Title: Functional assessment and coping behaviors among the rural black elderly /
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Title: Functional assessment and coping behaviors among the rural black elderly /
Physical Description: ix, 174 leaves : ill. ; 28 cm.
Language: English
Creator: Nickens, Lois Carolyn, 1938-
Publication Date: 1984
Copyright Date: 1984
 Subjects
Subject: African American aged -- Florida -- Alachua County   ( lcsh )
Rural aged -- Florida -- Alachua County   ( lcsh )
Anthropology thesis Ph. D
Dissertations, Academic -- Anthropology -- UF
Genre: bibliography   ( marcgt )
non-fiction   ( marcgt )
 Notes
Thesis: Thesis (Ph. D.)--University of Florida, 1984.
Bibliography: Bibliography: leaves 154-164.
Statement of Responsibility: by Lois Carolyn Nickens.
General Note: Typescript.
General Note: Vita.
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Bibliographic ID: UF00099592
Volume ID: VID00001
Source Institution: University of Florida
Holding Location: University of Florida
Rights Management: All rights reserved by the source institution and holding location.
Resource Identifier: alephbibnum - 000493700
oclc - 11988596
notis - ACR2560

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FUNCTIONAL ASSESSMENT AND COPING BEHAVIORS AMONG THE RURAL
BLACK ELDERLY













By

LOIS CAROLYN NICKENS






















A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY


UNIVERSITY OF FLORIDA


1984
































Copyright 1984


by
Lois Carolyn Nickens


















ACKNOWLEDGEMENTS


Partial support for this research was provided by a

faculty research grant from the University of Florida.

Additionally, many persons have provided me with help and

time in the production of this dissertation. These persons

have included both friends and family members, faculty

members at The University of Florida, and professional

counterparts in the area of aging.

Special thanks are extended to my chairperson, Leslie

Sue Lieberman, who has been a mentor as well as a friend.

Her guidance and direction, critiques and encouragements,

have been of incalculable worth to me and without her sup-

port this dissertation would not have been possible.

Other members of my committee were Dr. Russell Bernard,

Dr. Otto von Mering, Dr. Patricia Wagner, Dr. Lee Crandall

and Dr. Gordon Streib. Dr. Bernard has assisted in making

sure that the research design was rigorous and quantifiable.

Dr. von Mering has given me many helpful suggestions and

encouragement. Dr. Wagner served as the principal investi-

gator for the multiphasic research project that I coordi-

nated in 1981, and has increased my appreciation of the

nutritional problems faced by many elderly persons. I would

like to thank Dr. Crandall for assisting me in understanding

iii









the problems of the rural elderly. Finally, I would like to

thank Dr. Streib for his assistance. All of these persons

have provided assistance and support that made this disser-

tation possible.

Family support was given mainly by my husband, John,

and my daughter, Sheran. John has assisted with editorial

comments, statistical design and analyses. Furthermore, he

provided much moral support in times of critical need.

Sheran cheerfully accepted the fact that I could not take

her to the beach as often as she desired, and additionally,

took over many of my household tasks. My sons, although no

longer living at home, assisted by assuring me that it was

no incredible thing for a mother to pursue a doctorate "at

your age."

Finally, I would like to thank my friends and

professional cohorts at the District III Area Agency on

Aging. They offered me the use of their computers, assisted

me in finding sources of information, and even offered to

sit with my dog so that I could take a few days away from

this project.

This dissertation would not have occurred at all

without the many wonderful elderly people in this county who

have taken time to be with me over these last four years.

















TABLE OF CONTENTS


PAGE

ACKNOWLEDGEMENTS ...................................... iii

LIST OF TABLES ...... ..................................... vii

ABSTRACT ............................................ . viii

CHAPTER

ONE ANTHROPOLOGICAL INTERESTS IN GERONTOLOGICAL
ISSUES .... .................................... 1

Problem and Theoretical Orientation ........ 1
Literature Review .................. ......... 1
Rural Environment and the Elderly ....... 1
Black Elderly ............................. 4
Coping Through Social Contacts .......... 13
Independent Living ......................... 17
Methods of Determining Ability To Live
Independently ............................. 18

TWO STATEMENT OF THE PROBLEM ................ ...... 24

Problem Formulation .......................... 24
Specific Aims ................................. 25

THREE METHODOLOGY ................................... 28

Sample Selection .............................. 28
Geographic Location ......................... 29
Measurement of Functional Capacity .......... 30
Determination of Reliability and Validity of
the Functional Assessment Inventory ......... 32
Material Lifestyles of the Rural Black
Elderly ..................................... 33
Coping Nutritionally ......................... 33
Coping Medically .............................. 34
Participant Observation ........................ 35
Photography .................................. 36









THE COMMUNITIES AND THE BLACK ELDERLY ........


The Research Communities ..................... 38
Case Studies ..... ......... ............ 40
The Black Elderly In Archer .............. 40
The Black Elderly In Alachua ............. 53
The Black Elderly In Hawthorne ........... 63
The Black Elderly in High Springs ....... 70
The Black Elderly In Waldo .............. 77
Generalizations .... .... ...................... 80


FIVE RESULTS ..................................... 82

The Functional Assessment Inventory ......... 82
Sociodemographic Data ................... 83
Reliability of the FAI ................. 87
Validity of the FAI ...................... 87
Comparisons by Race and Sex ............. 90
Coping Behaviors ............................ 94
Sample Characteristics ................. 94
FAI Domains ............................ 94
Material Style of Life ................. 97
Coping Nutritionally ..................... 100
Coping Medically ....................... 108

SIX DISCUSSION .... ................................ 115

Reliability and Validity of the FAI ......... 115
Surviving With No Visible Means of Support .. 119
The Living Environment ................. 119
Food and Food Acquisition ............... 129
Health and Health Maintenance .......... 137
Conclusions .......................... ........ 145
Test of Hypotheses ..................... 145
Summary ................................... 150
Recommendations ............................ 151

REFERENCES CITED ........................................ 154

APPENDICES

A FOOD FREQUENCY ....................................... 165

B MATERIAL STYLE OF LIFE ............................... 170

C COPING STYLES OF THE RURAL BLACK ELDERLY .......... 172

BIOGRAPHICAL SKETCH ................................... 174


FOUR


















LIST OF TABLES


TABLE PAGE

I Sample Characteristics ...................... 85

II Test-Retest Scores ............................. 88

III Inter-Item Reliability Spearman Correlations 89

IV Spearman's Rank Order Correlations of FAI
Domain Scores and Multiphasic Data Base
Items ........................................ 91

V Mean FAI Scores by Race and Sex .............. 93

VI Comparisons by Race and Sex: t-test Values ... 93

VII Black Elderly Sample ............................ 95

VIII Material Lifestyle of the Black Elderly ..... 99

IX Food Frequency ................................. 103

X Food Procurement ............................ 107

XI Assessment of Physical Health ................ 109

XII Coping With Medical Needs .................... 112


vii

















Abstract of Dissertation Presented to the Graduate School
of the University of Florida in Partial Fulfillment of the
Requirements for the Degree of Doctor of Philosophy



FUNCTIONAL ASSESSMENT AND COPING BEHAVIORS AMONG THE RURAL
BLACK ELDERLY


By

LOIS CAROLYN NICKENS

December, 1984


Chairperson: Leslie Sue Lieberman
Major Department: Anthropology


The problem of this research was to determine the

reliability and validity of the Functional Assessment Inven-

tory (FAI) for measuring the functionality of the rural

black elderly. Additionally, the coping behaviors of the

rural black elderly were examined in depth in order to

assess the impact of coping behaviors upon maintenance of

lifestyle in this group.

Research was conducted from 1981 to 1984 among rural

elderly residents living independently in their communities

in Alachua County, Florida. Fifty-four elderly persons,

black and white were recruited through the snowball sampling

procedure to participate in the Functional Assessment phase

of the study. Subsequently, the black elderly persons


viii









participated in an in depth examination of coping

behaviors.

Determination of the reliability and validity of the

Functional Assessment Inventory (FAI) were determined

through a retrospective blind design. Results showed that

the FAI was reliable but had low concurrent validity when

compared to other measures of functionality.

The black elderly scored higher on the FAI than their

white counterparts. Scores of 17 or more on the FAI are

believed to indicate possible need of institutionalization

and many of this sample were in this category. However,

these black elderly, their FAI scores notwithstanding, were

not in need of institutionalization. The high scores of the

black elderly are attributable to the language of the in-

strument often not being understood and standardization

procedures prohibit adaptation of the language to their

education and culture.

The nutritional and health status of these elderly

subjects was assessed through interviews, clinical exami-

nations and biochemical measures. Coping behaviors of the

black elderly subsample were examined to determine how they

obtained the necessary nutrition and medical care. Coping

behaviors were assessed through use of a questionnaire and

by participant observation. Results showed that the black

elderly have made adaptive adjustments to their cultural

milieu which includes rural living, poverty and lack of

transportation.


















CHAPTER ONE
ANTHROPOLOGICAL INTERESTS IN GERONTOLOGICAL ISSUES




Problem and Theoretical Orientation


The focus of this study was to determine the

reliability and validity of the Functional Assessment Inven-

tory (FAI) and to ascertain functional capacities in the

activities of daily living, to examine the utilization of

informal social contacts as these relate to the maintenance

of lifestyle, and coping behaviors of rural black elderly.

Behaviors may be viewed as responses to the practical prob-

lems of life in conjunction with the person's perception of

these phenomena. The survival mechanisms of the rural black

elderly will be examined in the literature review which

follows.



Literature Review

Rural Environment and the Elderly

The process of urbanization of American society has

been rapid since the beginning of the 20th century but many

elderly people continue to reside in rural areas (non-Stan-

dard Metropolitan Statistical Areas as defined by the

Bureau of Census). At the present time it is estimated that










31 percent of the elderly people in this country continue to

live in rural areas; they constitute 44 percent of the

elderly poor but they receive only 18 percent of the federal

monies designated to meet the needs of the elderly poor

(Rural America Factsheet 1978). The disproportionate distri-

bution of money for the elderly poor in this country as a

whole is even more disproportionate in the South where 59

percent of the black elderly reside (Watson 1983).

The rural elderly are not only disadvantaged by the

inequity of governmental services. Rural residence places

constraints upon the individual in terms of the availability

of health care services, access to food stores, employment

opportunities and the ability to maintain social ties with

family and friends. Additionally, rural living for the

elderly people may place them in a uniquely vulnerable

position due to their reduced physical capacities.

The incidence of poverty is reported to be greater in

the rural areas than in the urban environment (Ansello 1980;

Carp 1976; Hooyman 1980; McKinney and Bourque 1971). In

1976, the average monthly Social Security payment for a

rural elderly person was $176 as compared to $203 for an

urban elderly person (Rural America Factsheet 1978). A study

that I conducted in Alachua County, Florida, in 1981, showed

that incomes of less than $4,000 a year were typical for the

rural elderly. This was $2,000 a year less than the incomes

of their urban counterparts.










Efforts of the rural elderly to maintain community and

social ties as well as to meet nutritional and health care

needs may be seriously impeded by lack of transportation. It

was observed by Patton (1975) that many of the rural elderly

are widows who have never driven and now experience frequent

transportation needs. Furthermore, problems with vision,

arthritic conditions and inability to finance the cost of

maintaining and operating a vehicle will prevent the older

person from driving.

Research investigating the quantity and quality of

family interaction comparing rural and urban elderly persons

has not yielded consistent results. Heltsley and Powers

(1975) suggest that the satisfaction of older persons from

interactions with both their children and their peers was

not affected by environmental setting (i.e. rural/urban).

Hynson (1975) also found that satisfaction with family

relations was not related to rural/urban residence, although

he reported that the rural elderly were more satisfied than

the urban elderly with their community, expressed greater

general satisfaction and less fear. Matthews (1965), how-

ever, suggests that rural elderly people are becoming more

isolated from social contacts and less assimilated into the

larger society than their urban counterparts.

Lack of transportation may also be one reason that the

elderly do not participate in Western medicine to the extent

of other segments of the society. However, other studies

have shown that rural elderly people perceive that doctors









are not interested in their problems and that their folkways

are considered in a pejorative way by the medical establish-

ment (Hill 1976; Murphree and Barrow 1970; Reynolds, Banks,

and Murphree 1976). Other factors which may relate to this

lack of utilization of medical services are poverty and lack

of satisfaction regarding interactions with medical

personnel.

Some researchers have also suggested that the rural

elderly do not utilize services to the extent to which they

are available. Such services include food stamps and Secur-

ity Supplemental Income (SSI). This has been attributed to

the rural elderly's intense feelings of pride and independ-

ence, as well as to their viewing these programs as welfare

(Ansello 1980; Moen 1981; Steinhauer 1980). These con-

straints, in conjunction with incomprehensible paperwork,

long waiting periods and high rates of illiteracy in this

population seem to preclude this group from using programs

that might provide assistance.

