What do people include when they self-rate their health? Differential associations according to health status in community-dwelling older adults

How do individual, social, environmental, and resilience factors shape self-reported health among community-dwelling older adults: a qualitative case study

BACKGROUND

While older adults are living longer, they often face health challenges, including living with multiple chronic conditions. How older adults respond and adapt to the challenges of multimorbidity to maintain health and wellness is of increasing research interest. Self-reported health, emerging as an important measure of health status, has broad clinical and research applications, and has been described as a predictor of future morbidity and mortality. However, there is limited understanding of how individual, social, and environmental factors, including those related to multimorbidity resilience, influence self-reported health among community-dwelling older adults (≥ 65 years).

METHODS

Informed by the Lifecourse Model of Multimorbidity Resilience, this explanatory case study research explored older adults' perceptions of how these factors influence self-reported health. Data were generated through semi-structured telephone interviews with community-dwelling older adults.

RESULTS

Fifteen older adults participated in this study. Four key themes, specific to how these older adults describe individual, social, environmental, and multimorbidity resilience factors as shaping their self-reported health, were identified: 1) health is a responsibility - "What I have to do"; 2) health is doing what you want to do despite health-related limitations - "I do what I want to do"; 3) the application and activation of personal strengths - "The way you think", and; 4) through comparison and learning from others - "Looking around at other people". These themes, while distinct, were found to be highly interconnected with recurring concepts such as independence, control, and psychological health and well-being, demonstrating the nuance and complexity of self-reported health.

CONCLUSIONS

Findings from this study advance understanding of the factors that influence assessments of health among community-dwelling older adults. Self-reported health remains a highly predictive measure of future morbidity and mortality in this population, however, there is a need for future research to contribute additional understanding in order to shape policy and practice.

Rural-Urban disparities in self-reported physical/mental multimorbidity: A cross-sectional study of self-reported mental health and physical health among working age adults in the U.S

Purpose

Self-rated physical health (SRPH) and self-rated mental health (SRMH) are both linked to excess morbidity and premature mortality and can vary across rural and urban contexts. This can be particularly problematic for rural residents who have less access to important health care infrastructure. In this paper, we assess the prevalence of and rural-urban disparities at the intersection of SRPH and SRMH, specifically self-rated physical/mental multimorbidity (SRPMM) overall and across rural-urban contexts.

Methods

Using a cross-sectional demographically representative national dataset of over 4000 working age adults in the U.S., we expose rural-urban differences in the prevalence of SRPMM and explore individual-level factors that may explain this disparity.

Results

Approximately 15 percent of working age adults reported SRPMM, but rural adults were at higher risk than their urban counterparts. However, this disadvantage disappeared for remote rural working-age adults and was attenuated for metro-adjacent rural working-age adults when we controlled for the fact that rural adults had lower household incomes.

Conclusion

Findings reveal a higher risk of SRPMM among rural adults, in part because of lower incomes among this group. This work acts as the foundation for facilitating research on and addressing rural-urban disparities in SRPMM.

Self-reported health and the well-being paradox among community-dwelling older adults: a cross-sectional study using baseline data from the Canadian Longitudinal Study on Aging (CLSA)

Background

Self-reported health is a widely used epidemiologic measure, however, the factors that predict self-reported health among community-dwelling older adults (≥65 years), especially those with multimorbidity (≥2 chronic conditions), are poorly understood. Further, it is not known why some older adults self-report their health positively despite the presence of high levels of multimorbidity, a phenomenon known as the well-being paradox. The objectives of this study were to: 1) examine the factors that moderate or mediate the relationship between multimorbidity and self-reported health; 2) identify the factors that predict high self-reported health; and 3) determine whether these same factors predict high self-reported health among those with high levels of multimorbidity to better understand the well-being paradox.

Methods

A cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging was completed (n = 21,503). Bivariate stratified analyses were used to explore whether each factor moderated or mediated the relationship between multimorbidity and self-reported health. Logistic regression was used to determine the factors that predict high self-reported health in the general population of community-dwelling older adults and those displaying the well-being paradox.

