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Claudio C. Garcia Pintos, Ph.D., Psychogerontologist of the Geriatric Day Hospital "San Pedro", Buenos Aires and "Clinica Privada del Plata", Buenos Aires; Professor at the Department of Psychology of the Argentine Catholic University "Santa Maria de los Buenos Aires"; Dean of the Humanistic Psychology College of the Vicente Lopez University, Buenos Aires.
Address: Virrey del Pino 2878, 1ro. "A", 1426 Buenos Aires, Argentina.

Excessive Behaviors and Meaning-in-Life Among the Active Elderly in Israel
David Guttmann and Ben Zion Cohen

Abstract:


What role does meaning-in-life play in the prevalence of excessive behavior patterns among active Israeli aged? Are such behaviors new, that is, developed after retirement, or do they manifest a continuation of previous life style patterns? What other factors affect these behaviors? Exploration of these questions is necessitated by the fact that between 1960 and 1980 the elderly population in Israel has grown threefold, while the general population increased by only seventy percent. Moreover, the recent influx of immigrants from the former Soviet Union contains a large proportion of elderly people, placing an ever increasing demand on the Israeli health care and social welfare systems.
The above questions were investigated in a sample of 148 active elderly living in the community with a shortened form of the Purpose in Life test. Excessive behaviors studied were medication abuse, alcohol consumption, smoking, and gambling. Subjects were participants at four retired persons' clubs operated by the municipal authorities in the city of Haifa. These four clubs were chosen to represent neighborhoods with differing socioeconomic levels and ethnic compositions in which attendees live. Data were collected by trained interviewers and recorded on a prepared schedule, which contained items on the demographic, familial, physical, and economic conditions in the past (age 50) and at present. Additional information was sought on their use of medications, consumption of alcohol, smoking, and gambling.
Findings indicated that the overall prevalence of excessive behaviors in this sample was lower than expected. Meaning-in-Life had a positive correlation (eta=.63) with these behaviors. However, it is not clear from the causal order whether these behaviors affect meaning-in-life, or whether they are affected by it. This finding needs further study with different samples and in different settings to ascertain its applicability to other elderly populations. From the additional findings it appears that excessive behaviors are associated with life style changes, even when these changes are for the better. Continuity in life style contributed to meaning-in-life, as did a secular outlook on life, economic situation and current level of health. A negative association found between meaning-in-life and religiousness needs further study as well.
The results offer further confirmation of the importance of Frankl's concept of meaning.

Zusammenfassung:


