Understanding causal associations between self-rated health and personal relationships in older adults: A review of evidence from longitudinal studies

Physical Activity, Sleeping Problems, Weight, Feelings of Social Isolation, and Quality of Life of Older Adults After Coronavirus Infection: A Longitudinal Cohort Study

BACKGROUND

There is debate as to whether a coronavirus infection (SARS-CoV-2) affects older adults' physical activity, sleeping problems, weight, feelings of social isolation, and quality of life (QoL). We investigated differences in these outcomes between older adults with and without coronavirus infection over 180 days following infection.

METHODS

We included 6789 older adults (65+) from the Lifelines COVID-19 cohort study who provided data between April 2020 and June 2021. Older adults (65+) with and without coronavirus infection were matched on sex, age, education, living situation, body mass index, smoking status, vulnerable health, time of infection, and precoronavirus health outcome. Weighted linear mixed models, adjusted for strictness of governmental policy measures, were used to compare health outcomes after infection between groups.

RESULTS

In total, 309 participants were tested positive for coronavirus. Eight days after infection, older adults with a coronavirus infection engaged in less physical activity, had more sleeping problems, weighed less, felt more socially isolated, and had a lower QoL than those without an infection. Differences in weight, feelings of social isolation, and QoL were absent after 90 days. However, differences in physical activity were still present at 90 days following infection and sleeping problems were present at 180 days.

CONCLUSION

Our findings found negative associations of coronavirus infection with all the examined outcomes, which for physical activity persisted for 90 days and sleeping problems for 180 days. Magnitudes of estimated effects on physical activity and sleeping problems remain uncertain.

Exploring factors associated with self-rated health in individuals with diabetes and its impact on quality of life: Evidence from the Survey of Health, Ageing, and Retirement in Europe

BACKGROUND

Self-rated health (SRH), a measure of self-reported general health, is a robust predictor of morbidity and mortality in various populations, including people with diabetes. Diabetes is negatively associated with SRH and quality of life (QoL). Little is known about how people with diabetes rate their health and which aspects influence the rating. Also, the predictive value of SRH on future QoL has not yet been evaluated.

METHODS

We analyzed data from 46 592 participants of the Survey of Health, Ageing and Retirement in Europe (SHARE). Using linear regression, we aimed to determine which sociodemographic, socioeconomic, medical, social, mental, and health behavior factors determine SRH in people with diabetes. In addition, we analyzed the predictive value of SRH on future QoL using the generalized estimating equations procedure.

RESULTS

We determined that country, current job situation, hospitalization, pain, polypharmacy, memory, eyesight, activities of daily living, number of chronic diseases, and depression are all linked to SRH. Together these variables explained 38% of the SRH's variance, whereas depression, pain, and memory had the greatest influence on SRH of people with diabetes. We also found that SRH independently predicted future QoL, supported by a regression coefficient of β = -1.261 (Wald chi-square test, χ2  = 22.097, df = 1, p < .05).

CONCLUSIONS

As SRH is linked to future QoL, we conclude that incorporating SRH assessment into medical evaluations can help health care professionals gaining a more comprehensive understanding of an individual's health trajectory and supporting patients to enhance their QoL.

Using self-reported health as a social determinants of health outcome: a scoping review of reviews

Reducing disease prevalence rather than promoting health has long been the objective of significant population health initiatives, such as the social determinants of health (SDH) framework. However, empirical evidence suggests that people with diagnosed diseases often answer the self-reported health (SRH) question positively. In pursuit of a better proxy to understand, measure and improve health, this scoping review of reviews examines the potential of SRH to be used as an outcome of interest in population health policies. Following PRISMA-ScR guidelines, it synthesizes findings from 77 review papers (published until 11 May 2022) and reports a robust association between SDH and SRH. It also investigates inconsistencies within and between reviews to reveal how variation in population health can be explained by studying the impact of contextual factors, such as cultural, social, economic and political elements, on structural determinants such as socioeconomic situation, gender and ethnicity. These insights provide informed hypotheses for deeper explorations of the role of SDH in improving SRH. The review detects several gaps in the literature. Notably, more evidence syntheses are required, in general, on the pathway from contextual elements to population SRH and, in particular, on the social determinants of adolescents' SRH. This study reports a disease-oriented mindset in collecting, analysing and reporting SRH across the included reviews. Future studies should utilize the capability of SRH in interconnecting social, psychological and biological dimensions of health to actualize its full potential as a central public health measure.