Results

None of the factors explored in this study moderated or mediated the relationship between multimorbidity and self-reported health, yet all were independently associated with self-reported health. The ‘top five’ factors predicting high self-reported health in the general older adult population were: lower level of multimorbidity (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.74-0.76), female sex (OR 0.62, CI 0.57-0.68), higher Life Space Index score (OR 1.01, CI 1.01-1.01), higher functional resilience (OR 1.16, CI 1.14-1.19), and higher psychological resilience (OR 1.26, CI 1.23-1.29). These same ‘top five’ factors predicted high self-reported health among the subset of this population with the well-being paradox.

Conclusions

The factors that predict high self-reported health in the general population of older adults are the same for the subset of this population with the well-being paradox. A number of these factors are potentially modifiable and can be the target of future interventions to improve the self-reported health of this population.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-02807-z.

What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK

Background

Levels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors.

Methods

Face to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’.

Results

Individuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals.

Conclusions

The disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02338-x.

Age Differences in Determinants of Self-Rated Health among Recipients of Publicly Funded Home-and-Community-Based Services

This research examined determinants of self-rated health (SRH) of publicly funded home-and-community-based services (HCBS) recipients and tested if the effects of determinants differ between older recipients and younger recipients with disabilities. Using Minnesota's data of 2015-2016 National Core Indicators - Aging and Disabilities survey (n = 3,426), this study revealed that functional status and community inclusion had both direct and indirect effects on SRH, with negative mood as a mediator. Community inclusion had a more pronounced effect on SRH in younger recipients than in older recipients. HCBS should address psychosocial needs and be tailored for recipients of different age groups.

What Factors Shape Self-Reported Health Among Community-Dwelling Older Adults? A Scoping Review

Self-reported health is a predictive measure of morbidity and mortality across populations. A comprehensive understanding of the factors that shape self-reported health among community-dwelling older adults, a growing population globally, is lacking. The aim of this review was to summarize the factors that are associated with self-reported health among this population and identify key areas for future research. Accordingly, we conducted a scoping review using the stage-wise framework developed by Arksey and O'Malley. We summarized 42 factors, as identified in 30 publications, and organized them into four categories. Key factors shaping self-reported health included the presence of chronic conditions and depressive symptoms. As the population of community-dwelling older adults continues to increase, there remains a need to understand how these identified factors shape self-reported health. To date, empirical research has been limited to observational and cross-sectional designs. There is a need to further explore these factors in longitudinal data.

Self-perceived general health among community-dwelling Portuguese older adults: do men and women differ?

Evidence on how gender intersects with relevant social constructs in later phases of life is scarce. This investigation examined gender inequalities in perceived health status (self-perceived general health; SPGH) by Portuguese elderly community-dwellers while considering psycho-social and socio-demographic determinants. This study used data from a representative sample of community-dwellers aged ≥65 years (N = 920), who were enrolled in the Portuguese Elderly Nutritional Status Surveillance System (PEN-3S) project. Associations between SPGH and socio-demographic and psycho-social variables, functionality and self-reported morbidity were tested; indirect effects of relevant predictors on SPGH were also tested using a bootstrap method. Gender inequalities in health were found: women significantly rated their health worse than men; overall, participants rated their health as fair. Education, functional status, depression symptoms and self-reported morbidity significantly predicted SPGH among women, whereas only the latter two were associated with SPGH among men. For both genders, depression was the strongest predictor of SPGH. Mediation analyses detected indirect effects of cognitive function and loneliness feelings on SPGH among older adults. Results herein provide insights on the predictive role of psycho-social variables on SPGH and support the need for considering the context when addressing the correlates of SPGH among Portuguese older adults. Altogether, these findings might support cost-effective interventions targeting the most vulnerable groups of the population to inequalities in health and its predictors.