In summary, rural residence seems to place the elderly

in a more precarious position than their urban counterparts

and thus in greater need of programs and service plans

designed to incorporate the differing needs and value orien-

tation of this group.




Black Elderly

The black elderly (i.e. aged 60 or over) were 11.7

percent (26.5m) of the total U.S. population in 1980; 7.9










percent of the 65 and over age group nationally and 22 per-

cent (N=3326) of the 60 and over age group in Alachua

County (Bureau of Census 1980). Nationally, one-third of all

black elderly continue to live in rural areas (Hill 1976)

with a higher proportion in the South than in any other

section of the country (Watson 1983). This population den-

sity presents a unique opportunity to examine the functional

capacities and lifestyle of this group. However, an under-

standing of this group is incomplete without an awareness of

the living conditions experienced by the black population as

a whole.

Prior to 1910, 90 percent of all blacks lived in the

South. After World War I, however, a decline in the agri-

cultural economy of the South resulted in many blacks'

moving to the North in search of industrial jobs. By 1940,

the proportion of blacks living in the South was down to 77

percent, dropping to 53 percent in 1970. No change was seen

in this proportion in the decade between 1970 and 1980 as

more blacks began moving back into the South compared to

those moving out. This reverse migration, however, did not

mean a return to a rural life but to residence in the urban

areas. By 1980, 85 percent of blacks lived in urban areas

compared to 71 percent of whites (Reid 1982).

Return to the South, however, has not meant an increase

in employment. Black unemployment remains about twice that

of whites. In October, 1982, unemployment in the U.S.

reached 10.4 percent,the highest point since the Depression.









It was 20.2 percent among blacks and 46.7 percent for black

teenagers compared to 21.7 percent for white teenagers (Reid

1982).

In addition to disparity in employment rates, major

differences were seen in median incomes during the decade of

the 1970s between the black and white populations. Median

incomes had increased for blacks during the 1970s to 61

percent of the median income of the whites but since that

time the income gap between black and white families has

widened again. In 1981, the median income for a black family

was $13,266 (56 percent) compared to $23,517 for white fdmi-

lies (Reid 1982).

As a result of widespread unemployment and lower in-

comes, the incidence of poverty increased in the black

family. Persons below the poverty threshold as defined by

the Bureau of Census in 1981 included 34 percent of all

black individuals compared to 11 percent of all white per-

sons (Reid 1982).

This economic adversity has not resulted in a decline

in the fertility rate for black females. In fact, there has

been a -rapid growth of the black population in all the years

between 1790 and 1980 and fertility rates have been higher

for black females than for white females since the keeping

of records was begun in 1920. While fertility rates have

hovered around 1.8 births for white females since 1979, the

rate has been 2.3 for black females.









At this same time, the percentage of one-parent black

families has risen from 20.6 percent in 1960 to 44.1 percent

in 1980. The proportion of children born to single mothers

has increased from 37.6 percent for blacks in 1970 as com-

pared to 5.7 percent for whites to 55.3 percent in blacks

and 11.0 percent in whites in 1980.

The role of kin in maintaining the lifestyle of black

families has been the focus of several studies. McAdoo

(1979) states that "turning of one's back" on poorer family

members may be a prerequisite for those blacks moving into a

middle class society. Stack (1975) found that poor and

working class blacks maintain close networks and are helped

substantially by kin. Other studies have shown that the

black family is twice as likely as the white family (14

percent versus 7 percent) to include extended family mem-

bers, especially grandmothers (Reid 1982).

With this overview of the U.S. black social and eco-

nomic situation, it is now possible to focus specifically on

the lifestyle of the black elderly.

Robert Butler, former director of the National Insti-

tute of Aging, stated that "to be old is bad enough: to be

old and not white is even more terrible" (1975, p.30). The

black elderly enter the stage of old age with fewer resour-

ces than their white counterparts; possessing fewer assets,

victims of a lifetime of social and economic disadvantages

(Sheppard 1978) and deprived of access, availability and

support services available to the rest of society (Dancy










1977). However, Gibson (1983) viewed these adversities as

contributing to better coping skills in the black person

during old age. She stated that the black elderly "arrive at

the penultimate transition--old age--more fortified, more

rehearsed, and better able to adapt to its exigencies,

despite fewer economic and social resources" (p.2).

This fortification observed by Gibson may be explained

by religiosity or locus of control. Antonovsky (1979) has

defined locus of control as a belief that there is someone

or something in control of one's life. The black elderly

seem to have found this locus of control in religion. Dancy

(1977) stated:

A strong orientation toward religion and the black
church is a cultural attribute which holds a great
deal of importance in the lives of the black
elderly. The black elderly have needed a frame of
reference to enable them to cope with the
oppressive forces of racial discrimination, and
for many this frame of reference is religion
(p.22).


Watson (1983) and Tate (1983) also found that ability to

adjust to stressful situations in the lives of black elderly

people was attributable to their degree of religiousness. A

strong belief in an omnipotent and loving God will not get

them to the grocery store but perhaps makes the inability to

go more bearable. However, it is possible that the black

elderly generally have better coping mechanisms since they

have always had to make out with fewer resources and perhaps

have different expectations.









The utilization of kinship ties to cope with old age

has traditionally been described as a characteristic of the

black elderly. Recent studies have found that, contrary to

popular belief, the older black person is not living in an

extended family setting but is living alone and is not

exchanging monetary resources with other family members

(Gibson 1983; Gibbs 1982). However, black elderly are more

likely than their white counterparts to have young children

living with them. Hill (1978) stated that two-fifths of

black women over the age of 60 had children living with them

compared to one-tenth of elderly white women.

Whether single or married, elderly black men and women

have incomes only two-thirds those of their white counter-

parts. Additionally, the median income of elderly blacks is

significantly lower than the level that the government has

defined as providing a minimum standard of living. In 1976,

the Bureau of Labor Statistics lower budget standard for a

retired couple was $4,695. Only 17 percent of whites were

below this level but 37 percent of the blacks were in this

category (Hill 1978). In 1980, these figures had decreased

to 13 percent of the white elderly but had increased to 38

percent in the black elderly population (Watson 1983). The

percentages are even worse for the elderly black female

living alone; 60 percent of this group are living in poverty

(Chunn 1978). In my previous study of Alachua County elderly

(Nickens 1981), I found that 89 percent of the black fe-

males, 73 percent of the black males, 50 percent of white









females and 23 percent of white males had incomes below the

poverty level.

Poverty most likely has an impact on findings of life

satisfaction in this population. The 1974 Harris Survey,

conducted by the National Council on Aging, found that the

elderly whites scored higher (58.2 percent) on life satis-

faction scales than the black elderly (41.3 percent)

(Register 1982). Phillips and Usui (1981) found statist-

ically significant differences on scores of life satisfact-

ion between black and white elderly. The black elderly

scored an average of three-fifths of a point lower that the

white elderly on a thirteen item life satisfaction scale.

In general, black elderly people express satisfaction

with their life at the present time and do not perceive it

as being more precarious that life at earlier times

(Robertson 1981; Gibson 1983). Explanations for this

phenomenon may be seen as resulting from a lifetime of

unfavorable working conditions and the presence of a steady,

albeit meager, income at the present time.

Another factor which may influence life satisfaction

may be degree of interaction with family and friends --

relationships that could provide emotional and material sup-

port for the older person. Unfortunately, research shows

that black elderly get no more satisfaction from these kinds

of ties than do white people. Jackson, (1971) compared black

elderly people who had been employed in both manual and

nonmanual jobs with the amount of instrumental aid and









affectional relationships between these people and their

offspring. She found that parents employed in nonmanual

jobs (the least needy!) were most likely to receive aid and

that their daughters were most likely to be the givers.

These high income black elderly, however, scored lower on

life satisfaction than high income whites (Jackson 1978).

Jackson stated that this may be attributable to heightened

expectations not fully recognized or unwillingness to accept

the subordinate status of old age. Furthermore, Robertson

(1981), in a study of reported frequency of interaction with

kin among rural black elderly people in Missouri, found less

frequent interaction than was expected. Huling (1978), in

fact, states that it is a myth that blacks "take care of"

their elderly even though he does concede that "a reciprocal

helping" relationship is a frequent pattern.

If black families are not caring for their elderly,

perhaps friends are providing important assistance. The

research that has been done suggests otherwise, but data are

scarce on this subject. Sterne et al. (1974) suggest that

friendships of the black elderly may not involve the inter-

personal intimacy and the resulting role supports necessary

for sustaining morale. Studies that have examined the role

of friends and family in the black population have not

typically included the black elderly and hence shed little

light on this question (Stack 1974; Jerome 1980; Kennedy

1980).









Whereas the role of family and friends in maintaining

morale in the black elderly may have been inadequately exam-

ined, studies in the elderly population as a whole have

found the role of friends to be more important in main-

taining morale than the interaction with family. Bell (1981)

states that "it is peer friendship, not filial relation-

ships, that basically determine morale in old age" (p.181).

Additionally, Woods and Robertson (1978) found no positive

relationship between frequency of contact with their child-

ren and higher morale in elderly people. They suggest the

possibility that frequent contact and assistance between

elderly people and their children may be "largely ritual-

istic, based on obligation which is devoid of warmth and

closeness" (p.369). If this is true, morale as well as

treatment of the elderly may be affected.

Studies of other cultures have shown that the treatment

of elderly people within a society is not necessarily the

same as that received by other members of the group (Simmons

1945). Societies under stress may employ various means of

dealing with members deemed unproductive (i.e. aged). A

holocultural analysis of treatment using the Human Relations

Area Files (HRAF) showed that 84 percent of all societies for

which there were data concerning the treatment of the aged

had some form of non-supportive treatment which in most

cases is death-hastening. Non-supportive treatment may be

found in the failure of givers to provide food, abandonment

of the elderly person, and verbal insults. Furthermore, the









elderly person may sustain loss of property and be

designated as undesirable members of society (eg. witches)

(Glascock and Feinman 1981). When a person is considered

young and intact by members of society, support for his or

her existence is said to be provided. However, once the

person passes into the decrepit category, support is with-

drawn.

While these studies do not focus on the current cohort

of black elderly people in this country, their cultural

milieu may be considered as one under stress. Stresses on

the young and middle-aged black person may have resulted in

a reduction of assistance given to the black elderly who

already receive lower Social Security checks and have re-

duced amounts of savings and other assets as compared to

their white counterparts. Since conditions of the black

society seem to qualify this group as one under stress, a

closer examination of the informal social contacts, funct-

ional capacity and coping mechanisms of these black elderly

is warranted.




Coping Through Social Contacts

Elderly people, like all members of society, must uti-

lize resources other than their personal capabilities in

order to handle the exigencies of life. The social contacts

of families and friends can be a powerful resource in allev-

iating the rigors of everyday life.









The role of social contacts in the lives of older

people has been shown to mitigate circumstances common to

their existence (Bell 1981; Robertson 1981; Tate 1983).

Various studies have shown a positive correlation between

perception of health and actual health status (Linn and Linn

1980; Suchman, Phillips and Streib 1958; Maddox and Douglas

1973; Nickens and Lieberman 1982) and perception of health

was shown to be improved when the person has family and

friend networks that provide sympathetic support (Boyer

1980). Those elderly with fewer social contacts viewed their

health more negatively than those with more contacts.

The elderly may not only benefit psychologically from

social contacts but contacts may have practical benefits for

them as well. These practical benefits may include economic

assistance, transportation services for medical and nutrit-

ional needs, aid with activities of daily living and help

with maintenance of the elderly person's home. Jonas and

Wellin (1980) found that elderly women were more likely to

receive assistance from personal acquaintances than elderly

men. The only men who were receiving significant amounts of

personal assistance were those who were married and the

spouse was the source of aid. Myerhoff (1978), however, in

her study of elderly Jewish women, found assistance was

given to elderly men by women who had been widowed.

Assistance is usually considered to emanate from the

family and family support is an acceptable cultural norm in









our society. However, many elderly people in our society

have no children and must find other sources of support in

old age. Johnson and Catalano (1981) found that married

couples who were childless had a smaller number of outside

support contacts and tended to rely on each other for all

their needs. In contrast, those older people who were never

married and were childless seem to have developed better

strategies over their lifetime by participating to a greater

extent with friends, neighbors and church activities in

preparation for the possibility of dependency. Furthermore,

Keith (1982) states that "acceptance from a peer does not

connote dependence in the way that support from a child or

an institution might" (p.202)

Proximity is important in the development of social

contacts. Age segregated housing has often been referred to

as a dumping ground for the elderly but Jonas and Wellin

(1980) found that people living in these houses were more

likely to develop strong support networks. In addition,

morale was greatly increased due to the fact that they were

able to reciprocate. Help was provided in terms of household

chores, emotional support, personal care and errands. If

proximity is important in the development of strong social

contacts, then we would expect the rural elderly to have

fewer strong social contacts and to have lower morale than

those residing in areas of high population density.