Welcher Zusammenhang besteht zwischen Lebenssinn und exzessiven Verhaltensmustern im Alter? Hat sich solches Verhalten erst im Ruhestand entwickelt oder ist es eine Fortsetzung des früheren Lebensstils? Welche weiteren Faktoren beeinflussen dieses Verhalten? Die Untersuchung dieser Fragen ist dadurch notwendig geworden, daß die Zahl der älteren Menschen in Israel zwischen 1960 und 1980 auf das Dreifache angestiegen ist, während die Gesamtbevölkerung nur um siebzig Prozent zugenommen hat. Auch besteht der jüngste Zuzug von Einwanderern aus der ehemaligen Sowjetunion zu einem großen Teil aus alten Leuten, woraus sich eine erhebliche Belastung des israelischen Gesundheits- und Wohlfahrtssystems ergibt.
Die oben angeführten Fragen wurden an einer Stichprobe von 148 aktiven Senioren, die nicht in Altersheimen wohnen, untersucht. Dabei wurde eine verkürzte Form des Purpose-in-Life-Tests verwendet. Die exzessiven Verhaltensweisen, die studiert wurden, waren: Medikamentenmißbrauch, Alkoholkonsum, Rauchen und Spielen. Die Versuchspersonen waren Mitglieder von vier Seniorenklubs, die von der Stadtgemeinde Haifa betrieben werden. Die vier Klubs wurden so ausgewählt, daß sie Bezirke mit verschiedenen sozioökonomischem Status und ethnischer Zusammensetzung repräsentierten. Die Daten wurden von geschulten Interviewern gesammelt und in einen Fragebogen eingetragen, der demographische, familiäre, körperliche und ökonomische Bedingungen der Versuchspersonen in der Vergangenheit (Alter 50) und der Gegenwart festhielt. Weitere Fragen betrafen den Gebrauch von Medikamenten, den Konsum von Alkohol, Rauchen und Spielen.
Die Ergebnisse zeigen, daß die Häufigkeit des Auftretens exzessiver Verhaltensmuster in der Stichprobe geringer war als erwartet. Subjektiver Lebenssinn zeigte eine positive Korrelation (eta=0.63) mit diesen Verhaltensweisen. Es ist aber nicht klar, ob das betreffende Verhalten das Sinnerleben beeinflußt oder umgekehrt. Weitere Untersuchungen an anderen Stichproben und unter anderen Bedingungen werden nötig sein, um die Gültigkeit dieser Resultate für andere Populationen von älteren Menschen sicherzustellen. Aus den weiteren Ergebnissen geht hervor, daß exzessives Verhalten offenbar mit Veränderungen im Lebensstil zusammenhängt, und zwar auch dann, wenn es sich um Veränderungen zum Besseren handelt. Eine Kontinuität im Lebensstil fördert das Sinnerleben, ebenso wie eine diesseitige Lebenseinstellung, die ökonomische Situation und der Gesundheitszustand. Die gefundene negative Korrelation zwischen subjektivem Lebenssinn und Religiosität erfordert ebenfalls weitere Untersuchungen.
Insgesamt liefern unsere Resultate einen weiteren Beweis für die Bedeutung des Franklschen Sinnkonzepts.

Introduction


..."Man's search for meaning is a primary force in his life and not a secondary rationalization of instinctual drives. This meaning is unique and specific in that it must and can be fulfilled by him alone; only then does it achieve a significance which will satisfy his own will to meaning". [1] (p.97)
When a person is unable to discover, recognize, and accept meaning, he finds himself in an "existential vacuum". This vacuum cries out for fulfillment. Those who are unable to fill their lives by finding a meaning are apt to pay a price in the form of psychiatric symptoms, such as anomie, addiction, and agression, which in their severest forms lead to what Frankl has termed "noogenic neurosis." And they suffer from anxiety and depression. Frankl claims that this is also true of the crises of pensioners and ageing people. [1]
Based on the above, the authors of the present study were interested to learn what role meaning in life plays in the prevalence of excessive behavior among active Israeli aged? Whether such behaviors are new, that is developed after retirement, or manifest a continuation of previous life style patterns? And what other factors affect these behaviors? Exploration of these questions is accentuated by the realization that between 1960 and 1980 the elderly population in Israel has grown threefold while the general population increased by only seventy percent. Moreover, the recent influx of immigrants from the former Soviet Union has contained a large proportion of elderly people, thus placing an ever increasing demand on the Israeli health care and social welfare systems. Thus the responsible professional can no longer look upon an eighty year old abusing alcohol or medications, or complaining that life has lost its meaning, with benign neglect. Awareness of the wide range of human behavior, and individual coping with the vicissitudes of ageing, require a similar, and equally diverse, set of strategies and answers.