Gender differences in psychosocial determinants of self-perceived health among Portuguese older adults in nursing homes

Objectives: Self-perceived health declines with age, varies by gender and is a predictor of mortality, morbidity, physical and psychological functioning. However, gender differences in health and illness perception are complex and not yet fully understood. This study aimed to explore gender-related differences in psychosocial determinants of self-perceived health among older adults living in nursing homes. Method: Nationwide face-to-face survey of the Portuguese population aged 65 and over. A representative sample of nursing homes residents was obtained through a multistage cluster random sampling of nursing homes, stratified by main Portuguese administrative regions (NUTS II). Results: Overall, 1186 nursing homes residents voluntarily enrolled in this study (participation rate, 93%) and a total of 515 participants (70.1% women) were considered to have adequate cognitive functioning to answer all questionnaires. A significant association between self-rated health and gender was found: 90.6% of all women (95% CI: 85.7-93.9) and 82.3% of all men (95% CI: 72.9-88.9) rated their health as less than good (p = 0.023). Gender-stratified analyses showed differences in psychosocial determinants of self-perceived health. While symptoms of depression and loneliness feelings were the major psychosocial determinants of poor self-perceived health among women, age and subjective financial well-being were the only determinants among men. Conclusion: Factors associated with perceived health, as representative of healthy ageing, were identified by gender, leading to future avenues for fruitful investigation. The acknowledgement of interpersonal and socioeconomic factors that determine the experience of ageing at a national level is crucial to improve the health of elders.

Weight perception and perceived attractiveness associated with self-rated health in young adults

Self-rated health (SRH) is a widely used and valid marker of overall health and wellbeing and demographic differences in SRH are well-established. To date, few studies have examined how multiple components of body image shape young adults' SRH. The purpose of this study was to investigate the contributions of weight perception and perceived attractiveness on SRH among young adults. Data were from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent to Adult Health (Add Health) and young women and men ages 24-34 were analyzed (n = 7044 women, n = 6594 men) in April 2018. All analyses were weighted and stratified by gender. Design-based F test and ordinal multinomial logistic regression were used. For both genders, relative to Whites, Hispanic, Black, and Asian young adults reported poorer health; women and men with higher education and income reported better health. Independent of measured body mass index (BMI), young adults who thought they were underweight or overweight reported poorer health relative to those who thought their weight was normal. Both young women and young men who thought they were more attractive also reported better health. This study demonstrates that weight status, perceived weight status, and perceived attractiveness independently impact SRH for both young men and women controlling for race/ethnicity, nativity status, marital status, education, income, and number of health conditions.

Impact of resilience on health in older adults: a cross-sectional analysis from the International Mobility in Aging Study (IMIAS)

OBJECTIVES

Self-rated health (SRH) is a predictor of objective health measures, including mortality and morbidity. The link between resilience and SRH among the elderly is unclear. We aim to examine whether resilience aligns with SRH and, secondarily, whether resilience can override the negative health consequences of adverse childhood experiences (ACE).

DESIGN AND SETTING

We use 2012, 2014 and 2016 data from the International Mobility in Aging Study, a longitudinal cohort study that collects survey and biophysical data from Albania, Brazil, Colombia and Canada. The main independent variables were resilience and ACE (social and economic).

PARTICIPANTS

Community-dwelling 65-74 year olds (in 2012) were recruited through primary care registers. The sample size of the study was 1506.

PRIMARY OUTCOME

The outcome measure was SRH.

RESULTS

We found that sex, site, economic ACE, current income sufficiency, current depressive symptoms, current physical function and current resilience were associated with current SRH. In regression analyses, we showed that the association between ACE and SRH disappeared once factors such as sex, site, income, depression, physical health and resilience were considered.

CONCLUSIONS

The association between resilience and health poses a compelling argument for building resilience throughout life.

Physical Health Mediates the Relationship between Psychological Well-Being and Engagement in Exercise across Age in a German Sample

The prevalence of chronic illness among middle-aged and older adults is increasing worldwide as the population continues to age. One way to prevent the continued increase and subsequent negative outcomes of chronic illness is to increase the number of individuals who engage in exercise. Thus, it is important to examine which factors predict engagement in exercise in middle-aged and older adults. As a result, the current study examined the relationship between physical health, psychological well-being, and engagement in exercise in a sample of middle-aged and older German adults. We found that increased age was associated with less frequent engagement in exercise. We also found that physical health mediated the relationship between psychological well-being and engagement in exercise. Finally, we found that age did not moderate the relationship between subjective well-being and engagement in exercise, suggesting that the role of physical health as a mediator was similar in older adults compared to middle-aged adults. These findings have important implications for interventions seeking to promote exercise among adults.