Economics also plays a role in the development of sup-

port contacts. Old people who have resources (whether mater-

ial or psychological) and have shared them usually develop

strong reciprocal relationships. Older people whose resour-

ces are meager may not be able to obligate others and reci-

procate (Wentowski 1981; Jackson 1971) and thus they may

have reduced networks.

Adequacy of social contacts in terms of absolute num-

bers is difficult to ascertain. Adequacy is a function not

only of quantity but also the quality of the interaction as

well as the fulfillment of the person's perceived needs.

Sokolovsky and Cohen (1978) found that the elderly residing

in the single room occupancy hotels (SRO's) placed great

value on being loners, independent and without societal

intrusion into their lives. Even though their networks were

small, they served the functions that the individuals de-

sired. If perceptions of poverty (Moen 1981; Streib 1976)

and health (Linn and Linn 1980; Boyer 1980) are important

indicators of a person's satisfaction with his or her life,

it is also possible that the individual's perception or his

or her social contacts is a measure of their adequacy.

The foregoing studies have contributed much to our

understanding of the role of social contacts in human life.

More work is needed, however, to determine the extent to

which rural black elderly people use social contacts that

would enable them to maintain their way of life.









Additionally, further research should examine a person's

perception of the adequacy of these social contacts.



Independent Living

One of the most frequently stated goals of all older

people in this country is the desire to remain independent,

especially to be able to remain in one's own home (Moen

1981). Some authors would have us believe that this is an

expression of a value orientation of the larger American

society. The anthropologist Francis Hsu has stated that

the American core value . is self reliance, the
most persistent psychological expression of which
is the fear of dependence. . In American
society the fear of dependence is so great that an
individual who is not self-sufficient is an object
of hostility (Hsu 1961, p.216).

Dependency may be either developmental or precipitated

by crises. Examples of developmental dependencies include

infancy, childhood, pregnancy and senescence. These transit-

ional stages are viewed as time-limited periods and thus

old age is a legitimate excuse for dependency only if

the dependency is for a limited period of time and term-

inated at the proper time by death (Clark 1972). This re-

sults in a conflict of values since the diseases associated

with old age tend to be chronic and result in long term-care

needs.

Not all societies share this value orientation. The

Ibo, for example, studied by Shelton (1965), are taught

interdependency from childhood and thus dependency is mutual

and is not considered negatively. The Ibo elderly can demand









care as a publicly acknowledged right without any sense of

guilt (Fry 1980; Kalish 1975). Anyone refusing to give such

care is ostracized by the larger society and receives no

spiritual benefit from the ancestors.

The Ibo and American black society have been termed

"collective" whereas the larger American society has been

called "individualistic" (Jerome 1980; Stack 1974). We

should expect, then, that black elderly would be treated

more like Ibo than are white Americans. In other words, we

would expect their needs to be met within the extended

family.

Recent research, however, shows that the black elderly

are living alone, many in rural settings (Gibbs 1982; Gibson

1983). Evidently, the rural to urban migration of the black

population has not included a significant proportion of the

black elderly. Perhaps the black population is becoming more

assimilated into the mainstream of American life, i.e.,

becoming more individualistic and less collective. If this

is true, the living conditions of the black elderly may

represent a change from prior lifestyles and research is

needed to determine how the black elderly are functioning in

this new cultural milieu.




Methods of Determining Ability to Live Independently

If the core American value is to live independently, as

has been suggested, the question of determining if a person

should be institutionalized assumes greater significance.










Currently, only five percent of the elderly are in an in-

atitutional environment (principally nursing homes and homes

for the aged) at any given time. However, it is estimated

that one in four elderly persons will be in a nursing home

at the time of his or her death (Khel 1977).

The decision to institutionalize a person has been

reached utilizing various methods such as recommendation of

physician or social worker, or through the use of instru-

ments designed to measure the functional capacity of the

person. I conducted a telephone survey of nursing homes in

Alachua County, Florida, and found that almost all patients

in one home were admitted by physician referral whereas in

the remaining three homes the majority of patients were

admitted by social service referrals.

Assessment by physician has been acknowledged to be

"disorganized and primitive" at the present time (Khel 1977,

p.121). Physicians may employ several means of evaluation

such as functional capacity and psychological assessments.

Functional capacity covers activities of daily living such

as feeding, bathing and grooming. Psychosocial assessment

deals with the persons ability to interact with others (i.e.

family members, peers, professional caretakers). Both are

considered pertinent to the person's ability to function

within his or her environment but one is not necessarily

more important than the other. A person with impaired func-

tional capacity may be able to mitigate these circumstances

by utilization of family resources and social resources.











However, these psychosocial assets may be overlooked by the

physician.

Efforts to provide a broader spectrum of information,

including both functional and psychosocial information, have

resulted in the development of instruments designed to

quantify these factors to a greater degree. One of the

most widely used instruments designed for this purpose is

the Functional Assessment Inventory (FAI).

The FAI is a shortened version of the Older Americans

Research and Service Center Instrument (OARS). The FAI has

undergone a systematic reduction of questionnaire items,

some rearrangement of items and the addition of a few new

items. The instrument evaluates five domains: social resour-

ces, economic resources, mental health, physical health and

activities of daily living. From the responses, the inter-

viewer makes a judgment of the functional status in each

domain along a six-point scale where l=excellent functioning

and 6=totally impaired (Pfeiffer, Johnson and Chiofolo

1981).

A major problem with the use of instruments such as the

FAI is the lack of studies determining their reliability and

validity. The OARS instrument, as well as the derived FAI,

are used widely for the purpose of clinical assessment,

population surveys, program evaluation, personnel training

and planning provision of social, economic, medical and die-

tary services (Fillenbaum and Smyer 1981). In spite of

their extensive use, the reliability and validity of these









instruments has not been determined for use in different

population segments of the U.S.

A recent effort to determine the reliability and vali-

dity of OARS was conducted at the Center for the Study of

Aging and Human Development at Duke University by Gerda

Fillenbaum and Michael Smyer (1981). The study used a

comparatively small sample size (N=33). Ratings based on

professional assessment provided the standard against which

the scores were measured. Spearman's rank order correlations

were highest for activities of daily living (.89) and lowest

for mental health (.67). Validation of the OARS instrument

is supported by its ability to discriminate among elderly

community-based residents in general. No work, however, has

been published as to the ability of the instrument to

effectively discern group heterogeneity among ambulatory,

community-based elderly. Studies of the OARS instrument were

conducted for test-retest reliability by researchers at Duke

University. However, no independent investigators have exam-

ined the reliability and validity of the OARS instrument or

the shorter FAI.

Pfeiffer (who developed the FAI), Johnson and Chiofolo

(1981) administered the FAI to 58 elderly persons in a

rural Florida county. They stated: "rapid, reliable and

valid assessment of the functional status of elderly persons

is a prerequisite for the efficient provision of appropriate

types of services" (p.433). Their conclusions, however, do

not declare that the instrument is either reliable or valid.









They conclude that "the findings suggest potential for the

widespread use of the shorter Functional Assessment Inven-

tory for determining the type, level, and appropriateness of

services for the elderly" (p.433). It should be noted that

the study included only one black and two Hispanic elderly

people and therefore limits any conclusions which might be

made concerning its applicability in ethnically hetero-

geneous populations.

Training sessions in the use of OARS and FAI stress

that the language of the instrument must not be changed but

that the items must be asked as written. Coyle (1981) found

this to be a problem when administering OARS to a rural

black elderly sample residing in Louisiana. She found it

necessary to use a black research assistant to translate the

terminology of the instrument to the older people. Without

this interpreter she states that "many interviews could not

have been completed" (p.3).

In conclusion, it seems that serious problems exist in

these methods of determining the ability of the older person

to maintain an independent life. The most serious of these

problems is the failure to include a cross-cultural per-

spective. Since this determination is of such critical

importance to older persons, greater care should be given to

making certain that the final recommendation as to their

ultimate mode of life is a correct one. Furthermore, elder-

ly Americans are an extremely diverse group with heritages






23


originating in many ethnic groups. Therefore, the possi-

bility of racial and ethnic differences, as well as location

of residence, may result in varying concepts of functional-

ity that should be included in any final recommendation.

Perhaps the utilization of support from family, friends and

service agencies will be different among groups. If this is

the case, the use of any one instrument to ascertain ability

to maintain lifestyles is questionable.

















CHAPTER TWO
STATEMENT OF THE PROBLEM




Problem Formulation


Poor economic and social conditions have placed the

rural black elderly in a disadvantaged situation. Speci-

fically, these people have less access to congregate meal

sites, shopping areas, and medical and government services.

Their income levels, in most instances, are low because they

had little or no Social Security paying employment before

retirement. Furthermore, the cultural emphasis on inde-

pendence among many of this age group prevents them from

requesting help from persons or agencies that might be

willing to assist them. Finally, as younger members of the

black family have moved to urban areas in search of employ-

ment, the older black people are typically left without the

support of extended family networks to alleviate their needs

during this period of life.

The focus of this study was to determine the ability of

the rural black elderly to maintain their independent

lifestyle. Two methods were used to assess their

functionality. The reliability and validity of the Funct-

ional Assessment Inventory (FAI) as a tool for assessing the










functionality of the black elderly was examined. Twenty

elderly white persons were included for comparative pur-

poses. The FAI is a formal approach of assessing function-

ality and a less formal approach--coping behaviors--was also

included in this research. Coping behaviors were invest-

igated to determine how they functioned to maintain the

lifestyle of rural black elderly people residing in Alachua

County, Florida. Specifically, the areas of social resour-

ces, economic resources, mental health, physical health and

activities of daily living were related to social support.

Particular emphasis was also given to the role of social

contacts in assisting the older person in obtaining nutrit-

ional requirements and medical care.

The assumption investigated was that extensive

reliance on kin (either real or fictive) found by resear-

chers who studied younger black families (Jerome 1980;

Kennedy 1980; Stack 1974), would not apply to the rural

black elderly. It was theorized that black families were

under increasing stresses as compared to other segments of

American society and that black elderly people would be

receiving little, if any, support from their families.




Specific Aims


The specific aims of this study were as follows:

1. To determine the reliability and validity of the

Functional Assessment Inventory (FAI) in the










domains of social resources, economic resources,

mental health, physical health and activities of

daily living in the rural black elderly population

and the usefulness of this instrument in describing

the coping behaviors of the rural black elderly;

2. To determine the roles of family and friends in

the procurement of nutritional requirements and

medical care.


Particular questions asked, along with the related

hypotheses, were as follows:

1. Is the FAI a valid and reliable instrument to

assess the functional capacity of the elderly

black person? It was hypothesized that cultural

differences would limit the usefulness of this

instrument among different elderly populations.

2. With whom do the rural black elderly interact? It

was hypothesized that the rural black elderly would

be interacting with friends more than with family

members.

3. How do the rural black elderly perceive the quality

of their life? It was hypothesized that regardless

of the number of informal social contacts, the

rural black elderly would view their life

positively.

4. Do the informal social contacts of this population

contribute positively or negatively to the main-

tenance of their lifestyle? It was hypothesized






27



that social contacts would function both positively

and negatively.

5. To what extent do informal social contacts function

to assist the rural black elderly in activities of

daily living? It was hypothesized that these

contacts would not contribute significantly to

activities of daily living.

6. Are the coping mechanisms used by the black elderly

adaptive or maladaptive in maintaining their

independence? It was hypothesized that coping

behaviors would function adaptively.

















CHAPTER THREE
METHODOLOGY




Sample Selection


A non-random sample of 54 rural, black and white, male

and female elderly persons over the age of 60 participated

in this study. Coping behaviors were examined in greater

depth for black (N=27) subjects. Participants in this re-

search had previously participated in a multiphasic screen-

ing and evaluation project that I coordinated in 1981.

Subjects were selected through a snowball sampling technique

with contacts being made at nutrition meal sites, in church

groups and through community leaders. From this larger

sample, which included both rural and urban elderly persons,

54 rural elderly who were living independently within the

rural areas of the county and were aged 60 or over, agreed

to participate in this study. Thirty four were black and 20

were white.










Geographic Location


Alachua County is located in North Central Florida.

This area includes 16 counties, all of which are predomi-

nantly rural in character. This area has not experienced the

large influx of retirees commonly associated with Florida's

retirement communities found in the southern areas of the

state. However, the number of elderly people in this area is

increasing. In 1950, 8.3 percent of the population of North

Central Florida were aged 65 or over. This percentage has

increased to 16.5 percent of the population in 1980

(District III Area Agency on Aging 1984).

Elderly persons in this area more frequently reside

in rural areas (i.e. towns of less than 2500 in population).

Fully 64 percent of the elderly live in these rural areas.

Even those elderly persons who live in the urban centers

have cultural orientations that are characteristically

rural.

The great majority of the elderly in this area are

Caucasian (89 percent). Within the non-Caucasian population,

most are black, with those of "other" races (mainly Spanish

in origin) comprising only one percent of the older popu-

lation (U.S. Bureau of the Census 1982). Alachua County has

15,226 white persons over the age of 60 and 3,326 black

persons within this age range.

