500 Adult Development and Aging
problems are not realized immediately, long-term adherence
is essential for the strategies to be effective (Burke et al.,
1997). Age does not affect adherence directly. However,
changes in cognitive functioning and multiple prescriptions
may make adherence more dif“cult with increasing age.
Aging and Coping with Disease
A growing body of literature indicates that older chronic pa-
tients are likely to cope better with chronic diseases than their
younger counterparts. Younger cancer patients, for example,
are more likely to be distressed than older patients (Van•t
Spijker, Trijsburg, & Duivenvoorden, 1997). Possible expla-
nations are that older adults with diseases are less distressed
than younger adults because they experience less violation of
cognitive schemas, they engage in more positive downward
social comparisons, and they perceive less attendant block-
age to central goals. It is also possible that this age difference
is an epiphenomenon of younger adults• propensity to report
greater distress in general. Finally, Neugarten (1976) points
out that the onset of chronic illness in old age is more usual in
that part of the lifecycle and therefore possibly less disrup-
tive. We found support for this last point in a study of 4,278
cardiac catheterization patients. We observed that physical
function and physical role function were lower with age,
whereas mental health, emotional role function, and vitality
were higher with age (Bosworth et al., 2000).
Geropsychology
In this chapter, we have not reviewed the literature with the
elderly as a clinical treatment population in detail. Geropsy-
chology has been an area of concern for a long time„
excellent review chapters have been collected for the past
20 years (e.g., Gatz, 1989; Nordhus, VandenBos, Berg, &
Fromholt, 1988; Qualls & Abeles, 2000; Storandt, Siegler, &
Elias, 1978). The research base needed to develop appropri-
ate treatments at the intersections of physical disease, and
aging is part of the content of behavioral medicine that health
psychologists need to know (see Siegler, Bastian, et al., in
press). An excellent set of chapters can be found in Smith and
Kendall (in press) in their special issue updating the clinical
aspects of behavioral medicine.
Gender, Health, and Aging
Menopause presents women with choices about hormone
replacement therapy that are determined not only by
menopausal symptoms but also by long-term possible
prevention of CHD, osteoporosis, and Alzheimer•s disease
(Matthews, Wing, Kuller, Meilahn, & Owens, 2000; Siegler
et al., 2002). Conversely, there is not a clear marker of
midlife in men. Like estrogens, androgen levels decrease
with age and have a broad range of effects on sexual organs
and metabolic processes. Androgen de“ciency in men older
than 65 leads to a decrease in muscle mass, osteoporosis, de-
crease in sexual activity, and changes in mood and cognitive
function, leading us to speculate that there may be at least
two phases of chronic diseases related to androgen levels in
men. Whether men over 65 would bene“t from androgen re-
placement therapy is not known (Tenover, 1999). Any poten-
tial bene“ts from this therapy would need to be weighed
against the possible adverse effects on the prostate and car-
diovascular system. Thus, considering men and women sepa-
rately may be useful (Siegler, Bastian, & Bosworth, 2001). In
fact, research on timing of menopause suggests that ovarian
aging may be a marker of an overall biological clock
(Robine, Kirkwood, & Allard, 2001; Snowdon, 2001).
An additional reason to examine the relationship between
health, disease, and aging separately for gender is that, at all
ages, women are more likely than men to have acute and
chronic conditions. The problem is not that they receive less
health care. In fact, women are more likely to be insured and
more likely to go to the doctor. Men have higher rates of cer-
tain diseases, notably heart disease, stroke, lung cancer, and
liver disease, but women have more of nearly all other chronic
conditions, including hypertension, arthritis, osteoporosis, eat-
ing disorders, diabetes, depression, and reproductive diseases
(Merrill & Verbrugge, 1999). Before 70 years of age, women
have a worse prognosis than men following acute myocardial
infarction (AMI; Vaccarino, Krumholz, Yarzebski, Gore, &
Goldberg, 2001). Studies in men suggest that psychosocial
factors are important determinants of cardiovascular health
(Kaplan et al., 1993; Orth-Gomer, Unden, & Edwards, 1988;
Williams & Littman, 1996). In particular, work stress has been
associated with increased coronary heart disease (CHD) inci-
dence and poorer prognosis in men (Schnall & Landsbergis,
1994). Among women in this age group, psychosocial stress
in relation to CHD has been studied rarely (Eaker, 1998).
However, it appears that work stress is not as relevant to
women whereas marital stress has been found to be a signi“-
cant increased risk of recurrent CHD and poorer response in a
middle-age sample of women (Orth-Gomer et al., 2000).Cancer and AgingCompared to the work on cardiovascular disease, there has
been less work in cancer. This is a major opportunity for
health psychologists interested in the intersection of aging
and health.