Continuity and Change


Adjustment to ageing is best understood by examining the complex inter­relationships among biological and social changes against the backdrop of life long experience [2,3]. In the process of becoming an adult and in meeting the challenges of adulthood, each of us develops attitudes, values, commitments, beliefs, preferences and tastes which we integrate, for better or for worse, into our personalities. As we become older we are predisposed to maintain continuity not only in these varied aspects of personalities, but also in our habits, associations, and surroundings. The failure to preserve a sense of continuity, as occurs frequently in the transition to institutional surroundings, is one of the most common precipitators of maladjustment and dysfunction in the elderly [4].
The conventional wisdom is that older persons are the same as they always were, only more so. This statement probably comes closest to the reality of ageing, provided that personality traits and habits are such that they can be extended into old age and continue to enjoy a degree of social approval. Furthermore, there are no major social, familial, economic, or geographic disruptions, and the physical processes of ageing present no inordinate difficulties. Atchley [3] refers to this state as "external continuity." Persons remaining in their natural environments, interacting with familiar persons, and exercising their strongly internalized skills and competencies, reinforce their feelings of self worth and self esteem:
Their heightened sense of autonomy and self sufficiency allow them to be as they always were, and as many of the responsibilities of younger adulthood fade away, they can be even more so.
Frankl asserts that each situation represents a challenge to man and presents a problem for him to solve. Everyone has his own specific vocation or mission in life to carry out a concrete assignment which demands fulfillment [1]. Change thus is inevitable. New life experiences, new environments, new technologies, and various losses in the physical, psychological, and the social spheres constantly challenge our adaptability. Atchley [3, p. 243] points out that we respond by defending our beliefs, our lifestyles, and our behaviors, "because to us they seem necessary for our security and survival. And the more valuable the person sees himself to be, the stronger the internal motivation for continuity."
Among the elderly continued involvement in social networks and community affairs allows for less preoccupation with the past because self worth is not contingent on "past glories." Elderly activists attain, in most cases, a sense of being in charge of their own lives.
The endless combinations of changing factors to which the ageing person needs to adjust are parallelled by an equally wide range of adjustment patterns. This immense complexity is mitigated only slightly by the commonalities of cultural and ethnic traditions, and a bit more by the similar responses of persons moving together through the life cycle. Within this rich diversity, social problems, and addictive and excessive behaviors are certainly present in significant quantities.

Excessive Behaviors


Frankl [1] claims that man has lost some of the basic animal instincts in which an animal's behavior is imbedded and by which it is secured. In addition however, Frankl says: "man has suffered another loss in his more recent development inasmuch as the traditions which buttressed his behavior are now rapidly diminishing. No instinct tells him what he has to do, and no tradition tells him what he ought to do. Sometimes he does not even know what he wishes to do. Instead, he either wishes to do what other people do (conformism) or he does what other people wish him to do (totalitarianism)." [1, p. 106]
The prevalence of excessive and addictive behaviors among the elderly is largely unknown. Similarly, the degree to which such behaviors represent continuity or innovation is an unexplored topic. The excessive behaviors studied in the present research were: substance abuse, alcohol abuse, gambling, and smoking. The concept of "excessive behaviors" was chosen for this study as it is more inclusive than "addictive" or "deviant" behaviors [5].

Substance Abuse


The most common deviance among the elderly is probably substance abuse, which can take several forms: Abuse of over the counter (OTC) medications; abuse of prescribed, particularly psychoactive drugs; alcohol abuse; and cigarette smoking. While ageing is not an illness, 80 to 85 percent of the elderly reportedly suffer from at least one chronic medical condition, compared to only 40 percent of the population under 65 years [6,7]. Most of the chronic conditions prevalent in the elderly population can be relieved or controlled by the proper use of medication, prescribed or OTC. In the United States where the elderly constitute 12 percent of the population, they consume more than 25 percent of the medications [8]. Similar findings have been reported for Britain [9] and for Sweden [10]. There are no data available in Israel about the use (legal or illegal) of medications by the elderly [11], but it is fair to assume that in Israel, as in the rest of the developed world, the elderly are the group most at risk for the abuse of medications.
Elderly people abuse medications in a variety of ways. They may not follow the directions of the physician, use them too much, too little, and/or use them at inappropriate times. They may disregard or not be aware of drug interactions with other drugs, with alcohol, etc. And they may use the medication against medical advice [8]. In addition, there is the danger of dependency, particularly with medications for which dosage must be increased to maintain the effect [12]. Moreover, the use of medication in suicide among the elderly has been noted repeatedly; barbiturates are the most common suicide drug for this population [13].
Medications consumed by the elderly are used by and large for treatment and relief of some major diseases, as well as for the common ailments of old people: insomnia, pain, digestive malfunction, nervousness, depression. The preference for OTC preparations, some 40 percent of all medications consumed by the elderly in the U.S. [14] may have less to do with the trouble and expense of a visit to the doctor, than with the safety and comfort associated with a familiar medicine. Interestingly, one study found that the most common form of medication abuse by the elderly is using less than instructed by the physician [8].
There are few indications of widespread use of illegal drugs by the elderly. DuPont [15] found that only 2 percent of the 50+ population of the U.S. used marijuana, compared to 56 percent of the 18 21 age group. While some studies have uncovered hidden addiction among older persons (e.g., Chapel [16]), most experts agree with Winick's [17] claim that illicit drug abusers typically "mature out" before age 50.