Due to the rural nature of this area, public transpor-

tation is very limited, or in some instances, non-existent.

When public transportation is available, the increasing










costs of taxis and buses prohibits their use by many of the

elderly people.



Measurement of Functional Capacity


The Functional Assessment Inventory (FAI) was admini-

stered to each person as a measure of his or her functional

capacity. The assessment was conducted in the individuals

home without the aid of informants.

The FAI is an abbreviated version of the OARS Multi-

dimensional Functional Assessment Questionnaire and was

developed by a multi-disciplinary team at Duke University

and refined by Eric Pfeiffer, M.D., presently director of

the Suncoast Gerontology Center at the University of South

Florida. The FAI has 11 distinct sections:

1. Short Portable Mental Status Questionnaire

(SPMSQ) which is used to assess the presence of

organic brain syndrome and as a basis for determi-

ning whether the subject can complete the question-

naire;

2. Socio-demographic background information including

race, sex, age, etc.;

3. Social resources information including quality and

quantity of relationships with friends and family;

4. Economic resources information including occupat-

ion, income and other resources;

5. Mental health information including two subjective

scales measuring life satisfaction and self esteem










as well as a 15-item Short Psychiatric Evaluation

Schedule (SPES) indicating level of functional

psychiatric symptomatology;

6. Information on physical health including the pres-

ence of physical disorders and the extent of

participation in physical activities;

7. Activities of daily living including information on

the performance of instrumental and bodily care

tasks that permit individuals to live independ-

ently;

8. Information on social and medical services used by

the subject in previous months and services they

believe they need;

9. An informant interview to be used when the subject

is unable to complete the questionnaire;

10. An interviewer assessment of data reliability;

11. A series of five scales on which the interviewer

rates the impairment on a 6-point scale where 1

excellent function and 6 = total impairment

(Pfeiffer, Johnson and Chiofolo 1981; Pfeiffer

1975; Pfeiffer 1976).

The Cumulative Impairment Score (CIS) is obtained by

adding the scores from each of the domains (social, eco-

nomic, physical, mental and activities of daily living). A

CIS of greater than or equal to 17 is considered to be the

score at which the person is possibly in need of institut-

ionalization (Beverly Burton, personal communication,











Suncoast Gerontology Center, University of South Florida). I

was train-ed in the administration and scoring of the FAI at

the Suncoast Gerontology Center at the University of South

Florida.



Determination of Reliability and Validity of the FAI


Two methods were used to determine reliability of the

FAI. In the first method, the test-retest, 10 randomly

selected subjects answered FAI questions a second time,

approximately four weeks after the initial test. Correlat-

ions were obtained between the total scores of the first

test and the total score of the second test through the use

of the Statistical Analysis System (SAS) Pearson's product-

moment correlation statistic. Also, correlations were simi-

larly obtained within test domains. In the second method,

the internal consistency was analyzed by correlating items

of each domain with the domain score.

Concurrent validity was determined by use of Spear-

man's Rank Order correlations between item scores on the FAI

and responses to similar data elements reported in the

multiphasic data base. Additionally, t-tests were calculated

to examine the relationship between mean scores in each

domain, the CIS and the SPMSQ by race and sex.

The multiphasic data base included data obtained from

an interview schedule, assessment of health status by a

physician, determination of immune functioning, biochemical









assessment of blood constituents and standard urinalysis.

The interview schedule required approximately three hours to

administer. Information was obtained from the interview

schedule on the social, economic, mental and physical attri-

butes of the subject, 24-hour recall data on dietary intake,

and a food frequency questionnaire.




Material Lifestyles of the Rural Black Elderly


The material lifestyle of the subject was determined

through the use of a checklist which included items related

to home ownership, age of home, construction materials,

physical condition, heating and cooling capabilities, kit-

chen facilities, miscellaneous items and subjective assess-

ment of the overall inhabitableness of the home (See

Appendix B).




Coping Nutritionally


Determination of nutritional practices was assessed

through the use of a food frequency questionnaire (See

Appendix A). The food frequency was obtained with the aid of

food models from the National Dairy Council. These models

were laminated onto heavy paper, hole-punched and placed in

notebook form to facilitate ease of data collection. The

person was asked if a particular food item was eaten daily,

weekly, monthly, during the year, or never.









Methods of food procurement were obtained through the

use of a questionnaire. Questions were asked concerning the

types of stores that the person most frequently used to

obtain food; frequency of receiving food from family,

friends, or other sources during the week; their course of

action should they need groceries at unscheduled times; how

they got to the grocery store on their last visit; and

amount of food that they either grow or raise for their own

consumption (See Appendix C).




Coping Medically


Each person in the sample participated in a clinical

assessment of their health status. The clinic was conducted

with the assistance of physicians and trained medical

personnel from Shands Teaching Hospital in Gainesville,

Florida. Transportation to and from the clinic was provided.

The health assessment and the transportation were given with-

out charge to the subjects.

Clinical assessment of health included blood pres-

sures, both sitting and standing; a SMAC-25 Profile and a

Complete Blood Count from fasting blood samples; a medical

history interview eliciting information concerning the pre-

sence of diseases such as coronary heart disease and

arthritis; and an assessment of the immune status of each

subject. Analysis of the SMAC-25 and CBC was conducted by

the Smith-Kline Laboratories in Tampa, Florida. The SMAC-25









Profile evaluates amounts of blood constituents such as

glucose, iron, cholesterol, triglycerides, etc. A CBC calcu-

lates the number of white blood cells, red blood cells,

hemoglobin and hematocrit levels. Immune functioning was

determined through the use of four antigens (Candida, mumps,

purified protein derivative (PPD), and trichophyton). These

antigens were injected intradermally on the volar surface of

the forearm with one-tenth ml. of each antigen. A circle

was made around each site with a skin marker and the subject

was asked not to wash these areas until a reading could be

done from 48 to 72 hours later.

Medical coping behaviors were assessed through the use

of a questionnaire (See Appendix C). Questions include when

a doctor was last visited; how the subjects got there; their

choice of actions when they became ill, including the use of

home remedies, prayer, treatment by neighbors or friends,

use of prescription or over-the-counter drugs and visit to a

doctor; and whether they had unmet medical needs at the

present time.




Participant Observation


Participant observation is perhaps the one method

most traditionally associated with anthropologists. Typi-

cally, this involves "moving in" on the subjects and

observing their daily lives. This method is best conducted









within demarcated populations and this has been the situ-

ation in the majority of studies of elderly people in this

country. The elderly who live in single room occupancy

hotels (Sokolovsky and Cohen 1978); those who live in old

age communities (Wellin and Boyer 1979); elderly who attend

senior citizens centers (Myerhoff 1978); and other bounded

areas (Clark and Anderson 1967; Keith 1982) have been the

focus of research relating to aging.

Moving in on subjects is more difficult when the

persons of interest are living independently and even more

difficult when they live in rural areas without a central

location for meeting together. These were the conditions

encountered in this research. In order to compensate for

these constraints, I have worked among this group for four

years; visiting in their homes, attending nutrition meal

sites, counseling family problems, becoming acquainted with

local shopping and medical facilities frequented by the

group and visiting their churches.




Photography


Photography has served a dual purpose in this re-

search. First, the camera has provided a visual documem-

tation of the material lifestyle of the subjects. But se-

cond, and perhaps more importantly, it has provided a way

whereby I was able to show my appreciation to the subjects






37


for what must often have seemed my interminable questions.

All subjects were given copies of all pictures made of them

and their surroundings.

















CHAPTER FOUR
THE COMMUNITIES AND THE BLACK ELDERLY






The Research Communities


The population of Alachua County is concentrated in

the city of Gainesville. However, there are several rural

outlying communities with populations varying from 1000 to

4000 persons. Five of these rural communities, Archer,

Alachua, Hawthorne, High Springs and Waldo, were the sites

of this study. The following data relating to these

selected towns were obtained from the U.S. Bureau of the

Census (1980), from the residents and from the respective

city halls.

Archer is located 12 miles southwest of Gainesville and

has a population of 1,230. Of this number, 39 percent

(N=481) are black and 60 percent (N-749) are white. Farming

is the main source of employment. There is one physician in

the town, one small grocery store and a convenience store.

There is no nutrition meal site available in Archer for the

elderly residents.

Alachua is located 16 miles northwest of Gainesville,

and can be reached by way of a major four-lane highway.

Alachua has a population of 3,561. Forty-seven percent









(N=1,679) are black and 52 percent (N=1,872) are white.

Until recently the town had a large meat packing plant, but

now is an agricultural town with numerous large and small

outlying farms. Alachua has one physician and one small

grocery as well as a few convenience stores. The town has a

nutrition meal site which served noon meals to approximately

25 (predominantly black) elderly persons.

Hawthorne is located approximately 25 miles southeast

of Gainesville. The town has a population of 1,303; 58

percent (N=762) are black and 41 percent (N=539) are white.

Hawthorne has the largest percentage of black population of

any town in Alachua County. Early industry included a

turpentine factory, and several of the older residents are

former employees. Hawthorne lies at the crossroads of sev-

eral state routes for agricultural transport. The town has

one dentist, one physician, several small groceries, and a

nutrition meal program serving approximately 35 elderly

persons.

High Springs is located approximately 25 miles

northwest of Gainesville and is nine miles from Alachua. The

towns are linked by the same major highway. High Springs has

a population of 2,491. Of this number, 68 percent (N=1,717)

are white and 30 percent (N=756) are black. Much of the

elderly population are made up of middle-class retirees from

the railroad and the federal government. The town has a

medical clinic, one large grocery store, several smaller

markets, and a nutrition meal site where approximately 30










elderly persons eat their noon meal from one to five days a

week.

Waldo is located 15 miles northeast of Gainesville and

is accessed by a major four-lane highway. The town has a

population of 993 with 22 percent (N=226) black residents

and 76 percent (N=539) white residents. This percentage of

black residents is one of the lowest among the rural towns

of the county. There are no physicians practicing in Waldo

and all the grocery stores are small minute market types.

There is a nutrition meal site available to approximately 25

of the elderly residents.




Case Studies


The Black Elderly in Archer

Six of the subjects who participated in this study

resided in Archer. All, however, live outside the boundaries

of the town. Five live on unpaved roads. Four of the six

subjects are included in the case studies. These four are

representative of the unreported cases and it is my belief

that the inclusion of the others would not contribute sig-

nificantly to the case studies.

Two males in this study seemed to have given much

thought to conditions and constraints of life and I have

termed them my "philosophers." One of these subjects is Mr.

J who lives on a dirt road outside of Archer. He owns 160

acres of farm land and the farm has provided him with a































Map Of Alachua County, Florida




















































GAINESVI LE


W..









source of income but he found it necessary to supplement

that income by driving a schoolbus for many years. I once

asked him how he came to own such a large parcel of land and

he told me that "land did'nt cost so much back in those

days." Furthermore, he stated that as acreage that "joined

mine" became available that he would buy these and that over

a period of time the amount had built up. Although he is 82

years of age, he is still driving his car and is a very

active man.

Mr. J and his wife have been married for 62 years, a

fact in which he takes great pride. He stated that he had

"never been separated." His wife was ill in 1981 when I

first met this family and she has continued in this situ-

ation to the present time. Her activities are mainly con-

fined to sitting in the house with occasional walks outside.

As a result of her illness, Mr. J does all the cooking for

the two of them. On my first visit, Mr. J told me that he

would like to eat out more in restaurants but that his wife

did not want to eat out. This was a statement that I had

never heard a man make before and after further questioning,

he revealed that he was doing all the cooking for himself

and his wife.

The concept of family seems very important to Mr. J

and on each of my visits to this home, I met both children

and grandchildren. He has 13 children, three of whom live

within the county. One grandchild lives in a house adjacent

to Mr. J and often drops in and out of his grandparents










home. On my first visit with Mr. J and his wife, this

grandson would not leave as long as I was there but after

that initial visit, I only saw him occasionally. I suppose I

had met with his approval and he believed his grandparents

were safe in my company. Although Mr. J's daughters live

outside the county, there are three who live in surrounding

counties and alternate coming on weekends to do cooking and

cleaning for Mr. J and his wife. He speaks very proudly of

his children and gave me the name of all his eight daugh-

ters. Interestingly, he did not give me the names of his

sons. Four of his daughters have obtained college degrees.

He stated that "it seems like my kids appreciate their

raising."

Growing and preserving food is still an important part

of Mr. J's life although he stated that most of the food

that he grows now is given away to neighbors and to his

family. He stated that he could not get his wife to eat

the vegetables anymore and that he "just don't want any-

more." He is currently growing corn, mustard greens, and

peas. He cans pears from several trees located in the yard.

He raises both beef and pork for consumption but will not

eat the pork himself. He stated that the "pork is against

my pressure."

Religious faith is a very important part of Mr. J's

life. He is an elder in a local black congregation and his

conversation is always interspersed with references to his

faith. He stated that he prayed often for health and "for









this family that love will continue to exist." He still

attends church meetings twice a week.