The Relationships Among Socio-Demographics, Perceived Health, and Happiness

This article explores explore the relationships among socio-demographics, perceived health, and happiness in a patient population of 221 adults recruited from 39 primary care practices in Alabama. We also explored whether the relationship between socio-demographics and happiness is mediated by perceived health. The dependent variable, happiness, was dichotomized as happy versus unhappy. Independent variables or correlates of happiness included race (Black or White), age (< 65 vs. 65 and older), gender (male vs. female), perceived income (sufficient vs. insufficient to meet basic needs), health literacy (adequate vs. inadequate), and self-rated health (excellent/very good/good vs. poor/fair). Data were analyzed using generalized linear latent and mixed models to examine the relationship between happiness and its correlates. Our findings suggest that adequate health literacy and better perceived health are associated with an increase in the likelihood of happiness. In addition, the relationship between perceived sufficient income and happiness is mediated by perceived health; whereas, individuals with sufficient income are more likely to have better perceived health, and as a result more likely to be happy. Other individual factors, such as gender, age, and race were not significantly associated with being happy or having higher perceived health in any of the models. Results suggest that policies aimed at increasing health literacy, promoting health, and reducing income disparities may be associated with greater happiness.

Self-Assessed Health into Late Adulthood

Abstract. Self-assessed health (SAH) is the personal assessment of one’s own health ( Idler & Benyamini, 1997 ; Jylhä, 2009 ). It is often measured using a single item asking whether adults rate their health as excellent, very good, good, fair, or poor. When measured at a single point in time, SAH relates to a variety of short-term and long-term health outcomes and behaviors, including morbidity, healthcare utilization, and mortality ( Benyamini, 2008 ; Mossey & Shapiro, 1982 ; Westerhof & Wurm, 2015 ). Recently, attention has shifted away from examining SAH at a single point in time toward understanding whether SAH trajectories can better predict health outcomes ( Ayyagari et al., 2012 ; Schmitz et al., 2013 ). Therefore, it is critical to understand the factors contributing to the SAH process. This article provides a multidisciplinary overview of SAH and SAH change while illustrating the benefits of adopting a lifespan approach in future research. The current SAH literature, including cross-sectional and longitudinal studies, is used to examine what is known about the SAH process into late adulthood. From the literature, it is clear SAH is a multidimensional construct, susceptible to age-related change and sociohistorical contexts. Understanding the developmental mechanisms and multiple influences underlying change, however, may help further the use of SAH as a life-long health-promotion tool. Lifespan concepts are applied to expand discussion and recommendations are made concerning the application of alternative variables and methodologies. Future studies of SAH should consider these personal perceptions of health not only as predictors of health outcomes in later life, but also as tools for effective health promotion in everyday life.

Determinants of self-rated health in an Irish deprived suburban population - a cross sectional face-to-face household survey

Background

Self-rated health (SRH) is amongst the most frequently assessed health perceptions in epidemiological research. While there is a growing understanding of the role of SRH, a paradigm model has yet to be widely accepted with recent studies concluding that further work is required in determining whether there are important predictors of SRH yet to be highlighted. The aim of this paper is to determine what health and non-health related factors were associated with SRH in a suburban deprived population in Dublin, Ireland.

Methods

A cross sectional face-to-face household survey was conducted. Sampling consisted of random cluster sampling in 13 electoral divisions, with a sampling frame of 420 houses. Demographic information relating to the primary carer was collected. Health status of the primary carer was measured through SRH. Household level data included the presence or absence of persons with a chronic disease, persons who smoked, persons with a disability and healthcare utilisation of general practitioner and hospital level services. A logistic regression model was utilised in the analysis whereby the odds of primary carers with poor SRH were compared to the odds of carers with good SRH taking health and non-health related factors into account.

Results

Of the 420 households invited to participate a total of 343 were interviewed (81.6 % response rate). Nearly half of the primary carers indicated their health as being ‘good’ (n = 158/342; 46.2 %).