Association between electronic device use and health status among a middle-aged and elderly population: a cross-sectional analysis in the UK Biobank

Aim

Few previous studies have investigated the impact of multiple types of electronic devices on health status, and the moderating effects of gender, age, and BMI. Our aim is to examine the relationships between the use of four types of electronics and three health status indicators in a middle-aged and elderly population, and how these relationships varied by gender, age, and BMI.

Subject and methods

Using data from 376,806 participants aged 40-69 years in the UK Biobank, we conducted a multivariate linear regression to estimate the association between electronic device use and health status. Electronics use was categorized as TV watching, computer use, computer gaming, and mobile phone use, and health status included self-rated health (SRH), multisite chronic pain (MCP), and total physical activity (TPA). Interaction terms were utilized to assess whether the above associations were modified by BMI, gender, and age. Further stratified analysis was performed to explore the role of gender, age, and BMI.

Results

Higher levels of TV watching (BSRH = 0.056, BMCP = 0.044, BTPA= -1.795), computer use (BSRH = 0.007, BTPA= -3.469), and computer gaming (BSRH = 0.055, BMCP = 0.058, BTPA= -6.076) were consistently associated with poorer health status (all P < 0.05). Contrastingly, earlier exposure to mobile phones (BSRH = -0.048, BTPA= 0.933, BMCP = 0.056) was inconsistent with health (all P < 0.05). Additionally, BMI (Bcomputer use-SRH= 0.0026, Bphone-SRH= 0.0049, BTV-MCP= 0.0031, and BTV-TPA= -0.0584) exacerbated the negative effects of electronics use, and male (Bphone-SRH = -0.0414, Bphone-MCP = -0.0537, Bphone-TPA= 2.8873) were healthier with earlier exposure to mobile phones (all P < 0.05).

Conclusion

Our findings suggest that the adverse health effects associated with watching TV, computer use, and computer gaming were consistent and were moderated by BMI, gender, and age, which advances a comprehensive understanding of the association between multiple types of electronic devices and health status, and provides new perspectives for future research.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01886-5.

Associations between patterns of participation in community activities and social support, self-efficacy, self-rated health among community-dwelling older adults

Certain types of community-based social activities improve the health issues of older adults; however, the present patterns of participation in community activities remain unknown. This study aims 1) to identify community-dwelling older adults' patterns of participation in community-based activities and 2) to evaluate the relationships between social support, self-efficacy, self-rated health, and the patterns of participation in community activities. This cross-sectional study used data collected from 146 older adults aged ≥65 years who participated in community events in Japan in 2018. Cluster analysis was used to identify subjects' patterns of participation in community activities. In the multinomial logistic regression model, the participation pattern (dependent variable), and social support and self-efficacy (independent variables), were included, adjusting for age, sex, and years of residency. Three participation pattern clusters were identified: diverse activities (58%), municipal events (30%), and senior citizen club (12%). The proportion of participants reported themselves healthy were 93%, 88%, and 78% for diverse activities, municipal events, and senior citizen club clusters, respectively. Compared to those in the senior citizen club cluster, older adults in the diverse activities cluster were more likely to have self-efficacy (adjusted odds ratio (aOR): 1.19, p = .041) and social support (aOR: 2.35, p = .018), while participants in the municipal events cluster were associated with only social support (aOR: 3.29, p = .022). Increasing social support and self-efficacy may promote seniors' participation in diverse community activities, which would be beneficial for their healthy aging. Further studies are needed to evaluate the causal relationships.

The impact of sources of perceived social support on readmissions in patients with heart failure

BACKGROUND

Lower levels of perceived social support have been known as an independent predictor of hospital readmissions in patients with heart failure (HF). However, the impact of sources of perceived social support on readmissions remain unexplored.

PURPOSE

The main purpose of this study was to investigate and compare the relative importance of social support from significant other, family, and friends on all-cause readmission and cardiac readmission in patients with HF.