Although Mr. J is 82 years old, he appears to be in

very good health. He says that he has pains in his joints

and back but that these are "due to me, it's time to have

pains and I'll just have to adjust." When asked about his

health problems in 1981, Mr. J said that he had heart

disease, high blood pressure and arthritis. When asked

again in 1982 and 1983, he stated that he had high blood

pressure and arthritis but made no mention of heart

problems.

Mr. J seems to have given much thought to the situa-

tions of life that he has encountered. For instance, in

discussing race relations between blacks and whites, as he

has experienced during his lifetime, he stated that "hit

weren't right." The educational system was one of those

things that was not right. He stated that the school buses

that he drove were always ones that had been discarded by

the white schools. He recalled one school superintendent

who had stated that no black children would ever ride on a

new school bus as long as he was the superintendent. Addit-

ionally, he stated that all the textbooks used by the black

children were books that had been discarded by the white

schools.

Mr. J was the first person to tell me that "schools

were different then." When I asked him what he meant by

that statement he told me that the rural black schools were









only open for two to three months out of the year.

Furthermore, he recalled one time when the school was only

open for six weeks before they ran out of money to operate

the school and had to close for the year.

Another subject from the Archer area was Mrs. M, a

76 year old woman who has been a widow for the past 17

years. She was the only person from this area who lived on

a paved road and her home was located approximately one and

one-half miles from the town of Archer.

The living conditions of Mrs. M are rather dire. The

home in which she lives is co-owned with her four sisters

and two brothers. It is located on approximately five acres

and was inherited from her parents. The house is a wooden

shack that has large cracks in the walls making it imposs-

ible to either heat or cool. When I visited with her in the

winter time, we would huddle around a small woodburning

heater located in the front room of her house. In the

summertime, we sat outside under the trees to escape the

oppressive heat inside. When I asked her how she kept warm

in the winter, she stated that "I just sets around this

stove." Water for the home is obtained from a well in the

rear of the house. An outhouse is located near the well.

The house is not only in bad physical condition but is

so filled with various items as to make it difficult to

navigate through the house. Fabric and cloths seem to be

all over the interior. Several scrap quilts were draped

over two chairs in the front room. A cloth covers a small









corner table where the television set is located. Further-

more, Mrs. M always had on several layers of clothing

regardless of the time of year. The kitchen walls are

covered with various sizes of pots and pans and the kitchen

counters are likewise covered with utensils as well as

cleaning aids and food. The door into the house enters

the kitchen and a narrow walkway leads into the front

room. Two small bedrooms are located adjacent to the

kitchen and the front room.

Mrs. M has four sisters and two brothers who reside

in the area. In fact, one brother who is totally blind lives

with Mrs. M. In addition to her siblings, Mrs. M has two

children, a son and a daughter. She stated that the son

lives "all different places." Her daughter lives next door

in a very nice mobile home. I have never seen this daughter

although I have met two of Mrs. M's sisters as well as her

brother who lives with her.

Assistance from family members is very minimal for Mrs.

M. When I first met Mrs. M her daughter owned a late model

car but Mrs. M stated that she had to hire someone to take

her grocery shopping or to medical appointments. I have

observed her walking the distance from a grocery store in

Archer to her home. On subsequent visits, the daughter no

longer had a car. I asked Mrs. M about this apparent

absence of assistance from her daughter and she explains

this by stating that "she has her own kids to care for. She

can't help me that much." Mrs. M seems to have lost trust









in other people. She stated that "I don't trust nobody

since my mother died."

The economic situation for Mrs. M is also severe.

Both she and her husband spent their working lives as

farmers and had not paid into the Social Security system.

She now receives the minimum amount of income from Security

Supplemental Income (SSI) and she stated that she is "just

barely scraping by."

Sufficient acreage is available to Mrs. M to grow a

substantial garden but she is not doing this. She stated

that "I ain't able anymore." She is, however, growing a

small amount of food although she does not preserve any for

later use. She was growing "greens" and this included both

mustard and collards. Black-eyed peas, acre peas and

tomatoes were also grown. She stated that she did not eat

pork because "pork don't agree with me."

The lifestyle of Mrs. M appears to be harsh but her

health seems to be quite good for a woman of her age. She

is very active, chopping the wood for her woodburning stove

and walking the mile and a half to the grocery store. She

stated that she had "high pressure and arthritis."

Additionally, she stated that she had "kidney problems" but I

was unable to determine exactly what she meant by this and

how it affected her activity. Her blood chemistry revealed

a low hemoglobin level.

The physical appearance of Mrs. M is very striking due

to the presence of a large golf-ball size growth directly in










the middle of her forehead. I questioned her about the

possibility of the growth being some form of malignancy but

she informed me that the growth had been there for many

years and had never created any problems for her. However,

I imagine that if there had been sufficient economic

resources available she would have had the unsightly growth

removed.

The living conditions of Mrs. M were so severe that

one might expect her to have a low morale but this was not

the case. She said that she "hardly ever worries" and that

she considers her life to be "pretty good." She was cheer-

ful on all my visits and seemed delighted to have someone

take an interest in her life.

Unlike Mrs. M, another Archer resident, Mrs. L does

not live under such adverse conditions. Mrs. L was born in

the Archer area. Her father had owned 170 acres at one time

but at the time of his death, the acreage had been redued to

80. Ten acres were given to each of seven children and to

his wife. Mrs. L was married at the time of this

inheritance and she sold her ten acres to help pay for 40

acres "across the road." She stated that land was "cheap

back then (1920s), about-$5 a acre, but that $5 was hard to

get". Cotton was the cash crop and none of the black far-

mers had any kind of mechanical equipment to assist in

harvesting. Peas and peanuts were also grown but mainly for

personal consumption. Mrs. L is currently considering

deeding the land to her children so that she could get more









help from the government. Her Social Security check is

low enough to enable her to receive SSI monies but she

cannot do this as long as she has the 40 acres. Her husband

has been dead for 18 years; she has nine living children and

is currently 73 years old.

Mrs. L lives in a small white frame house that she and

her husband built before they had any children. An

addition was added to the rear of the house several years

later. The house is raised off the ground with open space

visible underneath. It is in need of some repair. The

steps leading into the house are ramshackled and the screen

door needs replacing. The interior also is in need of

repairs. The main source of heat is a fireplace in the

living room but the fireplace does not produce enough heat

to even heat this room. Two pictures are prominently

displayed over the fireplace. One is a picture of Martin

Luther King, Jr. with his family and the other is a picture

of John F. Kennedy. Numerous pictures of family members

are displayed on small side tables.

Extensive numbers of family members live around Mrs. L.

One brother, a sister and two daughters live "just down the

road" and one son (aged 28) and one grandson (aged 19) live

in the house with her. Mrs. L had ten children in all but

only nine are currently living; six reside within the

county. She states that the son who lives with her is a

major source of help. He cooks when she "doesn't feel like

it", fishes and maintains a large garden. However, she









describes the grandson as "lazy" and of "no help." Although

the son lives with Mrs. L, she states that she is closer to

her younger daughter. On almost all my visits, this

daughter either called her mother or came by to visit and on

one occasion brought Mrs. L a pot of chicken and rice for

her dinner.

One of the things that Mrs. L regrets about her life

is that she never learned to drive. She stated that her

husband told her that she would "get killed if you get out

on that road" and he would not let her learn. She stated

that she wished she had learned anyway because when she

wanted to go somewhere "all I would have to do would be to

get in the car and take off."

Gardening is an important part of Mrs. L's life. She

maintains a small garden plot near the house where she grows

"all kinds of greens", onions and tomatoes. Her son

maintains a large garden farther down a dirt road and away

from the house. Peas, corn, okra, potatoes and beans are

grown on this plot. Mrs. L stated that she does not tend

to this larger garden because she is no longer able to

care for a plot of that size. She does preserve food from

the garden as well as fruits from pear and peach trees found

in the yard. Chickens roam freely around her yard and she

sells eggs from these chickens. She speaks proudly about

her "yeller" eggs and says that she sometimes sell these to

her neighbors when they want to make "real good cakes like

at Thanksgiving and Christmas time." She stated that she









does not eat pork anymore because her doctor had told her

that pork was not good for her.

In contrast to Mrs. L who had many family members

living around her, Mrs. E had no family members in the

area. Her husband had been a preacher but he had died in

1936 leaving her a widow at the age of 39. She is presently

89 years old and she never remarried. Although she had been

married for many years prior to her husband death, Mrs. E

never had a child. "Just weren't none for me. If the Lord

had intended me to have 'em, I would've" she stated. She

does not recall having any "female" problems. Although she

had no children of her own she stated that "I had other

peoples children." In addition to the absence of spouse and

children, all of Mrs. E's brothers and sisters were dead.

Life has not been as severe for Mrs. E as for some of

the other subjects but she does share life characterized by

poverty similar to others in these case studies. After her

husbands death, Mrs E found employment with a county judge.

This employment lasted for 40 years. She not only cleaned

and cooked but she also took care of the judge's children.

These are the childern whom she refers to when she discusses

having other peoples children. The judge is now dead but

the judges wife and his children continue to check on Mrs.

E and she calls on them when she needs help. Just prior to

my last visit, Mrs. E stated that she had to ask them to

help her pay a heating bill and they did. Furthermore, they

provide Mrs. E with assistance in getting to the grocery









store and doctors appointments. The judge's family is white.

Mrs. E's income at this time would allow her to qualify for

SSI monies but she stated that she had never tried to get

these monies. She stated that "I don't need welfare."

Although at the present time, Mrs. E is crippled with

arthritis, she still maintains her sense of independence.

"People need to do for themselves, that's what they ought

to do," she stated. Her knees are very enlarged from the

arthritis and she must use a cane in order to walk but she

said that "I prays a lot and asks the Lord to help me and He

does." She also had high blood pressure.


The Black Elderly In Alachua

Four of the black elderly subjects in this study live

in the town of Alachua and unlike the subjects in Archer,

all of these subjects live in the town rather than the

outlying areas. All live on paved streets in a section of

town inhabited only by blacks and I have included all of

them in the case studies.

Mr. M is a 70 year old man who lives alone in a

rented house. He and his wife have been divorced for seven

years and although they had seven children, Mr. M does not

know where they are. He stated that he does not believe

they are living in the county and he has not seen them for

several years. The only relative that he admits to having a

close relationship with is an aunt in Sanford and he stated

that this aunt would "take care of me if I need help." He

appears to be about six feet tall and would probably weigh










about 170 pounds. He moved to the Alachua area in 1931 "to

work."

The house where Mr. M lives has been condemned by the

town and on my last visit with him, he was looking fo.r

another place to live. This was causing him some problems

because most of the available places required more rent

than he felt he could pay. His current home is already

caving in on one side and I was most uncomfortable on my

visits there as I kept wondering when the side we were

sitting in might also collapse. He has no way of cooking

in the house other than an old hotplate that he stated he

used "just to heat up a few things." A gas room heater is

his only source of heat and this is totally inadequate in

the collapsing house. Furniture is very sparse with a

couple of straight chairs in the room that serves as both

sitting room and bedroom. The only other rooms are a

kitchen and a tiny bathroom. All homes within the city

limits are required to have indoor plumbing but there is no

hot water in the house.

I first met Mr. M at the congregate meal site in

Alachua where he eats a noon meal five days a week. Even

though surrounded by people at the meal site, Mr. M always

manages to sit out on a bench by himself, apparently

watching what is going on around him but never

participating. I observed this behavior on each visit that

I made to the meal site. He comes about an hour before the

meal, sits on the bench without interacting with the others










and leaves immediately after the meal. He is not an

unfriendly man and seemed to enjoy talking with me once he

found that I was interested in his life and experiences.

Tools are a part of Mr. M's attire. Sometimes

wrenches would be protruding from a pocket and sometimes

screwdrivers or various other tools were visible. This was

possibly a carryover from his working days when he was a

construction worker, mainly building houses. His reason for

carrying the tools now was that "I might need them. You

just don't know."

Mr. M was shot in the head 18 years ago when he "got

into it with some of the boys." A concave spot is visible

on his forehead where the shot entered. He is totally blind

in his right eye due to the gunshot wound. Furthermore, The

shooting ended his working life and he has had epileptic

seizures since that time. He is taking medication for this

condition. He states that the only other health problem

that "troubles" him is arthritis in his legs and on each

visit with him, complaints about pains in his legs

increased. Although a doctor is available in Alachua, Mr.

M hires someone to bring him into Gainesville when he needs

to see a doctor. He said that he had recently seen the

doctor and had to pay him $25 for the visit. After paying

the doctor this amount, he stated that "I can't buy the

medicine. Guess I'll have to wait till I get my next

check."









There were very few people in this study who stated

that alcohol consumption had been a problem to them but Mr.

M was one of those. He stated that his doctor had told him

to "quit that drinking or I wasn't going to live." He

stated that he has not drunk any alcoholic beverages in six

years now.

Due to the fact that Mr. M lives in the town area,

grocery stores are within walking distance to him but he is

limited to only those items that he can carry in his arms.