Adjusting for the effects of other factors, the odds of primary carers with second level education were increased for having poor SRH in comparison to the odds of those with third level education (OR 3.96, 95 % CI (1.44, 11.63)). The odds of primary carers who were renting from the Council were increased for having poor SRH compared to the odds for those who owned their own property (OR 3.09, 95 % CI (1.31, 7.62)). The odds of primary carers that were unemployed (OR 3.91, 95 % CI 1.56, 10.25)) or retired, ill or unable to work (OR 4.06, 95 % CI (1.49, 11.61)) were higher for having poor SRH than the odds of those in employment. If any resident of the household had a chronic illness then the odds of the primary carer were increased for having poor SRH compared to the odds for a primary carer in a household where no resident had a chronic illness (OR 4.78, 95 % CI (2.09, 11.64)). If any resident of the household used the local hospital, the odds of the primary carer were increased for having poor SRH compared to the odds for the primary carer in a household where no resident used the local hospital (OR 2.01, 95 % CI (1.00, 4.14)).

Conclusions

SRH is affected by both health and non-health related factors. SRH is an easy to administer question that can identify vulnerable people who are at risk of poor health.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-3442-x) contains supplementary material, which is available to authorized users.

Predicting Self-Rated Health in Diabetes and Chronic Heart Failure - A Multiple Mediation Model

PURPOSE

Self-rated health (SRH) is a powerful predictor of health-related outcomes such as morbidity and mortality. Aim of the current study was to examine the role of comorbidity, well-being, functional health, and physical limitations as possible predictors of SRH in diabetes and chronic heart failure (CHF).

METHODS

Three large samples with persons suffering from diabetes (n = 974), CHF (n = 955), or both diseases combined (n = 934) were analyzed longitudinally over the course of 4 months. To test the mediating effect of comorbidity, well-being, functional health, and physical limitations in association with former and future SRH multiple mediator models were applied.

RESULTS

Across all groups emotional well-being was a consistent and powerful determinant of SRH. The effects of functional health and physical limitations on SRH were also significant but varied between diagnostic groups. The number of comorbid diseases did not predict SRH.

CONCLUSION

Emotional well-being and physical health appraisal were strong predictors of SRH. Thus, SRH may be improved by influencing well-being and physical health appraisal via targeted interventions.

Older patients' perceived burdens of their health problems: a cross-sectional analysis in 74 German general practices

BACKGROUND

Older patients often experience the burden of multiple health problems. Physicians need to consider them to arrive at a holistic treatment plan. Yet, it has not been systematically investigated as to which personal burdens ensue from certain health conditions.

OBJECTIVE

The objective of this study is to examine older patients' perceived burden of their health problems.

PATIENTS AND METHODS

The study presents a cross-sectional analysis in 74 German general practices; 836 patients, 72 years and older (mean 79±4.4), rated the burden of each health problem disclosed by a comprehensive geriatric assessment. Patients rated each burden using three components: importance, emotional impact, and impact on daily activities. Cluster analyses were performed to define patterns in the rating of these components of burden. In a multilevel logistic regression analysis, independent factors that predict high and low burden were explored.

RESULTS

Patients had a median of eleven health problems and rated the burden of altogether 8,900 health problems. Four clusters provided a good clustering structure. Two clusters describe a high burden, and a further two, a low burden. Patients attributed a high burden to social and psychological health problems (especially being a caregiver: odds ratio [OR] 10.4, 95% confidence interval [CI] 4.4-24.4), to specific symptoms (eg, claudication: OR 2.3, 95% CI 1.3-4.0; pain: OR 2.3, 95% CI 1.6-3.1), and physical disabilities. Patients rated a comparatively low burden for most of their medical findings, for cognitive impairment, and lifestyle issues (eg, hypertension: OR 0.2, 95% CI 0.2-0.3).

CONCLUSION

The patients experienced a relatively greater burden for physical disabilities, mood, or social issues than for diseases themselves. Physicians should interpret these burdens in the individual context and consider them in their treatment planning.

Physical activity, screen time and self-rated health and mental health in Canadian adolescents

OBJECTIVE

Physical activity (PA) and screen time (ST) are associated with self-rated health (SRH) in adults; however, SRH has been less studied among youth, and information about self-rated mental health (SRMH) is lacking. This study examined the associations of PA and ST with SRH and SRMH among adolescents.

METHODS

Cross-sectional data from the 2011-2012 Canadian Community Health Survey included 7725 participants aged 12-17years, representing 1,820,560 Canadian adolescents. Associations of self-reported PA and ST to SRH and SRMH were assessed, controlling for age, race/ethnicity, smoking, highest household education and weight status.

