studies have examined whether these psychological factors contribute to health differences.

NEEDED RESEARCH

Does greater experience of and exposure to chronic stress account for some racial and ethnic health differences among older adults? This question has yet to be systematically investigated; the evidence is incomplete and so far inconclusive. Better measurement of relevant dimensions of stress would be critical to understanding whether and how it affects health differences. While rating scales try to encompass the variety of sources, how adequately they do so is unclear. Such dimensions of the stressful experience as exposure, appraisal, and response (Lobel et al., 1992) require attention.

Research Need 12: Study populations of different racial and ethnic groups to assess the connection between health and the stresses that accumulate over a lifetime.

Despite the considerable research on stress and health, it is still unclear what role stress plays in the health of older adults of different groups. Some minorities, especially blacks and Hispanics, appear to experience higher levels of chronic stress, but it has not been determined whether this is linked to relatively higher morbidity and mortality as they age. Various stressors may be of concern for different groups—discrimination and racism, as discussed above, but also socioeconomic pressure, acculturative stress for immigrant populations, the stress of family responsibilities, and agingrelated problems. Research should focus on sources of stress that apply particularly to minority populations and on the suggestions in the literature that reactions to stressful events may vary across groups.

The assessment of cumulative stresses over the life course should be given special attention and may be especially relevant. People who have experienced more “lifetime adversities” have been shown to exhibit potentially pathogenic physiological activity (Singer and Ryff, 1999). Older minorities, especially blacks and perhaps other groups, have complex life histories that often involve substantial adversity. Investigation of how this affects health in old age, with attention to cohort and historical effects, is a fruitful direction for investigation.

Several psychological factors are associated with stress, including depression, anxiety, and anger or hostility, and may also play a role in health differences. Although a good deal of research has examined the effects of these factors on morbidity and mortality, little of this research has focused exclusively on older adults, and even less has focused on racial and ethnic differences.



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