Alcohol Abuse


"Such widespread phenomena as alcoholism and juvenile deliquency would not be understandable unless we recognize the existential vacuum underlying them" [1]. Alcohol abuse by the elderly falls into two categories: "early onset" drinking problems, beginning at an early age and persisting into old age, account for about two thirds of elderly alcohol abusers; "geriatric alcoholics" begin their compulsive drinking at middle age or later. This "late onset" group shows less psychological and health impairment and has better chance for recovery with appropriate treatment and support [18,19].
After heart disease and cancer, alcohol abuse is the third leading health problem in the United States. Alcoholism can shorten life expectancy, cause heart disease, brain damage, falls and accidents, and impotence in men. Butler and Lewis [12] claim that chronic alcoholism can lead to liver dysfunction, and general deterioration of the personality.
Alcoholism in the former Soviet Union is wide spread and steadily growing as alcohol is central, culturally accepted and supported. "Soviet citizens consume an average of 11.2 litres of pure alcohol per year and an estimated 4.4 litres per head of samogon or home brew; this makes them the world's heaviest drinkers of distilled spirits." [20, p.441]. There are no statistics available about the proportion of the elderly among the alcohol abusers in that country, but a much shorter life expectancy, especially for men, than in other developed countries is a good indication of its consequences.
Zinberg [21] found that alcohol abuse was responsible for a high percentage of psychiatric hospitalizations among the elderly. Glantz [22] studied alcohol abuse over the life span and found that excessive drinking peaks between ages 40 and 50, and then declines gradually until age 65. After 65 there is a sharp increase. Alcohol related problems such as drunkenness, driving under the influence, appear to be on the rise among the elderly in the United States according to statistics on citations and arrests [23,24]. Comparable statistics on alcohol abuse by the elderly in Israel are not available.

Gambling and Smoking


Compulsive gambling among the aged is another topic about which little is known, although visitors to casinos in Nevada or Atlantic City invariably notice that many of the customers, especially at the slot machines, are elderly, and many of these elderly are women. Cardplaying is a common activity, where allowed, both at old age homes and at day centers for the elderly.
This phenomenon seems to be as common in Israel as in the U.S. Rosencrance [25] viewed the sustaining social arrangements that develop among the players and the social rewards derived from the game as the major factors in excessive gambling. Elderly customers are very much in evidence at the booths where the lottery tickets are sold but, once again, no age specific data are available.
Rogers [26] has pointed out that the typical cigarette smoker in the older population groups is a person who started smoking without fully realizing the consequences, and subsequently was unable to quit. In 1986, in the U.S., 26.5 percent of the population was smoking. This included 16.7 percent of males and 12 percent of females over 65, indicating that the over 65 group smoked less than the general population [27]. Comparable figures for Israel are not available.
The present study will examine the prevalence of the above behaviors in a sample of Israeli elderly, socially active and living in the community. It will also examine their attitudes to life and attempt to identify the relationships among continuity, attitudes, and four behaviors: medication abuse, drinking, gambling, and smoking.