RESULTS

Excellent/very good SRH was reported by 78% of active vs. 62% of inactive adolescents, and 77% of those meeting vs. 70% of those exceeding ST guidelines (both p<0.001). Excellent/very good SRMH was reported by 81% of active vs. 76% of inactive adolescents, and 84% of those meeting vs. 78% of those exceeding ST guidelines (both p<0.001). Inactive adolescents had twice higher odds of sub-optimal SRH, and inactive girls had 30% greater odds of sub-optimal SRMH. Adolescents exceeding 2h/day ST had 30% greater odds of sub-optimal SRH, and 30-50% greater odds of sub-optimal SRMH.

CONCLUSION

PA and ST are independently associated with health perceptions among Canadian adolescents. Interventions should consider health perceptions in addition to biomedical outcomes.

The components of self-perceived health in the Kailali district of Nepal: a cross-sectional survey

Self-perceived health is a health measure with well-established links with mortality, healthcare services utilization, and future health. Various components of self-perceived health have been identified in different populations. In this study, we aimed to investigate the components of self-perceived health in a Nepali population. This was a cross-sectional survey conducted in the Kailali district of Nepal in 2014. The sample was initially consisted of 309 households, representative of the population of one municipality and one village; however, 304 participants were included in the analyses. Information on socio-demographic characteristics, health condition, satisfaction with healthcare services, psychological factors, and health behaviors was extracted. Logistic regression analyses were carried out to identify putative components of self-perceived health. Among the 304 respondents, 244 (80.3%) and 60 (19.7%) perceived their health as good and poor, respectively. Middle age and lower satisfaction with healthcare services were associated with worse self-perceived health, accounting for 10.3% of variance. No regular exercise, drinking, smoking, and being unhappy were also related with worse self-perceived health, after adjustment for age and satisfaction level. In the final model, however, drinking status did not significantly contribute. Our findings support previous findings that individuals with positive health behaviors and psychological wellbeing are more likely to perceive their health better. This study may direct public health policies toward more targeted interventions.

A cross-sectional survey of self-rated health and its determinants in patients with hypertension

AIM

The purpose of the study is to investigate the levels of self-rated health, blood pressure control, understand their relationships between the self-rated health and blood pressure control, and to identify the extent to which demographic, disease and psychosocial factors predict the self-rated health of hypertensive patients.

METHODS

The study adopted a cross-sectional design. Nine hundred forty-two subjects with essential hypertension were invited to join the study, 807 completed the survey. Self-report questionnaires were used to collect data. The hierarchical logistic regression was used to test the determinants of self-rated health status.

RESULTS

Of all the subjects, 59.3% rated their health status as good, and 41.7% perceived their health status as poor. In terms of levels of blood pressure control, nurse-measured blood pressure showed that 40.2% of the subjects had good control levels, 59.8% for poor control levels. There were positive relationships between good self-rated health and controlled blood pressure of hypertensive patients (p<0.05). The logistic regression model showed that the determinants of subjects' self-rated health included income (OR=4.28; 95% CI=1.86-6.25), duration of hypertension diagnosis (OR=4.06; 95% CI=2.17-6.35), treatment adherence (OR=9.02; 95% CI=5.36-15.51), physical activity (OR=13.81; 95% CI=10.16-19.57) and social support (OR=8.63; 95% CI=7.17-11.35).

CONCLUSIONS

The self-rated health status and blood pressure control for patients with hypertension is suboptimal, effective strategies should be developed to improve patients' general health.

What does Self Rated Mental Health Represent

BACKGROUND

Unlike the widely used self rated health, the self rated mental health was found unsuitable as a proxy for mental illness. This paper analyses the relationships between the self ratings of physical health, mental health and overall health, and their association of with the objective indicators for physical and mental health.

DESIGN AND METHODS

The study is a secondary analysis of data from a nationwide representative sample of the non-institutionalized adult residents of Israel in 2003 that was collected via computer-assisted personal interview methods [n=4859].

RESULTS

The self rated physical health and the self rated mental health were strongly related to each other yet the self rated mental health was not related to chronic physical conditions and the self rated physical health was not related to mental disorders. In a multiple logistic regression analysis, those with positive self rated mental health had 93 times the odds of reporting positive overall health whereas those with positive self rated physical health had 40 times the odds of reporting positive overall health.

