FUNCTIONAL ASSESSMENT AND COPING BEHAVIORS AMONG THE RURAL
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
Lois Carolyn Nickens
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
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-
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
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 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
ACKNOWLEDGEMENTS ...................................... iii
LIST OF TABLES ...... ..................................... vii
ABSTRACT ............................................ . viii
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
A FOOD FREQUENCY ....................................... 165
B MATERIAL STYLE OF LIFE ............................... 170
C COPING STYLES OF THE RURAL BLACK ELDERLY .......... 172
BIOGRAPHICAL SKETCH ................................... 174
LIST OF TABLES
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
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
LOIS CAROLYN NICKENS
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
participated in an in depth examination of coping
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
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
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
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.
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
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
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
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
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 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
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-
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
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.
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
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
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
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
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-
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
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.
STATEMENT OF THE PROBLEM
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.
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
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
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
4. Do the informal social contacts of this population
contribute positively or negatively to the main-
tenance of their lifestyle? It was hypothesized
that social contacts would function both positively
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.
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
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
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
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-
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
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-
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
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
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).
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
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 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
for what must often have seemed my interminable questions.
All subjects were given copies of all pictures made of them
and their surroundings.
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
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
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
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
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.
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
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
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
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
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
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
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
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
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
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
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
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"
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
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
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
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
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
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
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
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
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
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
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.
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
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
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.
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.
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
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
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
Avg. Age 76.2 Avg. Age 73.6
N % N %
1. 0-4 yrs.
2. 5-8 yrs.
3. High School
4. High School
5. Trade School
6. 1-3 yrs. College
7. 4 yrs. College
8. Post Graduate
Length of Residence:
2. Less than 5 yrs.
3. 5 yrs. or more
Marital Status :
5. Never Married
Black Females White Females
Avg. Age 76.9 Avg. Age 73.6
N % N %
6 31 2 13
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
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.=Social; Eco.=Economic; Ment.=Mental; Phys.=Physical;
ADL=Activities of Daily Living; CIS=Cumulative Impairment
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
Social Number of
meals/week eaten with family .33
meals/week eaten with friends
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.
Heart disease n.s.
Creatinine, serum n.s
SGPT (serum alanine transaminase) 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