775 participants for the survey were selected using quota sampling. The group targeted were community-dwelling males and females aged 65 years and over. These were selected from a population (NSW) consisting of 13% people 65 years and over (ABS, 1998). Participation in the study was voluntary. Students were given two questionnaires and required to find one male and one female aged over 65 years to willingly complete the questionnaires. Subjects were required to fill out a consent form, eliminating any ethical concerns to do with confidentiality and privacy issues.
Materials
The questionnaire filled out by the participants was divided into two sections; variables and activities of daily living (Appendix 1). The first section consisted of variables including age (in years), gender (male/female), marital status, smoking habits, alcohol consumption, exercise, health, no. of long-term diseases, and hospitalization within the past year (yes/no). Subjects were asked if they had ever been a regular smoker. If yes, this was further broken down into number of cigarettes per day and number of years they smoked.
Alcohol consumption was defined using a scale of 1 (never) – 5 (no. of days /week), as well as the number of drinks consumed on each of these occasions. Exercise (which was defined as a 30minute walk, exercise class, 1 hr gardening etc.) was measured using a scale of 1 (never) – 5 (no. of days per week) both currently and in past (age bracket 40-64 yrs). Self- reported health rated on a scale of 1 (poor) – 5 (excellent) & 6 (unsure). Long-term disease diagnoses (yes/no) included arthritis or rheumatism, high blood pressure, coronary heart disease, diabetes, cancer, and stroke.
The second section consisted of questions based on the subjects “activities of daily living”. This is a common technique used to assess health-related functional limitations. Thirteen activities were selected including; bathing, eating, dressing, getting in and out of bed, getting to the toilet, getting outside your home, walking, using the telephone, doing light and heavy housework, shopping, cooking and preparing meals, and handling money. Before each question, the subject was asked ‘Because of a health or physical problem, do you have difficultly…’. Their answers were measured using the following scale: 1 (no difficulty), 2 (some difficultly), 3 (lots of difficulty), 4 (unable to do it) and 6 (can’t say).
Procedure If accessible in person, the two sections were read out to the participant in a quiet environment, and they answered the questions according to the scale mentioned above. If the person was not accessible in person, the questionnaire was either faxed or posted to them and filled out accordingly, or read out to them as an interview over the phone. DISCUSSION The results of the survey do suggest a correlation among health related behaviors, activates of daily living, health status and the development of heart disease.
The results yielded a strong relationship between smoking and heart disease, thus confirming assumptions previously assumed that cigarette smoking contributes to heart disease. The fact that non-smokers had a 1/7 chance of having heart disease while 1/4 smokers were diagnosed with heart disease clearly supports this. There are concerns, however, to do with the validity of this data, as the participants may have been influenced by their interviewer i.e. not being truthful about the amount of cigarettes they smoke because of the presence of a family member, or the fear of being embarrassed or ridiculed. To eliminate this issue in future research, anonymity between the interviewer and the interviewee could be employed.
When comparing each individual category with small differences in exercise frequency, a difference in the incidence of heart disease did not follow a consistent trend, and thus, surprisingly, the results for exercise were not as definitive as expected. This was perhaps due to the small and limited population sample. However, when comparing the two extremes (never Vs 7 days/wk) there was an observable decrease in the incidence of heart disease, corresponding to previous theories that more frequent exercise decreases the likely hood of developing heart disease. Both results from health-related behaviours confirm the idea mentioned earlier that a person with better health habits will postpone disability (e.g. long-term illness such as heart disease) and in turn, survive longer.
When considering health status, the results indicate that people with heart disease are more likely to rate their health status as poor. These results however, may not have been totally accurate as the ratings were self-reported, and not medically confirmed. The questions were also closed and therefore limited the interviewee’s response. People may have had different definitions of what a ‘good’ health status is. Likewise, people with heart disease are more likely to be hospitalized. 547 people who do not have heart disease were not hospitalized in the last year, while 227 who do have heart disease were. Yet this result is somewhat limited as the question did not specify whether or not the hospitalization resulted because of heart disease. One could argue that hospitalization due to other illnesses is irrelevant.
The results of the activities of daily living were inconclusive because the validity of the information collected was questionable. This is due to the accessibility bias of the population sampled. The participants selected for the survey were those who could be accessed and thus those in hospitals, nursing homes etc. were unintentionally excluded. This resulted in a relatively healthy sample and consequently the majority of the participants circled ‘no difficulty’ in completing all the daily activities.
Therefore it was difficult to distinguish any clear relationship. Anonymity is once again also an issue, as the results may have been influenced by the participants feeling too embarrassed to admit to having difficulty in basic skills. The perception of what is considered to be ‘difficulty’ is also something that could be refined in future or backed up by medical diagnoses. Other limitations of the experiment included language barriers associated with the understanding of the questions, which could be prevented in future by the utilization of interpreters, as well as the unequal numbers of males and females. As it has been shown in previous studies that there is a higher incidence of heart disease in males, this may have influenced the results and therefore should be avoided in future by the regulation of the number of each gender.
REFERENCES
Ades PA, Savage PD, Tischler MD, Poehlman ET, Dee J. Niggelj (2002) ‘Determinates of disability in older coronary patients’, American heart journal,143,151-156 Moore, Rosenberg M & Fitzgibbon S (1999) ‘Activity limitation and chronic.