He stated that once a month a friend would come by and

take him to the store so that he could buy more groceries.

When I asked him who this friend was, he could only remember

"James. I can't think of his last name." He did say,

however, that this person would not take any money from him

for this service.

Whereas Mr. M had few interactions with family or

friends, this was not the situation of Mrs. B. When I

first met Mrs. B she was living alone within the black

district of Alachua. However, on subsequent visits she had

moved in with a granddaughter due to her declining health

status and even though her health seemed much improved on my

last visit, she continued to live with her granddaughter.

Mrs. B has been a widow for 18 years and has four children,

two of whom live in the county. I met her daughter on one

occasion but the daughter appeared to be intoxiacted and

was uncommunicative. In contrast, the granddaughter seemed

very interested in her grandmother's health and asked many










questions about ways to improve her nutritional status and

her health in general.

The home where Mrs. B is now living with her gran-

daughter is located in a public housing project and appears

very unkempt. The walls are very dirty and in need of paint

and the house smelled of urine. Two small children scamper

around the house and are the likely source of the smell.

Both children are part of the family, belonging to the

granddaughter and a niece.

Health seems to have been a particular problem to Mrs.

B for several years. On my first visit with her she stated

that "I'm very happy now cause when you've got your health,

you've got everything." She said that she had previously

been ill with ulcers and heart disease but that these had

all cleared up now and she was feeling fine. Six months

later she was so ill that I really did not see how she could

survive. At that time she told me that she "hurt all over."

She stated that she had arthritis, heart trouble, ulcers,

hiatal hernia, cancer and anemia. Furthermore, she stated

that she did not have enough money to buy all the medicine

that had been prescribed and when I asked her what she

considered to be her greatest problem, she very quickly

responded "money." On my last visit to Mrs. B, I found her

health much improved and she was caring for those same two

small children that I had first encountered in her house.

Severe illnesses had been such a part of Mrs. B's life

for the past several years and I thought she might be able









to give me some insight into how she reacted to the onset of

these health problems. "I pray hard," was her primary

reaction. She stated that she did not use any home remedies

anymore because "the doctors say not to use those old home

remedies like we used to."

The inability to remain active was a particular

concern to Mrs. B. "I was raised on a farm--raised to

doing something. This don't seem right to just sit here"

she stated.

I am sure that every researcher has subjects that are

considered absolutely unforgettable and the following lady

from Alachua was one of those persons to me. Mrs. G is an

80 year old woman with a toothless, perpetual smile. She

has been a widow "for so many years I can't remember." Even

when her husband was alive, he was evidently not the ideal

husband. "He didn't help me none. He spent all his money

on other women," she stated.

The marital union did, however, result in the birth of

two children; a son and a daughter. The son died while in

the Navy but his daughter, Mrs. G's granddaughter, lives in

Alachua and Mrs. G lives with this granddaughter. Mrs. G

first told me that her daughter was in Chattahoochee at the

state mental hospital and she had no idea if she was still

alive. On a later visit she told me that she did not know

where her daughter was living.

The granddaughter is the major caregiver and the level

of care seems total. For instance Mrs. G stated that she









had no idea about how much money she received every month

because her granddaughter "gets my check and takes care of

all my money." A great-grandson "gives me a few dollars

along." Mrs. G lives with her granddaughter and the

granddaughter takes care of all the grocery shopping and

takes Mrs. G to any doctor's appointments that she may have.

The housing condition for Mrs. G is better than for

many of my other subjects. The house is owned by her

granddaughter and is constructed of concrete block with no

major visible defects. The yard is large enough to have a

small garden where various greens, onions, and a small

amount of corn are grown during the summer months. Mrs. G

eats her noon meals at the congregate meal site in Alachua

but says that "I don't eat pork."

The past continues to be a major focus in the present

for Mrs. G. On all my visits with this lady, she recounted

her early life experiences and the story was always the

same. Her story is one of abuse, first from her

grandmother and mother and later from her husband. She says

that her grandmother was "a slavery time lady who wouldn't

let you open your mouth." Mrs. G seems to make some

connection between the slavery status of her grandmother and

the treatment given to her as a granddaughter. Mrs. G seems

to feel that the "meanness" of her grandmother was related

to her status as a "slavery lady" but Mrs. G has trouble in

elucidating exacting what she means by these statements.

Many of my inferences were drawn from the expression on her









face and the tone of her voice when she discussed the

situation.

The Living situation with her mother was no better than

that what she experienced with her grandmother. Mrs. G

stated that her mother was "a street walker and she wouldn't

let me go to school." Her mother was not around for long

periods of time during which Mrs. G was left with her grand-

mother. Mrs. G recalls that a family wanted to take her and

send her to school but her mother would not allow them. She

also says that she remembers many nights of sleeping out in

fields and woods trying to hide from her mother or

grandmother but always being found and brought back. She

states "my mama never telled me right from wrong."

An early marriage did not improve the living conditions

of Mrs. G. She states that her husband "beat me" and "ran

off with other women." Mrs. G was forced to make her own

way by cooking for other people and hoeing in their fields.

These kinds of living experiences could very reasonably

result in a negative personality but this is not the

situation with Mrs. G. She is always smiling, visiting

with all the people at the meal site, talking with neighbors

and seemingly enjoying life immensely. Her present life,

when compared to her past, is probably better than anything

she ever expected and she says that her life is now "good."

The health status of Mrs. G is exceptionally good for

a person of her age. She states that she has hypertension

but none was found when her blood pressure was taken and she









is not taking any medication for hypertension. Furthermore

she states that she has diabetes which she is controlling by

diet and no "out-of-range" values were found for blood glu-

cose levels. She also stated that she had arthritis in 1981

but on other visits stated that she did not have this con-

dition. She had no response to the four antigens when her

immune functioning was checked in 1981.

The final subject living in Alachua is Mrs. H. She is

a very thin, frail appearing woman of 72. Her husband died

six years ago and she has lived alone since that time. Her

home is a small four-room wood frame house and as in so many

of the instances in this study, the home is very cluttered.

An exercise bike is found in one corner of the living room

but Mrs. H says that she does not use it very often. The

bike was given to her by her son.

Mrs. H has two children, both sons. One son lives

within the county but the other son is not living in the

state. I have never met the son who lives in the county but

according to Mrs. H he is very actively involved in her

life. For instance, this is the son who bought her the

exercise bike and she says that he also comes and mows her

yard whenever it needs mowing. She has no grandchildren or

other family members living near her but pictures of her

children and grandchildren are found on the walls and the

tables in the house.

The physical and mental condition of Mrs. H has

declined radically over their years that I have known her. A









major problem would appear to be her total disinterest in

eating. She attends the congregate meal site for her noon

meals five days a week but even there she tends not to eat,

simply nibbling at the food. I have wondered if perhaps

this refusal to eat was an unconscious way of committing

suicide. I discussed her refusal to eat with the meal site

manager and we decided upon a plan to see if we could get

Mrs. H to eat. The plan called for enlisting the assistance

of other meal site participants and giving Mrs. H an extra

amount of attention and letting her know that we were going

to be checking up on her to see that she was eating. The

plan has only been moderately successful. When she sees me,

she usually begins the conversation with "I have eaten ...."

but she continues to decline. She does appear to enjoy the

extra attention from her friends at the meal site.

Diet may also have been an important factor in the

mental condition of Mrs. H. She had the highest score

(i.e. greatest mental impairment) on the Short Psychiatric

Evaluation Schedule of any of the subjects in this research.

Her health problems do not seem severe enough to be causing

her this degree of mental anguish. She says that she does

have arthritis and heart trouble but there are no extreme

outward manifestations to these problems. Rather, she seems

to have lost the will and vigor to live.









The Black Elderly in Hawthorne

Six subjects live in Hawthorne; four males and two

females. Four are included in these case studies. They are

not confined to any particular area of the town but all live

within the boundaries of the town. I originally met these

people at the congregate meal site where they meet for lunch

everyday.

Mr. T is a small, sprightly man who is 82 years of age.

He lives alone, his wife having died almost two years ago.

His home is a small wood frame home with a living room,

kitchen, two bedrooms, a bathroom and a small back porch

where he keeps his washing machine and prepares his herbal

medicines. The house is surrounded by a small yard with a

fence around the area. Unlike many other elderly people in

this sample, Mr. T's home is not cluttered. Furthermore, he

maintains his home immaculately clean. He owns his home.

Although Mr. T lives alone, he is surrounded by family

members. A sister lives on one side of him and a brother on

the other. I never had the opportunity to meet the sister

but I have met the brother and he is much younger that Mr.

T. In addition to the siblings, Mr. T has one daughter

and she lives in the town also. The daughter has several

children and these children are often in and out of Mr. T's

house. Mr. T says that this daughter will "look after me

when I need help but she can't do too much 'cause she's got

children of her own to look after." He says that this










daughter does come over and do his laundry and that she

also does his grocery shopping for him.

Transportation for Mr. T does not only consist of that

provided by his daughter because Mr. T is an avid bicycle

rider. The bike provides him transportation to the

congregate meal site five days a week and he says that the

last time he went to see his doctor that he rode the bike.

Religious faith is an important part of Mr. T's life.

On one visit to his house he showed me where he kept his

Bible located under his mattress. "It's all to me. Reading

this book would help anybody. If it wasn't for the Lord I

wouldn't be here this long."

In addition to help from the Lord, Mr. T also uses the

natural resources around him to help maintain his health.

He takes frequent walks into the woods that are near his

home to search for the roots and plants that he uses for his

medicines. These plants and roots include rabbit tobacco,

snake root, wild garlic and asafetida. These plants and

roots are prepared in various ways and preserved in old

whiskey bottles.

Self-treatment has not always resulted in the best

interest of Mr. T. When he was a young man, "back in the

20s," Mr. T was involved in an automobile accident that

broke the humerus bone in his left arm. Mr. T attempted to

set the bone himself and put the arm in a sling. The

treatment did not work and as a reult of that treatment,

Mr. T's upper arm gives the appearance of having been tied










into a knot. It is grossly deformed but Mr. T has learned

to manipulate and use his arm to an amazing extent. I asked

him why he had not sought medical help and he stated that

his friends tried to talk him into this course of action

also but that "I was just too hard-headed."

Health is not a major concern to Mr. T at this time.

He has some arthritis which causes him some pain in his legs

and he says that he has high blood pressure. However, he

says that "high pressure" is not a problem as long as he

drinks a cup a day of an elixir that he prepares from wild

garlic roots preserved in vinegar.

Mr. T and Mr. R are close friends. Like Mr. T, Mr.

R is also an avid bicycle rider and they eat their noon meal

together at the congregate meal site. Mr. R is a very tall,

thin man who is 69 years old.

Mr. R lives in a small five-room wood frame house

located on a dirt road near the city limits of this rural

community. A fence surrounds the yard and serves to hold

the chickens that wander loose within the confines of the

fence. There is no grass in the yard.

Extensive family members are also found around Mr. R

but he is not so happy with his family connections. Mr. R

married his present wife during his more mature years and

they have three teenage sons from this union living at home

with them. Additionally, his wife has two daughters from a

previous marriage living with them and each of these daugh-

ters have several small children.









The daughters from his wife's previous marriage are a

major cause of dissension between Mr. R and his wife. Mr. R

once called me and asked me to come and visit his wife.

When I asked what seemed to be the problem, he stated "she

needs a talking to. Those girls are giving her hush-mouth

money but I ain't getting none." It seems that the

daughters were giving their mother a minimal amount of money

all along but none to Mr. R and he felt that he should be

given something to compensate for their presence. Mr. R's

wife said that she expected that the daughters would be

moving out in the near future. However, the daughters were

still there two years later and the strain between Mr. R and

his wife seemed to have increased. On my last visit, he

stated that "I hope I don't kill nobody."

Mr. R has worked at various kinds of jobs over his

life. He stated that he was "raised on a farm" and his

first employment was on a chicken farm. From this, he went

to a job with a pulpwood company and finally to a job with a

concrete company. Working with a concrete company has had

two major impacts on Mr. R's life. First of all, the job

resulted in a larger Social Security check than that of many

of the other subjects in this research and, according to Mr.

R, the job "ruined my nerves." He frequently appears agi-

tated and when asked to evaluate his mental health, he

stated that his nerves were "poor" and "worse" than they

had been in prior years.









At the beginning of this chapter I stated that there

were two men among the subjects that I have referred to as

"philosophers" and Mr. J from Archer was one of those men.

The other "philosopher" is Mr. H and he lives within the

city limits of Hawthorne. Mr. H is 77 years old and has

lived with his daughter--his only child--for the past eight

years since the death of his wife. He speaks very proudly

of his daughter whom he says is "college educated."

Mr. H, like Mr. J, has not only experienced life but

has tried to determine why life has been as it has. One

day after Mr. I had described some of his experiences in a

segregated society, I commented to him that I was amazed at

his acceptance of me--a white female researcher--and I asked

him why he felt that he could talk with me. "White women

have given my people more help than any one else. Why,

they're even more better than our own people are to us," he

explained. This "better" characteristic was only ascribed

to the white female, however, and not to the white male. He

went on to explain that "we're still having troubles from

the white man."

