In a paper on habit mechanisms in smoking, Hunt and Rlatarazzo(3) noted that the resumption of smoking or the relapse rate over time for a group of people who had successfully completed a treatment program and given up smoking conforms to a negatively accelerated, typical "extinction" curve such as those presented in Fig. 1. Their original figure was based on some 17 studies. The curves in Fig. 1 are based on some 84 studies.The curve should be considered as illustrative, or typical, rather than mathematically exact, as not all the studies surveyed utilized the same time periods in reporting the follow-up information and many of them gave data only for a single point in time, which of course makes individual curve fitting impossible. We arbitrarily selected 3, 6, and 12 months and established each point by averaging all the studies that reported for any of the three times. We also have constructed individual curves for each of those studies that reported data over comparable periods, the average of these studies, and the average of all studies that reported for only one of these points, etc. All the curves are remarkably similar.They are marked by a steep decline during the first 3 months, a subsequent gradual levelling off, and by an asymptotic level well above zero. Originally, we had hoped to use the differences in slope between individual curves as a differential criterion to evaluate various treatment techniques, but the lack of uniformity in reported follow-up data, plus the common sources of contamination in the different techniques themselves as noted by Bernstein('), suggest that the field is not ready as yet for sophisticated evaluative methods.While we are not yet ready to comment on slope differences between treatment techniques, the universality of the curve characteristics permits two general comments, one practical and one theoretical. On the practical side, the high incidence of relapse or "backsliding" during the first 3 months would indicate that, even disregarding those failures who never do manage to stop smoking despite treatment, treatment methods as presently practiced make only a moderate impression on those who do manage to stop. Either the usual treatment period is too brief or the methods too inefficient to produce a lasting effect. Obviously, the majority of "patients" need some further supportive or booster treatment during the first 6 months after successful completion of therapy.More interesting to us are the theoretical implications of the curve in becoming asymptotic before it reaches zero. Why is it that roughly 20% of the Ss treated never return to smoking? If this is attributable to some personality and/or physiological characteristics, then this group of people certainly deserves further study. The steepness of the slope of the curve and its relatively sudden leveling off above zero suggest that they may be a discrete and easily identifiable group. We are more inclined, however, t o believe that bwo kinds of learning may be involved, one of which is susceptible to the usual r...

Evaluation of physical functioning plays a valuable role in clinical geriatrics as well as in aging research. Physical functioning has generally been assessed through self- or proxy-report. An important addition to this form of assessment is the use of performance measures of physical function, in which individuals are asked to actually perform specific tasks and are evaluated using standardized criteria. Although there has been limited methodological work on physical performance instruments, this approach offers a number of potential advantages. Several performance assessments have been developed that correlate highly with other measures of health status and predict need for long-term care and mortality. It is suggested that more widespread use be made of physical performance assessments and that they be evaluated as measures of functioning in cross-national studies, as indicators of change in functioning over time, as endpoints in intervention studies, as tools for identifying persons functioning at high levels, and as sources of relevant information for the clinician.

This study was designed to demonstrate the feasibility of forecasting functional health for the elderly. Using life-table techniques, we analyzed the expected remaining years of functional well-being, in terms of the activities of daily living, for noninstitutionalized elderly people living in Massachusetts in 1974. The expected years, or active life expectancy, showed a decrease, from 10 years for those aged 65 to 70 years to 2.9 for those 85 or older. Active life expectancy was shorter for the poor than for others, and women had a longer average duration of expected dependence than men. The measure of active life expectancy provides important information about health at a given population level, in terms other than death. This information can be used for actuarial purposes in planning and policy making. It is also useful in identifying high-risk populations for which preventive health care and medical care can compress morbidity during the last years of life.

The Internet (electronic mail and the World Wide Web) may provide new opportunities for communication that can help older adults avoid social isolation. This randomized controlled trial assessed the psychosocial impact of providing Internet access to older adults over a five-month period. One hundred volunteers from four congregate housing sites and two nursing facilities were randomly assigned to receive Internet training or to a wait list control group. The pre & post measures included the UCLA Loneliness scale, modified CES Depression scale, a measure of locus of control, computer attitudes, number of confidants, and overall quality of life. Participants received nine hours of small group training in six sessions over two weeks. Computers were available for continued use over five months and the trainer was available two hours/week for questions. At the end of the trial, 60% of the intervention group continued to use the Internet on a weekly basis. Although there was a trend toward decreased loneliness and depression in intervention subjects compared to controls, there were no statistically significant changes from baseline to the end of trial between groups. Among Internet users (n = 29) in the intervention group there were trends toward less loneliness, less depression, more positive attitudes toward computers, and more confidants than among intervention recipients who were not regular users (n = 19) of this technology. Most elderly participants in this trial learned to use the Internet and the majority continued to use it on a weekly basis. The psychosocial impact of Internet use in this sample suggested trends in a positive direction. Further research is needed to determine more precisely, which older adults, residing in which environmental contexts are more likely than others to benefit from this rapidly expanding information and communication link.