Functional disability of the aged is largely associated with chronic diseases that are highly prevalent among minorities. Thus, a multi-disciplinary team will conduct two linked prospective studies among a Black elderly cohort that will, a) determine the incidence and prevalence of hypertension and diabetes and their relationship with functional disability among 1000 older Blacks, and, b) initiate a medical-educational-psychosocial intervention among a 280 person subgroup with hypertension co-existent with diabetes. Part A, the epidemiological study, will provide data about morbidity and mortality associated with diabetes and hypertension, especially functional disability related to these conditions and their complications. This study will also provide knowledge of the health risk behaviors (nutritional, smoking, alcohol and exercise habits), health beliefs and attitudes, and patterns of health service utilization of Black older persons with diabetes and/or hypertension and determine their relationship with medical outcomes. Little is known of the natural course of these conditions among Black elderly and less is known of how diverse health and psychosocial factors influence these outcomes. Part B, the intervention study, will identify Black aged persons that have hypertension coexistent with diabetes, but no indications of physical frailty. This study will be an intensive medical, educational, and psychosocial program designed to reduce progressive impairment. It will focus on altering multiple risk factors that are associated with diabetes and hypertension-related morbidity. Specifically we will seem to prevent or reduce the prevalence of disease complications, functional decline and death. Since the multiple consequences of diabetes and hypertension are highly prevalent among older Blacks, a program with integrated secondary and tertiary prevention strategies can help to diminish the likelihood of functional decline among this population. Both studies will be longitudinal with four (the epidemiological study) and eight (the intervention study) assessment points, respectively. Data will be analyzed to determine correlates and predictors of outcomes and, in the epidemiological study, these outcomes will include cardiovascular, renal, ophthalmologic, and neurological endpoints, as well as basic functional ability.