Method
Sample:


A team of trained interviewers approached persons in attendance at four Retired Persons' Clubs operated by the municipal authorities in the city of Haifa. The four Clubs were chosen to represent neighborhoods with differing socioeconomic levels and ethnic compositions. A total of 117 interviews were obtained at the Clubs. Each interviewee was asked if he could recommend a friend, not present at the Club, who might agree to an interview at his or her home. This resulted in an additional 31 (20.9%) respondents who proved similar to the original 117 (79.1%) in their personal attributes. All of the subjects were living in the community and none were invalids.
Instruments:
The data were collected by the interviewers and recorded on a prepared schedule. The schedule contained items soliciting information on the demographics of the respondents; items regarding their perceived familial, social, physical, and economic conditions in the past (age 50) and at present; items on their use of medications, consumption of alcohol, smoking, and gambling; and a ten item meaning in life scale based on the Purpose in Life Test (PIL) [28,29].

The Purpose in Life (PIL) Test was developed by Crumbaugh and Maholick [28] as an operationalization of Frankl's [1] basic concept of "existential vacuum". Frankl explained that the existential vacuum is a "widespread phenomenon of the twentieth century" and manifests itself mainly in a state of boredom [1].


The PIL has demonstrated its usefulness both in therapy and in research. The test has two parts. The first part consists of twenty statements in the semantic differential format. Each statement is rated on a seven point scale. The second part contains thirteen sentence completion items. For the present study, a shortened form of the first part was employed, that is, ten semantic differential statements. These covered the topics addressed by the PIL and were considered closest to the concept of meaning in life: the quality of life, the sense of self worth, the noo dynamic dimension, i.e., the tension between what one feels has been achieved so far in life and what he or she still wishes to accomplish [l], clarity of goals, and diversity of experience. (The ten items are presented in Table 5, below).
An additional set of questions in the interview schedule elicited information on the respondent's lifestyle   his present occupation, voluntary activities, religiousness   and on recent significant events, such as an operation, an accident, or the death of a loved one.

Results:
The demographic and personal characteristics of the subjects are displayed in Table 1.

  Table 1 here  

As can be seen in Table 1, the mean age of the subjects is 75, and 70.3 percent (n=104) are female. The majority of the sample immigrated from the USSR or Eastern Europe (59.9%, n=88), but this is not a sample of new immigrants. Of the 137 (92.6%) born outside of Israel, 90.5 percent (n=124) have been in the country at least thirty years. The level of education is surprisingly low (mean = 9.7 years, sd=4.0); many of these are persons whose educations were interrupted by World War Two and the Holocaust. The largest category of marital status is "widowed" (52.7%, n=78) and 49.0 percent (n=72) live alone. A large majority (86.6%, n=123) are retired, and 23.0 percent (n=34) describe their current economic situation as poor or very poor. All the subjects are Jewish and they divide about equally into religious traditional (49.3%, n=72) and secular (50.7%, n=74).


Table 2 presents the prevalence of the four excessive behaviors examined by the study: consumption of OTC medications, consumption of alcoholic beverages, cigarette smoking, and gambling.

  Table 2 here  

All four of the behaviors presented in Table 2 are less prevalent in the sample than the literature might lead one to expect. Of the twenty two (14.9%) respondents reporting daily use of OTC medicines, fifteen stated that they were referring to aspirin or aspirin type preparations; one was referring to a multipurpose vitamin tablet. Only one subject reported a frequency of alcohol use more than once daily. Most of the subjects (61.8%, n=89) had never smoked cigarettes, sixteen (11.1%) admitted to being regular smokers. Of these, seven stated that they are smoking more in old age than they are did before. Seventeen subjects (11.5%) reported playing cards more than once a week, nine (6.1%) stated that they purchased lottery tickets at the rate of more than one a week. The total number of persons in the sample reporting at least one of these behaviors was fifty three (36.1%); of these, thirty eight (71.7%) stated that these behaviors had either begun or significantly increased since age fifty.
Table 3 presents the subjects' responses to questions about whether their personal situation had improved, deteriorated, or remained essentially unchanged since the age of 50. The questions covered nine areas in which change often proves threatening to the elderly.