When comparing the totality of life now to what it was

in previous times, Mr. H states, "living now is like being

in heaven. The young folks don't like to hear us old folks

talk like this. They think it's slave talk. But Missy, you

just don't know where we'ves been."

The health of Mr. H has declined significantly over the

past few years. On my first visit with him, he was a









robust, vigorous person who enjoyed putting puzzles

together. However, on my next visit a year later, Mr. H

appeared to be distressed over his health. "I don't know

what's wrong with me but I know somethings wrong," he

stated. He said he had been to see his doctor but "he

didn't reveal any serious problem to me." His failing

health was obvious on proceeding visits as he continually

lost weight and said that "seems like nothing don't taste

good." His doctor finally told him that he has inoperable

cancer and although this was hard to accept, he seems less

distressed now that he knows exactly what is wrong with him.

"I'm prepared to meet my Maker," he stated.

Not all of my subjects living in Hawthorne are males.

Two are females and Mrs. V is one of those. She is 82 years

old and she lives alone in what she calls a "government

rebuilt house." All of her family members have died; her

brothers and sisters, her husband, and one child who was

born dead.

Mrs. V and her husband bought their small home "a long

time ago." Her husband was a "turpentine man" and she

worked "in the fields and in a laundry." The house was

renovated several years ago with the aid of federal monies.

It is in very good condition and is well kept both inside

and out.

Social contacts are minimal for Mrs. V with most of her

contacts coming from the congregate meal site where she has

her noon lunch five days a week. "I ain't got many friends.









People ain't like they used to be," she stated. The main

social contact outside the congregate meal site is a

"godchild" who, according to Mrs. V would "give me some help

if I needed it." This godchild provided the transportation

for Mrs. V's last visit to the doctor but she charged Mrs. V

$10 for the trip. Mrs. V uses the Older American's Council

(OAC) for one trip to the grocery store every month but at

other times she must walk to a small store that is within

walking distance. I asked her if she had ever thought about

what she would do if she became ill and had to have some

assistance and she responded that "I'll have to leave that

up to the Lord."

Mrs. V not only has few social contacts; she also has

meager economic resources. Her work in the fields and in

the laundry has resulted in a very small amount of income

from Social Security but she is also receiving a small

amount of money from Security Supplemental Income (SSI). At

one time she had received food stamps but has now decided

that "it's too much trouble. I'd rather do without. It

weren't much anyway."

Outwardly, Mrs. V appears to be a very happy woman.

She always has a smile and apparently gets along well with

her counterparts at the meal site. However, happiness was

not expressed when I asked her about the quality of her

life. During the years that I have known Mrs. V she has

consistently rated her life in general, her emotional health

and her physical health as poor. Furthermore, she says that









she worries a lot. "I,m always so tired that I can't do

anything," she stated. She is taking medication for a

heart problem and for high blood pressure but she expresses

no faith in the medical establishment. 'Bout the best

thing you can do is talk to the Lord 'cause He's the only

one can heal you," she stated.


The Black Elderly in High Springs

Six of the elderly people who have participated in this

research live in High Springs; four females and two males.

With the lone exception of one man, all live "across the

tracks," both literally and figuratively, in an area known

as "the quarters." Only black persons live here. The

streets are mainly unpaved and the area appears blighted.

There are several "juke joints" in the area. Three of

these subjects are included in the case studies.

The oldest person in this study is Mrs. D who is

94 years old. She is affectionately called "Grandmother D"

by her friends at the congregate meal site. She has been a

widow for over 20 years

Mrs. D lives in a home that must have been beautiful

at one time but now is on the verge of disintegration. The

house is an old two story frame house with a porch across

the front. The steps leading into the house are now rickety

and the porch has many loose or missing boards. There are

cracks in the walls and several windows have broken

windowpanes. A small gas heater is located in the living

room area and a free-standing kerosene heater is located in










Mrs. D's bedroom. On one particularly cold day when I was

visiting with Mrs. D, she tried to light the kerosene heater

but she did not know how and we had to continue our visit in

a very cold room. There is no hot water available in the

house. This home, as so many others in which I have

visited, seems to be exploding with items that it surely

took a lifetime to collect. Mrs. D sleeps in a in a bed

that is literally piled high with quilts and covers.

Social contacts are minimal for Mrs. D at this time of

her life due to her age and physical health. She has

outlived all four of her children. She shares her house

with a grandson and granddaughter but I have never seen them

there. She explains that they are working during the day

but that they are there during the evening. Her declining

health prevents her from participating in the congregate

meal program anymore but friends from the meal site bring

her a lunch everyday and stop in to visit with her for a

while. The friends from the meal site have expressed their

concern to me over the refusal of Mrs. D to eat all the

food that they bring her but she says that she only wants

the milk 'cause I don't have much of an appetite

anymore." These daily contacts keep Mrs. D informed of the

personal and social activities of her friends and she seems

to enjoy these daily visits.

Obtaining food presents no problem to Mrs. D. Her noon

meals are brought to her and her granddaughter does the

grocery shopping and preparing of the evening meal. When I









asked Mrs. D about gardening she stated "Lordy child, I miss

my garden. I don't fool with it anymore, ain't able to do

it."

The physical health of Mrs. D has declined rapidly over

the years that I have known her. She did not respond to the

four antigens when her immune functioning was checked in

1981. At that time, however, she was participating in the

meal site program everyday and she was able to come to

Gainesville for the medical checkup. However, on each

subsequent visit, she was no longer able to leave her house.

Her only physical complaint was about the arthritis in her

knees. The knees are very swollen and make it difficult,

if not impossible, to climb the steps that lead in and out

of her house. She is not taking any medications.

Faith appears to be the major source of comfort to Mrs.

D at this time. All conversation, regardless of the topic,

somehow evolves back to this faith. She states, "I don't

use those home remedies anymore. I pray, and the Lord's

done blessed me." When I asked her about her activities

everyday, she stated "I'm serving my God." After one visit,

I asked her if I might return the next week to see her and

she replied, "surely child that would be fine but if I don't

get to see you here, I'll see you in heaven."

Perhaps Mrs. D's faith accounts for the optimistic

outlook that she has although life could not have been easy

for her. She worked in the fields as a child and later

after her marriage, she continued this activity along with









her husband. As a result, she had no Social Security

benefits when she became too old to work. She receives a

small amount each month from Security Supplemental Income

(SSI) and she gives most of this to the grandchildren in

return for her care. These problems, however, do not seem

to bother her. When I asked her about her satisfaction with

life, she responded, "I'm perfectly satisfied. The Lord's

looking out for me. If He likes me, I guess I'm 'sposed to

like myself and I sure do."

Although life has been difficult for all these elderly

people, few live in circumstances as dire as those of Mr. C.

He is an 85 year old man who appears to be several years

younger. He has been separated from his wife for about

three years and has one son by this wife. Mr. C states that

this son is "bout 20 years old. He lives with his mama and

I don't never see him."

The house where Mr. C lives is delapidated to the point

of being almost uninhabitable. He pays $55 a month for rent

of the house. The area around the house is grown up in

weeds and bushes which make getting into the house somewhat

difficult. A door that is swinging on it's hinges leads

into a small screened porch. Inside, the house has a living

room, bedroom kitchen and a bathroom. All the floors are

bare wood. In the living room, there is an old couch, a

straight-back chair and a small kerosene heater. The house

always feels cold in the winter and there is no method of

cooling during the summer.









The health status of Mr. C seems to have improved

during the years that I have known him. My first visit with

Mr. C lasted for about three hours. After this visit, I

arranged for him to come into Gainesville for a medical

examination. He came to the clinic with several other black

elderly persons, all of whom he was acquainted with. I met

him at the door of the clinic and much to my surprise, he

draped his arms around me and began crying. My first

assumption was that he was in a strange area and that his

crying was most likely a fear reaction. He could not seem

to tell me what was wrong but I happened to look down at his

feet and saw that his feet were swollen to several times

their normal size. I asked if he was hurting and he could

only nod his head affirmatively. After getting him seated

in a chair and elevating his feet, the physicians assistant

took his blood pressure and found it to be over 200 systolic

and 100 dystolic. The clinic physician checked him and

found him to be in congestive heart failure. A call was

made to Mr. C's doctor in High Springs and the clinic

physician explained Mr. C's condition to his doctor.

The doctor's reaction was one of anger. He stated that

he could not get Mr. C to keep his appointments or to take

his medication and that he simply had no more patience with

Mr. C. In actuality, however, Mr. C had no way to get to

the doctor's office and had not told anyone of his need.

Furthermore, transportation to a pharmacy and paying for

medications presented Mr. C with seemingly insurmountable









obstacles. Once these needs became known, his friends at

the meal site began taking him to the doctor and the

pharmacy whenever he needed to go. On my last visit, there

was very little swelling in his feet and he said he was

taking his medication.

The mental outlook of Mr. C seems incongruous with his

total life. I asked him if he had a friend or someone that

he could talk to when he had troubles. "I don't have no

troubles," he replied. At another time he stated, "I'm

happy all the time." When I asked him what he would do if

he became too ill to care for himself, he explained that his

next door neighbor would take care of him. However, this

neighbor is a young woman with several small children and it

seems unrealistic to me that she would take on the care of

this man. Overall, at this time, he seems to be coping

adequately in meeting his needs mainly due to the efforts

of friends at the meal site, but if his needs increase, it

is doubtful that he could maintain his independent lifestyle

All of the subjects discussed up until this point

either are presently or have in the past, been married.

The following subject, Ms. 0, has never been married.

According to Ms. 0, "I've had lots of boyfriends. I just

never married 'em." Ms. 0 is 66 years old and lives alone

in a house belonging to a friend. She pays no rent because

she says "I take care of this house for the lady who owns

it."









Although Ms. 0 never married or had any children of her

own, more children are found around Ms. O's home than any

of the other subjects. The reason is popsicles. Ms. 0

gets up every morning and freezes a batch of popsicles. The

children, both black and white, come every day after school

and quietly knock on her door and tell her what flavor they

would like. She gets the popsicle out of the freezer; they

give her a dime and then they leave. The whole exchange is

characterized by quietness but many smiles. I have never

seen the children behave rowdy and Ms. 0 looks forward to

these afternoon exchanges. She says that she makes a

little money in this way but mostly she simply enjoys having

the children drop by. She states, "Somedays I don't feel

like making popsicles or selling 'em. Then I close the

curtains and shut the door and play like I'm not here."

These times are the exception however, and from 10 to 15

children may stop by on any afternoon.

Another distinguishing characteristic of Ms. 0 is that

she is currently employed. She cleans an office building

five afternoons a week. The office building is within

walking distance but I have noted that Ms. 0 can and does

walk rather long distances. Although Ms. O uses several

methods to improve her financial status, her income is still

less than $300 a month. She states, "I have barely enough

to just get by on."

The major health problem of Ms. 0 is diabetes which she

seems unable to bring under control. The normal range for









glucose level in the blood is from 70 to 110 mg/dl but Ms.

O's blood glucose level was 361 mg/dl when she came to the

clinic for a checkup. Even though the blood glucose level

was very high, her doctor did not change the amount of

medication that she was receiving. She takes three pills a

day for the diabetes, one pill "to improve my circulation,"

and a pill to control high blood pressure. Ms. 0 eats her

noon meals at the congregate meal site and no special diets

are available there for people who need them.

Life in general is not as severe as that of other of

the subjects but Ms. O does not perceive of the qualtiy of

her life as being as good as some of the other people have.

Scores greater than six on the Short Psychiatric Evaluation

Schedule (SPES) section of the Functional Assessment

Inventory (FAI) are considered by its developers to be

pathological. Ms. O scored seven on the SPES but I believe

this score is more related to her diabetic state than to her

mental state. I have spent many hours with Ms. 0 and found

her to be a very pleasant and cheerful person to be around.

She rates her satisfaction with life in general as only fair

but this may be a more reasonable assessment than many of

the others that the black elderly subjects in this study

have expressed.


The Black Elderly In Waldo

Five subjects live in the small town of Waldo. Instead

of considering them separately, as I have the other

subjects, I will discuss them together. I have chosen to do










this because they share so many similarities. They are Mrs.

L, aged 82; Mrs. E, aged 77; Mrs. A, aged 81; Mrs. G,

aged 83; and Mrs. M, aged 81.

These five women live very near each other and are very

good friends. Mrs. E, the youngest of the group, is the

only one who owns and drives a car and she provides

transportation to the grocery store and to doctors

appointments for the other women. I asked her if she did

not consider this to be burdensome but she explained, "it

gives me more time to visit." Adequate visiting time does

not appear to me to be a problem because on visits to any of

these women, one or more of the others were likely to drop

in for a chat. Mrs. E is the only one of the group who is

still married but her husband has been ill for several

years.

