of the characteristics of health and health behavior of older women. A brief summary of a study's findings on the practice of health habits among a group of elderly widows is presented in this article followed by discussion of the findings in relation to other research, and suggestions for further investigation.
Breslow and his co- workers2,3 identified seven basic health habits that are significantly related to the health of both sexes throughout adulthood, and to life expectancy up to 75 years of age: 1) Never smoking cigarettes; 2) Moderate or no use of alcohol; 3) Getting seven to eight hours of sleep per day; 4) Eating breakfast almost every day; 5) Eating snacks between meals less often than every day; 6) Engaging in regular physical activity; and 7) Maintaining desirable weight (ie, being not more than 10% above ideal weight). Palmore4 found a similar positive relationship between three of these health habits and the health of older men - exercise, no smoking, and moderate weight.
A correlational study was conducted to identify the strength of health locus of control (HLC), self-rating of health, number of health problems, and demographic variables as predictors of the practice of these seven health habits by elderly widows.
Overview of the Study
Widows who lived in apartments in two housing units in a large Mid-Atlantic city were invited to participate in the study. This involved having height and weight measured and filling out three questionnaires: the Background Data Questionnaire, the Multidimensional Health Locus of Control Scale, and the Health Habits Questionnaire. The sample consisted of 84 volunteers, the majority of whom were black (71%). The remaining 29% were white.
Other demographic characteristics included a mean age of 73 years and an average of nine years of education and 19 years of widowhood. Twenty-nine percent of the subjects rated their health as good to excellent, while the majority (71%) rated it as fair to poor. The mean number of health problems reported was three, among which arthritis, hypertension, and vision problems were most frequently noted.
Data collection was conducted in small group sessions ranging from 30 to 45 minutes in length over a period of five weeks. Once they understood the task, most subjects completed the instruments independently. A few were given individual assistance with care to ascertain their beliefs without biasing their responses.
CORRELATION OF STUDY VARIABLES WITH PRACTICE OF HEALTH HABITS
Summary of Findings
Practice of Health Habits. The women in this study reported practicing an average of 4.5 of the seven health habits, compared to an average of 4.9 in 1965 and 1974 surveys of Breslow et al of a large adult population.3 Twentytwo (26%) reported the practice of sis to seven health habits, a level of health habit practice that Breslow found to be most positively related to life expectancy. An almost equal number (19, or 23%) reported practice of one to three health habits, a level that Breslow found associated with significantly higher mortality over a 9'/z year period. More than half of the subjects (43, or SI'%) reported practice of an in-between number four to five health habits.
The following health habits were reported as practiced by more than half of the subjects: moderate or no use of alcohol (98%); eating breakfast regularly (79%); getting regular exercise (78%); and not eating snacks daily and never having smoked (both 50%). The surprisingly high number reporting sufficient exercise to qualify for practice of this health habit, may be related to the instrument's allowing the subjects to define for themselves "sometimes taking a long walk" or "doing physical exercises almost every day." One subject in her 80s was a bilateral, abovethe-knee amputee who managed her activities of daily living independently and reported doing daily exercises "that I can do." Another 80-year-old spontaneously demonstrated how she integrated exercising with her daily prayer sessions which included singing and dancing. Several widows mentioned attending exercise classes in local senior centers.
It is not surprising that fewer of the subjects (45%) reported getting seven to eight hours of sleep regularly considering the changes in steep patterns that occur with aging, for example, taking longer to get to sleep and more frequent awakening. Even fewer (33%) were <10% above desirable body weight for their height and body build according to the Metropolitan Life Insurance revised 1983 tables.5 Factors that may make maintaining recommended weight difficult for older women include the decreased metabolic rate and activity level that result in a decreased caloric requirement for this age group, as well as the fact that eating may be one of the chief pleasures of life still available to the older widow.
The appropriateness of using the same weight chart for all adult women may also be questioned. The Metropolitan Life Insurance tables indicate that these norms were developed to apply to adults up to 59 years of age. Also, the 1-in to 3-in height loss that occurs with aging places the individual woman in a lower desirable weight range than when she was younger. No discussion of this has been found in the literature. There is also some evidence6·7 that a less stringent weight criteria (ie, up to 20% to 25% above desirable weight) is congruent with maintaining health and longevity, except for males in their 40s. a Using this less stringent criteria, over half of the subjects (57%) would have been credited with practicing this health habit.