  Table 3 here  

As can be seen in Table 3, deterioriation was reported by a majority of respondents for health (65.6.%, n=97), sleep (65.5%, n=97), and general level of energy (67.6%, n=100). A majority reported that no essential change had taken place in the areas of appetite (58.6%, n=86), digestion (59.5%, n=88), and emotional state (68.9%, n=102). This last variable was measured by a question asking the respondent how well he or she deals with anger. The fifteen subjects (10.1%) reporting that in old age they had improved in this area, constituted the largest number reporting improvement on any of the variables presented in Table 3, except for living arrangements (with whom the subject lived). While all of the subjects were living in the community, most had experienced a change in the composition of their households: Sixty seven (45.6%) said their situation was worse than it had been, 42 (28.6%) said it was the same, and 38 (25.9%) reported improved living arrangements.
To explore the influence of continuity vs. change on excessive behaviors in the sample, two indices were constructed. The first, a dichotomous index of excessive behavior, included anyone with a positive reponse in the first category of any variable in Table 2, above, in the "yes" (n=53) group; all other were placed in the "no" group (n=94). The second index, a measure of continuity vs. change in old age, was based on the variables of Table 3. Each response indicative of either improvement or deterioration was scored 1, no change was scored 0. The result was an eleven category index ranging from O to 10, with a mean of 5.2 (s.d. = 2.2) and a near normal distribution. The index of excessive behaviors, when correlated with the index of continuity, yielded a moderately strong correlation (eta = .28), indicating an influence of continuity on the presence of excessive behaviors for these subjects. This relationship is presented, along with the bivariate association of excessive behavior with additional variables of interest, in Table 4.

  Table 4 here  

As is evident from Table 4, the variable most strongly related to excessive behavior is meaning in life (eta = .63). Other variables showing moderately strong correlations with excessive behaviors are improvement in lifestyle (eta = .39), level of education (eta = .32), and hours per week spent volunteering (eta = .31).
The bivariate correlations presented in Table 4 did not prove robust in multivariate analysis. A simple discriminant analysis explained less than 9 percent of the variance of the dependent variable (Wilks' lambda = .913). As described in the previous section, the study utilized a short form of Part I of the Purpose in Life test [29] as a scale to measure meaning in life. As in the original instrument, each of the items was scored on a seven point scale. Table 5 shows the means and standard deviations for each of the ten items, its correlation with the total scale, and Cronbach's alpha, a measure of reliability based on the principle of inter item consistency.

  Table 5 here  

The range of inter correlations (.41 to .81) and the value of Cronbach's alpha (.88), seen in Table 5, attest to the reliability of the meaning­-in life scale as used in this study. The highest ratings (mean = 5.2) were given by the respondents to the item stating that "life has been significant", reflecting their agreement with that statement. The lowest ratings (mean = 3.4) were assigned to the item stating "each day is different."
Table 6 presents the results of a multiple regression analysis with meaning in life as the dependent variable.

  Table 6 here  

The multiple regression equation shown in Table 6 explains a considerable amount of the variance in the subjects' scores on the Meaning in life instrument (R = .37). Loneliness contributes the strongest prediction (beta =  .37), followed by changes in lifestyle (beta =  .18) and previous socioeconomic status (beta = .18). The first two of the predictors are negatively associated with meaning in life; i.e., the less lonely the subject and the less the subject has undergone lifestyle changes, the higher the meaning in life score is likely to be. An unexpected finding is the negative association of meaning in life with religiousness.

