Handbook of Psychology

Research Opportunities in Health Psychology and Aging 499

together implicates shared environmental in”uences. The
twins were born between 1886 and 1958. Longitudinal data
were collected by mail and in personal interviews every three
years. McClearn and Heller developed a battery of sophisti-
cated statistical methods for analysis of their data that allows
them to estimate parameters in adjacent age bands of respon-
dents that include estimates of relative genetic, environmen-
tal, and shared variance from the ages of 36 to 76. They
present data on three measures of lipids„serum cholesterol,
HDL cholesterol, and triglycerides„taken at in-person vis-
its. While we may have thought this complex enough„data
show that relative proportions of genetic, shared rearing en-
vironment, and nonshared rearing environment change with
age differentially for the health-related variables studied„
this is particularly striking for the three indicators of choles-
terol measured at in-person testing. The complex patterns
show important age relationships that had not been even
dreamed of before.
Ewbank (2000) reviewed the extraordinary progress in ge-
netics during the past 10 years and puts it in context. While
written for demographers, the data is useful for psychologists
as well. Demographers are more advanced in their thinking
about the role of behavioral and social variables on survival
and the role that age plays in such models. One gene has
“gured prominently in the study of Alzheimer•s disease:
apolipoprotein E. It has three different common polymor-
phisms„e2, e3, and e4„and individuals can have one of six
combinations. The e3/e3 is the most common and is found in
60% to 70% of most populations. The e3/4 and the e4/4 are
associated with increased risk of both AD and CHD, and the
e2/2 and e2/3 are associated with a reduced risk of AD. In
particular, the detailed discussion of the apolipoprotein E
gene, which has implications for both Alzheimer•s disease
and ischemic heart disease, is particularly useful, along with
a paper by Corder et al. (2000) indicating that APOE deter-
mines survival time in those over age 85 due to cardiovascu-
lar disease, not due to dementia. For a complete discussion of
the genetic factors in Alzheimer•s disease, see Roses and
Saunders (2001).
The genetics revolution is also changing what we thought
we knew about cognitive changes in survival, distance from
death, and terminal drop. See Bosworth & Siegler (in press)
for a detailed discussion of these issues.

RESEARCH OPPORTUNITIES IN HEALTH
PSYCHOLOGY AND AGING

Aside from the traditional understanding of the role of aging
on disease and the role of disease on aging, there are some
opportunities for research in health psychology that will

bene“t from a consideration of aging or are better studied

from an aging point of view. These include stress and aging,

decision making, adherence to treatments for chronic disease,

coping with disease, and gender differences in health. Health

psychology also has important contributions to make to stud-

ies of cancer and aging.

Stress and Aging

Psychosocial factors and stress are key health psychology

concerns (see Baum & Posluszny, 1999). An excellent venue

to study the relationship between stress and aging has been

caregiving. Work by Vitaliano et al. (in press) and by

Robinson-Whelen, Kiecolt-Glaser, and Glaser (2000) has

been important in using this approach to study the physiolog-

ical as well as the psychological consequences of caregiving.

Decision Making

Decisions about health may be compromised by cognitive

changes (see Peters, Finucane, MacGregor, & Slovic, 2000),

thus research on decision making that takes these cognitive

changes into consideration is needed. Even without cognitive

changes, older persons may be more dependent on children

and spouses in making decisions about health care screening

and treatment options.

Adherence and Chronic Disease

Health psychology can play an important role among the

elderly in terms of behavioral interventions. It is known that

risk-reduction programs are ef“cacious (see Burke, Dunbar -

Jacobs, & Hill, 1997, for a summary). However, the extent to

which these programs are effective in the individual may

depend on adherence. Nonadherence crosses treatment regi-

mens, age and gender groups, and socioeconomic strata.

Adherence is a signi“cant problem. It is estimated that 50%

of individuals discontinue participation in cardiac rehabilita-

tion programs in the “rst year, 16% to 50% of hypertension

patients discontinue their medication in the “rst year of treat-

ment (Flack, Novikov, & Ferrario, 1996; Jones, Gorkin, Lian,

Staffa, & Fletcher, 1995; Juncos, 1990), and 20% to 80% of

patients who have antidepressant medications prescribed fail

to adhere to the prescription at one month (DiMatteo, Lepper,

& Croghan, 2000). Nonadherence rates for hormonal

replacement medication over one to two years range from

27% to 61% (Brett & Madans, 1997; Chung, Lau, Cheung, &

Haines, 1998; Faulkner, Young, Hutchins, & McCollam,

1998; Hemminki & Topo, 1997; Oddens & Boulet, 1997;

P. Ryan, Harrison, Blake, & Fogelman, 1992). Since the ben-

e“cial ef fects of risk reduction on many chronic diseases and