None of these women ever had a living child. Mrs. E

stated that she was told by her doctor that she had a

"crooked womb" and was therefore unable to conceive but she

states that "I raised a niece." Mrs. L had "one baby born

dead. Something went wrong with my womb." The other ladies

apparently had not considered a reason for this problem.

Mrs. A stated that "it just weren't meant to be" and Mrs. M

said that "I guess I should've asked a doctor but I didn't."

All of these women own their homes with the exception

of Mrs. G and she rents a home owned by Mrs. M. The homes

appear to be in adequate condition although Mrs. A says

that termites are eating the house and she has no money for










repairs. She inherited the house from her parents and she

keeps the house very neat, both inside and out. The rental

home of Mrs. G is in poorer condition than the other homes.

There are broken windowpanes, broken boards on the porch and

cracks between the boards in the walls. A hot water heater

was only recently added to the house and she, as so many

others in this study, keeps her house totally cluttered.

Mrs. L and Mrs. A apparently demand more privacy that the

other women because their homes are enclosed by fences.

Religion is also very important to these women. Mrs. M

states, "I be praying all the time. I ask the Lord to

strenghten me." "I rely on prayer. It gets me through,"

states Mrs. E.

I had heard so many of my subjects discuss the

importance of religion in their lives that I began to

assume a common morality for all my subjects and this mistake

was brought to my awareness by Mrs. G. One day as we were

discussing her inability to have children, I asked her how

long she was married to her husband. She replied, "Oh,

'bout two years." I suggested that perhaps this might

explain why she had no children. A large smile came over

her face as she patiently explained to me, "honey, I might

not have been married long but I shore had plenty of boy-

friends. In fact, I'm still looking for one but those men

down there at the meal site ain't no good." I was well

reminded to not take too much for granted with my elderly

subjects.









Only one of these women is growing any food although

all stated that growing a garden was a part of their past

that they missed. The general consensus seems to be that

as expressed by Mrs. L when she states, "I'm not able to

garden anymore." Mrs. G, however, continues to grow

various "greens" and she grows these both within her yard

and in a discarded bathroom commode which sits in her

front yard. Mrs. L provides the women with transportation

to the grocery once a week. All the women with the

exception of Mrs. L, eat their noon meal at the congregate

meal site. Mrs. L states that she eats at home in order to

be with her husband.

Another interesting similarity between these women was

that three of these women only had vision in one eye and the

other eye was damaged. Mrs. G lost the ability to see in

one eye due to glaucoma and she has limited vision in the

other eye from the same problem. Mrs. M was accidently

burned as a child and this accident resulted in the loss of

vision in one eye. She has a cataract that is limiting her

vision in the other eye. Mrs. L lost one eye "in a fight"

and she also has a cataract resulting in reduced vision in

her other eye.




Generalizations



The black elderly people in this sample share many

similar characteristics. They live in rural areas and many










have no or few family members still living in the area.

Most are poor and have low educational levels. Very few

have personal transportation and therefore must rely on

others to get them to the grocery stores and medical

appointments.

Coping with adversity has been a way of life for these

people. They grew up in a segregated society in which the

black person had very little opportunity for advancement.

The development of survival strategies had to be learned at

a very early age and these strategies are now sustaining

them during their old age. Stoicism appears to be a major

part of their adaptive strategy. I was frequently told that

I should not worry about them because their perception was

that they would be fine, regardless of the circumstances.

The mental outlook of these people is overwhelming opti-

mistic and I always left their presence with an upbeat

feeling.

These elderly people were using many resources to

assist them in maintaining their independence. Families

and friends were the source of much of their assistance but

in the absence of these resources, these older people used

formal service agencies, creative transportation sources

such as bicycles, or they were willing to walk significant

distances to obtain their needs. They have much to offer us

in learning to cope during adversity and these skills may

yet be needed by all people in our society.

















CHAPTER FIVE
RESULTS




The Functional Assessment Inventory


The purpose of this study was twofold. First, to

determine if the widely used Functional Assessment Inventory

(FAI) was reliable and valid for use within a black elderly

sample, and second, to examine the lifestyle and coping

mechanisms of the black elderly. The first section addresses

the issue of reliability and validity of the Functional

Assessment Inventory (FAI).

The FAI is a modification of the older version of the

Older Americans Research and Service Center Instrument

(OARS). Modifications included a systematic reduction of

questionnaire items, some rearrangement and the addition of

some new items. The instrument evalutes the social

resources, economic resources, mental health, physical

health and activities of daily living (ADL) of the

individual. From the responses, the interviewer makes an

evaluation of each domain along a continuum where

1 = "excellent" and 6 = "totally impaired." The scores of

each domain are summed to provide an overall cumulative

impairment score (CIS). These total scores are then used to









assess the needs of the subject and develop a plan to meet

these needs. The plan may recommend assistance from various

service agencies or institutionalization may be recommended

if the CIS is 17 or higher.




Sociodemographic Data


The sample consisted of fifty-four rural Alachua

County residents: 14 black males; 5 white males; 20 black

females and 15 white females. The white elderly were

included for comparative purposes. All subjects had partic-

ipated in an earlier (1981) research project that evaluated

their health and nutritional status. Selection was made

through a snowball sampling technique. Their socioeconomic

characteristics are summarized in Table I.

The average age of the subjects was 75. White males

and females had an average age of 74 and black males and

females had an average age of 76.

Educational attainment was low for all subgroups with

the possible exception of the white females. Eighty six

percent (N=12) of the black males, 74 percent (N=15) of

black females, 60 percent (N=3) of the white males, and 13

percent (N=2) of the white females had not attended high

school at all.

The majority of these subjects were either life-long

residents or had lived in the area for more than five

years. All of the white males (N=5) had lived here five









years or longer. Furthermore, 93 percent (N=13) of the black

males, 90 percent (N=18) of the black females and 74 percent

(N-11) of the white females were longterm residents in the

area.

The females in this sample were more likely to be

widowed than were the men. Eighty seven percent (N=13) of the

white females and 84 percent (N=17) of the black females

were widows. However, only 6 of 14 black males and 2 of 5

white males were widowers.

Low incomes were characteristic of all the subjects but

were more frequently found in the black rather than the white

subsample. Black females had the lowest incomes with 83

percent (N=17) having incomes either below the poverty level

or classified at "near poverty". Near poverty is defined as

income between the poverty level and 125 percent of poverty

(Longino 1983). Fifty five percent (N=9) of the black males

and 51 percent (N=9) of the white females had incomes below

the poverty level but no white males had incomes at this

low level.

Home ownership was high for this group. Eighty percent

(N=4) of the white males; 50 percent (N=10) of the black

females; 40 percent (N=6) of the white females and 36 per-

cent (N=5) of the black males owned their homes. More infor-

mation about the physical condition of the homes of the

black elderly is presented in a later section.













Table I. Sample Characteristics.


Black Males White Males
(N=14) (N=5)
Avg. Age 76.2 Avg. Age 73.6

N % N %


Education:
1. 0-4 yrs.
2. 5-8 yrs.
3. High School
(Incomplete)
4. High School
(Complete)
5. Trade School
6. 1-3 yrs. College
7. 4 yrs. College
8. Post Graduate



Length of Residence:
1. Seasonal
2. Less than 5 yrs.
3. 5 yrs. or more



Marital Status :
1. Married
2. Widowed
3. Divorced
4. Separated
5. Never Married

Income:
1. 0-$999
2. $1,000-$1,999
3. $2,000-$2,999
4. $3,000-$4,999
5. $5,000-$6,999
6. $7,000-$9,999
7. $10,000-$14,999


Own Home:
1. Yes
0. No


1 20
2 40


1 7


1 20
1 20


1 7
13 93


5 100


2 40
2 40

1 20


3 60
2 40


1 80
4 20


5 36
9 64













Table I--extended.


Black Females White Females
(N=20) (N=15)
Avg. Age 76.9 Avg. Age 73.6

N % N %


9 43
6 31 2 13


4 21



1 5






2 10
18 90



1 5
17 85

1 5
1 5


10 50
10 50


2 13
1 6







4 26
11 74



2 13
13 87


6 40
9 60






87


Reliability of the FAI



Measures of reliability showed that the FAI was a

reliable instrument. Specifically, the test-retest measure

of reliability was conducted within a time interval of four

weeks. Correlations between responses of the two tests re-

vealed that the instrument was reliable at the p <0.01 level

of probability. Eighty four percent of the scores of each

domain were the same and 100 percent of the scores were

within one point. Results are summarized in Table II.

Additionally, examination of the inter-item measures

of reliability revealed high correlations between total

CIS scores and each of the five domain scores. The inter-

item test for reliability was highest for the mental health

domain and high values were also found for the physical

health, economic and social domain in descending order. The

value for activities of daily living had the lowest relia-

bility of the domain items, and that was .65. Spearman

correlations of the inter-item reliabilities are shown in

Table III.




Validity of the FAI


Validity of the FAI was assessed by conducting a

Spearman's Rank Order test for correlation between items on

the FAI and the large data base already in existence for

this group. Correlations were evaluated between individual





















Table II. Test-Retest Scores.


Case 1 Case 2 Case 3 Case 4 Case 5


Test-Ret. Test-Ret. Test-Ret. Test-Ret. Test-Ret.

Soc.* 4 4 2 2 2 2 4 4 2 3
Eco.* 4 4 4 4 3 3 4 4 4 4
Ment.* 4 5 3 2 3 3 4 5 4 4
Phys.* 4 4 3 3 3 3 4 4 3 3
ADL* 3 3 2 2 2 2 4 3 3 4
CIS 19 20 14 13 13 13 19 20 16 18






Case 6 Case 7 Case 8 Case 9 Case 10



Test-Ret. Test-Ret. Test-Ret. Test-Ret. Test-Ret.


Soc.
Eco.
Ment.
Phys.
ADL
CIS


2 2
3 3
2 2
4 4
4 4
15 15


2 2
3 3
2 2
4 4
2 2
13 13


2 3
4 4
3 3
4 4
2 2
15 16


2 2
4 4
2 3
3 3
3 3
14 15


3 4
4 4
3 3
3 3
3 3
16 17


* Soc.=Social; Eco.=Economic; Ment.=Mental; Phys.=Physical;
ADL=Activities of Daily Living; CIS=Cumulative Impairment
Score.



























Table III. Inter-Item Reliability Spearman Correlations.


Domains Social Economic Mental Physical ADL**
# of Items 9 16 7 14 17

CIS** .74* .75* .80* .79* .64*

* p < 0.001
** ADL=Activities of Daily Living
CIS=Cumulative Impairment Score









items on the FAI and comparable items in the multiphasic

data base as well as total scores in each domain of the FAI

and individual items in the multiphasic data base.

A high correlation was found with similarly phrased

questions. For example, questions of total income revealed

correlations of p <0.001 when responses between the data

bases were compared. However, when total scores for the

domains were correlated with related individual items in the

multiphasic data base, correlations were often not signifi-

cant. Results for total FAI scores and individual items in

the large data base are summarized in Table IV.




Comparisons by Race and Sex


The mean values for the six domains and the SPMSQ

were compared by race and sex. Comparisons were made between

white and black females; black males and black females;

black males and white females; white males and black fe-

males; white males and white females; and white males and

black males. A t-test was used to determine significance

between the means of these groups. These values are summa-

rized in Tables V and VI.

Statistically significant differences were found for

race and sex comparisons. White females and males had better

scores in all categories. However, due to the small number

of white males, along with an unusually high CIS score for











Table IV. Spearman's Rank Correlations of FAI Domain Scores
and Multiphasic Data Base Items.


Multiphasic Data Base


r Sig.


Social Number of
Number of
Number of
Extent of


meals/week eaten with family .33
friends
meals/week eaten with friends
family involvement


Economic Use of food stamps -.57 p<0.0001
Income -.48 p<0.001
Number of meals/week eaten with family .26 p<0.05
Income from SSI .48 p<0.03


Mental Zung's Depression Scale n.s
Holmes Stress Scale n.s.


Physical Ease of movement .34 p<0.01
Diabetes (verbal assessment) -.33 p<0.01
Glucose (biochemical assessment) .35 p<0.01
LDH (lactic dehydrogenase) .29 p<0.03
Level of activity n.s.
High blood pressure n.s.
Low hemoglobin levels n.s.
Cancer n.s.
Heart disease n.s.
Creatinine, serum n.s
SGPT (serum alanine transaminase) n.s.
Arthritis n.s.


CIS* Income -.36 p<0.01
Low triceps skinfold -.26 p<0.05
BUN (blood urea nitrogen) n.s.
Self assessed health status n.s
All items related to social involvement n.s
All items related to mental status n.s.
All items related to ADL n.s.


SPMSQ* Income -.47 p<0.001
Low triceps skinfold -.38 p<0.01
Education level n.s.
Age and birthday n.s.

CIS=Cumulative Impairment Score
SPMSQ=Short Portable Mental Status Questionnaire


p<0.01
n.s.
n.s.
n.s.




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