Discussion


As stated previously, "excessive behaviors" were chosen   rather than "addictive" or "deviant" as the former is more inclusive [5]. Even so, the subjects of the study provided only a modest amount of such behavior to be analyzed. Daily use of OTC medications, daily alcohol use, gambling, and smoking, even when defined at levels that are only mildly "excessive," did not reach a prevalence rate of 15 percent in the sample. It may be that these behaviors are less common than expected among the elderly in Israel, but it is more likely that the low rates are a result of the sampling method employed. The subjects were recruited through clubs for senior citizens and nearly 80 percent were members of these clubs. They are, therefore, "active" elderly and may not be representative of less socially involved persons in the same age group.
Based on the results of this study, we may say that no dramatic patterns emerged with respect to involvement of the elderly respondents with excessive behaviors. The correlation of such behaviors with meaning in-­life proved strong (eta = .63) but the causal order is ambiguous; it is not clear whether the behaviors affect the meaning in life or whether they are affected by it. Two other correlations, while less powerful, are of interest: The correlation of excessive behaviors with change in lifestyle (eta = .28) and with improvement in lifestyle (eta = .39). It appears that excessive behaviors are associated with lifestyle change, even when these changes are for the better. When lifestyle is continuous, and the elderly person is interacting with familiar stimuli, the likelihood of developing excessive behaviors is reduced. The excessive behaviors, as reported by this sample, do indeed "develop." Most often, they are either new behaviors or have significantly increased in old age. This was of special interest in the case of cigarette smokers; of sixteen respondents who defined themselves as regular smokers, six had significantly increased their smoking when past age fifty, and two had actually begun smoking when past fifty. Nine of the seventeen regular cardplayers had begun playing cards since age fifty as well. Thus, for this sample, the excessive behaviors are more innovation than continuation of previous behavior patterns.
Most of the subjects of this research experienced significant changes in their later years. While most reported that their economic situation and living arrangements had either remained stable or improved, a majority reported deterioration in their general health situation, their sleep patterns, and in their level of energy. More than half said that their situation concerning appetite, digestion and emotional state had not changed significantly.
The extent to which these subjects found meaning in their lives related most strongly to how often they felt lonely. This finding is supportive of theories about loneliness, which is one of the least discussed subjects in gerontological literature [30]. One of the difficulties inherent in understanding loneliness in old age is that it is often conceputally confused with, or, at least, closely associated with a variety of related but distinct topics, such as isolation, desolation, loss, depression, sadness, boredom, desperation, estrangement or alienation. All of these outward expressions of the psychological and social state of loneliness may or may not be present in the case of an individual. As Maimonides has said: "Old age in practice, alas, is different from old age in theory..." [31, p.280]. Or as one of the subjects in an early study has put it: "I have no family, I have no money, and all my close friends are dead. No one cares what happens to me. My fling is over and I would just as soon die as not. My life is perfectly meaningless" [32].
Continuity in lifestyle also contributed to meaning in life, as did a secular outlook, economic situation, and current level of health. The negative association found between meaning in life and religiousness needs further explanation. In gerontological literature for example, Baum and Baum [33] found that religion had the strongest influence on the psychochomoral health of those aged 68 72 years who have already undergone the scrutiny of their past lives. They found that influence can lead to integrity or to despair, depending largely on the mechanisms operating. Since the population in the present study was, by and large, older than the age group to which Baum and Baum [33] were referring, it may be assumed that these subjects had accomplished their life reviews. Thus a different approach to the above finding seems to be in order.
According to Frankl [1], even a person who stands on the firm ground of his religious convictions can still despair and lose meaning in life. Frankl cites the case of an old Rabbi from Eastern Europe who told him how desperate he was because he had no son of his own (his children died in Auschwitz) to say Kaddish (the prayer after the dead) for him. The old Rabbi's desperation was due, however, to his fear that he would not be able to join his martyred children in Heaven. In such cases, Frankl says, the role of the psychotherapist is to put himself in the place of the patient and draw upon the latter's religious convictions as a spiritual resource   thus opening a new point of view for the suffering experienced.
To sum it up: The sample under study in this research lacked representativeness and no conclusion can be drawn beyond its boundaries. The findings within this group of 148 elderly, however, offer partial confirmation for Atchley's [3] continuity theory in ageing. With regard both to the avoidance of excessive behaviors and to philosophical outlook, lifestyle continuity into old age appears to have lasting and salutory effects. The findings also offer further confirmation to the decisive importance of Frankl's [1] concept of meaning.