CONCLUSIONS

The self rating of mental health presents a qualitatively different dimension from mental illness. The self rated mental health is two times more important than the self rated physical health in predicting the self rated overall health Significance for public healthThe present study is an original study on the self rated physical, mental and overall health measures. Because of the wide range of associations with other health indicators, and the simplicity with which they are collected, self-rated health measures are widely used in large population surveys.The present study questions the automatic assumption that the self rated mental health functions as a proxy measure of psychiatric morbidity, and suggests that the self rated mental health is more closely related to subjective well-being. The results show that self rated mental health predicts self rated general health better than self rated physical health.

Longitudinal associations between self-rated health and performance-based physical function in a population-based cohort of older adults

BACKGROUND

Although self-rated health (SRH) and performance-based physical function (PPF) are both strong predictors of mortality, little research has investigated the relationships between them. The objective of this study was to evaluate longitudinal, bi-directional associations between SRH and PPF.

METHODS

We evaluated longitudinal associations between SRH and PPF in 3,610 adults aged 65-89 followed for an average of 4.8 (standard deviation [SD]: 4.4) years between 1994 and July 2011 in the Adult Changes in Thought study, a population-based cohort in the Seattle area. SRH was assessed with a single-item question in the ACT study. Participants were asked at each evaluation to rate their health as "excellent", "very good", "good", "fair", or "poor" in response to the question "In general, how would you rate your health at this time". PPF scores (ranging from 0-16, with higher indicating better performance) included walking speed, chair rises, grip strength, and balance.

RESULTS

At the baseline visit, participants averaged 74.5 (SD: 5.8) years of age and 2,115 (58.6%) were female. In multivariable linear mixed models, PPF declined with age, with more rapid decreases associated with very good, good, and fair (vs. excellent) baseline SRH. Adjusted annual change in PPF was -0.17 points (95% confidence interval [CI]: -0.19, -0.15) for individuals with excellent baseline SRH and -0.21 points (95% CI: -0.22, -0.19) for participants with fair SRH. In multivariable generalized linear mixed models, lower baseline PPF quartiles were associated with lower odds of excellent/very good/good SRH at age 75, however, differences between baseline PPF quartiles diminished with age.

CONCLUSIONS

These results suggest that less than excellent SRH predicts decline in physical functioning, however, poor physical functioning may not predict change in SRH in a reciprocal fashion. SRH provides a simple assessment tool for identifying individuals at increased risk for decline in physical function.

Application of a health-related quality of life conceptual model in community-dwelling older Chinese people with diabetes to understand the relationships among clinical and psychological outcomes

AIMS/INTRODUCTION

The present study applied the Wilson-Cleary model of health-related quality of life (HRQOL) by using the structural equation modeling (SEM) approach to understand the interrelationships among clinical, sociodemographic and psychological characteristics in older people with diabetes.

MATERIALS AND METHODS

This was a cross-sectional study with 452 Chinese older people with diabetes recruited from three primary care clinics. A series of assessments were made, including four instruments: the Chinese version of the Short Form 36 Health Survey, Older American Resources and Services Multidimensional Functional Assessment Questionnaire, Rand Mental Health Inventory and Medical Outcomes Study Social Support Survey; and clinical outcomes (diabetes-related characteristics and physiological data).

RESULTS

In the present study, we identified six patient individual and environmental characteristics, namely, age, sex, physical activity, psychological distress, social support and adequacy of income, that significantly influence HRQOL directly or by way of physical functional status and general health perception.

CONCLUSIONS

Improving social and financial support as well as providing interventions to promote physical activity and to cope with psychological distress in this patient population might be effective to eventually enhance their HRQOL. The present findings add to the literature the underlying complex biological and psychological processes of HRQOL, and take the body of knowledge in HRQOL of older people with diabetes to a theoretical level, and provide insights for development of appropriate strategies to optimize their HRQOL.