Except for the item related to smoking, the Health Habits Questionnaire provided information on present health habits. Whether the subjects' selfreports reflected consistent long-term practice of the other health habits is questionable. Breslow 's longitudinal data, however, indicated that health habit practice in the same adult sample over a 916 year period changed very little. Wiley and Camacho's8 longitudinal analysis of the same data indicated that two of the seven health habits were not predictive of future health status, ie, eating breakfast and snacking. Clearly, more research needs to be done to determine the degree of benefit beginning or continuing such health habits has in reducing mortality and morbidity in old age.
Health Locus of Control Orientation. The Health Locus of Control (HLC) variable was included in the study because prior research9 indicated a positive relationship between internal ity and health behaviors. The study's findings indicated that these older women had, as a group, remained as internal as larger samples of healthy adults;9 that is, they believed just as strongly that their health is dependent on their own actions. However, the sample was also found to be more externally oriented; that is. they believed more strongly that their health is also dependent on powerful others (such as family members or health professionals) and on luck, chance, or fate. Considering the decrements of aging and the illnesses that can occur despite the best care one can take of oneself, it is not surprising that these older women viewed their health as controlled by chance aJmost as much as by themselves or powerful others. These women were also realistic in viewing their health as more dependent on powerful others while retaining their own sense of responsibility for their health.
Relationships Among Study Variables. Of the variables studied, internal HLC correlated most strongly with the practice of health habits by these older women (Pearson r= .26; p-<.OI). As indicated by the Table, the only other variables found ?? be significantly related to health habit practice (p=<.05) were: number of health problems (r= - .23); health self-rating (r=,23); and years of education (r= .22). Further analysis revealed that only HLC internality was shown to be a significant predictor of the practice of health habits. This variable was found to account for only 7% of the variance in the number of health habits practiced by this predominantly black sample of elderly widows. Variables not looked at in this study, such as past and present socioeconomic status and life roles, functional level, future orientation, life satisfaction, and length of marriage, may be more powerful predictors of the practice of health habits by elderly widows.
Discussion of Findings in Relation to Other Research
Brown, Muhlenkamp et al10 found, in an adult female population more highly educated and more affluent than the sample used in this article, that HLC orientation accounted for approximately 20% of the variance in health promotion activity. Laffey and Eisenberg" found the perception of the importance of physical exercise to be a much more significant predictor of the amount of physical exercise reported by a sample of adult women than internal HLC. Educational level was also found to be a significant predictor of health habit practice in this study.
These researchers suggested that ascertaining the clients' views about the benefits of specific health behaviors may be more useful than measuring HLC orientation. They also suggested that tools focused on more specific beliefs or expectancies than "health" might measure variables more predictive of health habit practice, eg, exercise or weight control-specific HLC scales. Also, generalized expectancies are more predictive of behavior in novel situations. Since there is so much publicity about exercise today, it was suggested that exercise-related health behavior may be less tied to HLC orientation than are less publicized and visible health behaviors.
Belief in effectiveness of preventive health activities has recently been found to be significantly associated with age.'2 Elderly women are subject to many threats to important self-care capabilities, such as energy level, selfesteem, and independence. Careful assessment of their health beliefs and perceptions, their future orientation, as well as their lifestyle, is needed as a basis for designing effective interventions to promote and maintain health habits in the face of age-related functional deficits.
Suggestions for Future Research
Further exploration of demographic variables is needed to identify the best predictors of the practice of health habits by older women. The health-related beliefs and perceptions about specific health habits of different groups of elderly women should continue to be investigated with a focus on how these variables relate to actual health behavior. If futher studies indicate that HLC- internality is a useful predictor of the practice of health habits by older women, experimental studies to test ways of supporting internality in this population group should be done.
In-depth studies of specific health habit practices are needed to increase our knowledge base regarding health in older women. For example, Krondl, Lau et al13 found health beliefs to be strong motives in food selection by healthy seniors who lived alone. Women showed greater use of several items, especially fruits and vegetables. Further study is also needed regarding the relationship between specific health habit practice and the present and future health status of older women to more clearly identify which health behaviors continue to have a significant positive impact.
Even though older women have always outnumbered older men, men have much more often been the subject of gerontological research. It is time to examine more closely the nature of health in the older woman. By the year 2000, there will be ten women for every five men over the age of 75.14 The typical older woman of tomorrow is likely to be healthier, better educated, native born, and not living with a spouse. She is also likely to be more independent and articulate regarding her health needs. Nurses, as important Healthcare providers, will need to demonstrate through research and practice that they have the knowledge and ability to work with older women in ways that promote and protect healthy aging.15
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- The author wishes to acknowledge the support of the Robert Wood Johnson Foundation, through its Nurse Faculty Fellowship Program in Primary Care, for the study described in this article.
CORRELATION OF STUDY VARIABLES WITH PRACTICE OF HEALTH HABITS