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Table 1. Description of the Sample


Age: Mean = 74.0, SD = 7.1 (Range 61 to 91)
Sex: Females 70.3% (104); Males 29.7% (44)
Birthplace:

Israel 7.4% (11)

USSR, Eastern Europe 59.5 (88)

Africa Asia 24.3 (36)

Western Europe 6.8 (10)

Other 2.1 ( 3)


Education: Mean = 9.7 years, SD = 4.0
Marital Status:

Married 40.5% (69)

Widowed 52.7 (78)

Divorced 2.7 (4)

Other 4.1 (6)
Living Arrangements:

With spouse 38.1% (56)

With others 12.9 (19)

Alone 49.0 (72)


Perceived Economic Status:

Good 29.7% (44)

Satisfactory 47.3 (70)

Poor 23.0 (34)


Occupational Status:

Working in previous occupation 11.3% (14)

Working in new occupation .7 (1)

Retired 86.6 (123)

Other 1.4 (2)
Previous Occupation:

Self employed 11.0% (16)

Salaried professional 2.7 (4)

White collar, clerical 30.1 (44)

Technical, industrial 17.8 (26)

Housewives 24.7 (36)

Other 13.7 (20)
Religiousness:

Religious 6.8% (10)

Traditional 42.5 (62)

Secular 50.7 (74)


Table 2. Prevalence of Drinking, Smoking, OTC Medication Use,

and Gambling in the Sample
Use of OTC Medications:

Daily 14.9% (22) [a]

Less than daily 85.1 (126)
Alcohol Use:

More than daily 0.7% (1) [b]

Daily 4.9 (7)

Less than daily 94.4 (134)


Cigarette Smoking:

Regular smokers 11.1% (16) [c]

Occasional smokers 4.2 (6)

Quit 22.9 (33)

Never smoked 61.8 (89)
Card Playing:

Regular players 11.5% (19) [d]

(more than one weekly)

Play, but not for money 22.9 (34)

Occasional players 6.8 (10)

Non players 58.8 (87)


Lottery Tickets:

Heavy players 6.1% (9)

(more than one weekly)

Players (+/- 1 ticket per week) 17.7 (26)

Non players 76.2 (112)

________________________________________


a. Of these, 15 report use only of aspirin or aspirin type medications

b. Increased since age 50

c. Since age 50, 6 increased, 2 began

d. Since age 50, 2 increased, 7 began

Table 3. Perceived Changes in Old Age (since age 50)
Economic Status: Better 18.9% (28)

Worse 37.9 (56)

Unchanged 43.2 (64)
Standard of Living Better 22.3% (33)

Worse 13.5 (20)

Unchanged 64.2 (95)
Living Arrangements: Better 25.9% (38)

Worse 45.6 (67)

Unchanged 28.6 (42)
General Health: Better 6.8% (10)

Worse 65.5 (97)

Unchanged 27.7 (42)

(includes: "as expected with ageing")


Appetite: Better 5.4% (8)

Worse 36.5 (54)

Unchanged 58.1 (86)
Digestion: Better 4.7% (7)

Worse 35.8 (53)

Unchanged 59.5 (88)
Sleep: Better 3.4% (5)

Worse 65.6 (97)

Unchanged 31.1 (46)

Energy Levels: Better 4.7% (7)

Worse 67.6 (100)

Unchanged 43.2 (41)


Emotional State: Better 10.1% (15)

Worse 20.9 (31)

Unchanged 68.9 (102)

Table 4. Bivariate Associations of Selected variables with Excessive Behaviors


Excessive behaviors with continuity of lifestyle: eta = .28
" " " improvement in lifestyle: eta = .39
" " " meaning in life eta = .63
" " " current socioeconomic

situation Cramer's V = .13


" " " marital status phi = .04
" " " loneliness phi = .08
" " " level of education eta = .32
" " " volunteering eta = .31

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