The Down syndrome advantage: it depends on what and when you measure

A "Down syndrome advantage"--better outcomes for individuals with Down syndrome and their families than for those with other intellectual/developmental disabilities (IDD)--is reduced when variables confounded with diagnostic category are controlled. We compared maternal outcomes in a longitudinal sample of families rearing children with Down syndrome or other IDD, and found that a Down syndrome advantage is (a) most likely when the metric is about the son/daughter rather than the parent or family more globally, (b) may be present or absent at different ages, and (c) is partially explained by higher levels of adaptive behavior for individuals with Down syndrome. We discuss the importance of multiple measures at multiple times, and implications for family expectations and adjustment at various life stages.

Shifting positivity ratios: emotions and psychological health in later life

OBJECTIVE

A positivity ratio of approximately three positive emotions to one negative emotion has been found to distinguish between flourishing and languishing (optimal vs. poor psychological health). The current study assessed 2-year shifts (2008, 2010) in positivity ratios among 295 older adults and considered whether such shifts were associated with concurrent changes in psychological health (perceived stress, depressive symptoms, and perceived control).

METHOD

Based on participants' reported positive and negative emotions, we identified two positivity ratio groups who were characterized by ratios that did not change, either remaining persistently optimal (above 2.9) or persistently suboptimal, and two groups that depicted shifts in ratios that either became optimal or became suboptimal.

RESULTS

Most participants (67%) remained in their initial group, but shifts between categories did occur in both directions. Ratio groups and time (2008 vs. 2010) were predictor variables in 4 × 2 generalized estimating equations that were computed for each psychological health measure. The hypothesized positivity ratio group × time interaction emerged for each psychological health measure. Ratio shifts that 'became optimal' were associated with a significant concurrent decrease in stress and an increase in perceived control; ratio shifts that 'became suboptimal' were associated with a significant increase in depression.

CONCLUSION

Although older adults who began with a suboptimal positivity ratio were unlikely to experience a shift to an optimal ratio, findings are more encouraging for those who began with an optimal positivity ratio. The majority of these older adults retained optimal positivity ratios over time and appeared to flourish.

Coping and depression in old age: a literature review

BACKGROUND/AIMS

The interest in the relation between coping and depression in older persons is growing, but research on the concepts and instruments of coping in relation to depression among older persons is scarce and systematic reviews are lacking. With this background, we wanted to gain a systematic overview of this field by performing a systematic literature search.

METHODS

A computer-aided search in MEDLINE, CINAHL, PsycINFO, Embase, PubMed and www.salutogenesis.fi was conducted. We systematically searched for studies including coping and depression among persons 60 years of age and above. The included studies were evaluated according to predefined quality criteria.

RESULTS

Seventy-five studies, 38 clinical and 37 community settings, were included. Of these, 44 were evaluated to be of higher quality. Studies recruiting samples of older persons with a major depressive disorder, moderate or severe cognitive impairment or those who were dependent on care were scarce, thus the research is not representative of such samples. We found a huge variety of instruments assessing resources and strategies of coping (55 inventories). Although we found the relation between resources and strategies of coping and depression to be strong in the majority of studies, i.e. a higher sense of control and internal locus of control, more active strategies and positive religious coping were significantly associated with fewer symptoms of depression both in longitudinal and cross-sectional studies in clinical and community settings.

CONCLUSION

Resources and strategies of coping are significantly associated with depressive symptoms in late life, but more research to systematize the field of coping and to validate the instruments of resources and strategies of coping in older populations is required, especially among older persons suffering from major depression and cognitive decline.

Factors related to poor self-perceived oral health among community-dwelling elderly individuals in São Paulo, Brazil

The present study investigated the prevalence of poor self-perceived oral health and its association with oral health, general health and socioeconomic factors among elderly individuals from São Paulo, Brazil. The sample consisted of 871 elderly individuals enrolled in the Health, Wellbeing and Aging cohort study. Self-perceived oral health was measured by the question: "How would you rate your oral health?". Most subjects self-rated their oral health as good. Among dentate individuals, poor oral health was related to depression, poor self-rated health, dental treatment, dental checkups and the psychosocial subscale scores of the Geriatric Oral Health Assessment Index. Edentulous individuals were more likely to report poor oral health, whereas those with higher psychosocial scores were less likely to report poor self-rated oral health. Poor self-rated oral health is associated with general health factors and the psychosocial impact of oral health on quality of life, regardless of socioeconomic and clinical health measures.