METHODS

The prospective cohort study was used to recruit a total of 299 patients with HF in Taiwan between May 2012 and December 2014. Demographic and clinical characteristics, Multidimensional Perceived Social Support Scale (MPSSS), and 18-month follow-up readmissions were recorded during the hospital stay. Univariate and multivariate logistic regressions were constructed to determine the impact of levels and sources of perceived social support with all-cause readmission and cardiac readmission.

RESULTS

A total of 158 patients (52.8%) and 118 patients (39.5%), respectively, had all-cause readmission and cardiac readmissions within 18 months. Multivariate logistic regression yielded inverse associations between levels of perceived social support and readmissions by 18-months. Importantly, social support from significant other was significantly associated with a lower risk of readmissions, both of all-cause readmission and cardiac readmission, in patients with HF, even after controlling for possible covariates, social support from family and friends.

CONCLUSIONS

Social support from significant other, rather than from family and friends, was relatively and inversely associated with 18-month all-cause readmission and cardiac readmission in patients with HF, which is consistent with the hierarchical compensatory model.

The Reciprocal Relationship between Instrumental Support from Children and Self-Rated Health among Older Adults over Time in Rural China

Objective: To investigate the dynamic interplay between instrumental support from children and self-rated health (SRH) among older adults over time in rural China. Methods: Data came from a regional representative, longitudinal study The Well-Being of Older People in Anhui Province collected in 2001, 2003, 2006, 2009, and 2012. At baseline, 1636 respondents reported having at least one child. Bivariate latent change score modeling was conducted, and sequential model comparison was used to assess the directionality of the reciprocal association. Results: Older adults who received higher levels of help with household chores from children tended to experience improvement in subsequent SRH, irrespective of gender. There is no evidence to support the influence of SRH on subsequent changes in instrumental support. Discussion: This study sheds light on the sequence of changes between support and health processes using population-based data within a specific sociocultural context.

Self-reported health as a predictor of mortality: A cohort study of its relation to other health measurements and observation time

Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. We examined the association between SRH and mortality and how this is affected by time and health measurements in a prospective cohort study using repeated measurements and physical examinations of 11652 men and 12684 women in Tromsø, Norway. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death for SRH, controlling for pathology, biometrics, smoking, sex and age. SRH predicted mortality independently of other, more objective health measures. Higher SRH was strongly associated with lower mortality risk. Poor SRH had HR 2.51 (CI: 2.19, 2.88). SRH is affected by disease, mental health and other risk factors, but these factors had little impact on HRs (Poor SRH: HR 1.99; CI: 1.72, 2.31). SRH predicted mortality, but with a time-dependent effect. Time strongly affected the hazard ratio for mortality, especially after ten-year follow-up (Poor SRH HR 3.63 at 0-5 years decreased to HR 1.58 at 15-21 years). SRH has both methodological and clinical value. It should not be uncritically utilised as a replacement instrument when measures of physical illness and other objective health measures are lacking.

Culturally-specific productive engagement and self-rated health among Taiwanese older adults

Productive aging is one of the most prominent gerontological concepts in Western societies over the past three decades. However, it is relatively unknown what types of productive engagement affect self-rated health in Asian societies. The mechanisms linking them are also not thoroughly explored. Using the representative 2017 Taichung Good Elderly Life Survey (N = 616), this study examined whether and how work-related, family-related, and community-related types of productive engagement are associated with self-rated health among older adults in Taiwan. This study first revealed the culturally-prioritized types of family-related engagement (i.e., emotional support for adult children and leisure care for grandchildren) and several types of community-related engagement were significantly and positively related to self-rated health, whereas employment, financial and instrumental types of support/grandparenting, and volunteering were not. Second, this study indicated that the previously understudied psychosocial mechanisms (i.e., resilience, sense of control, making new friends, and schedule compliance) partially accounted for the association between productive engagement and self-rated health. Findings suggest the importance of examining culturally-specific indicators of productive aging and their differential health effects in non-Western contexts.

Mediating effect of social support on the associations between health literacy, productive aging, and self-rated health among elderly Chinese adults in a newly urbanized community

With the growing urbanization of China, which has changed older adults' living conditions, lifestyle, and the source of support, coupled with rapid population aging, the health status of the elderly should be paid attention to. In addition to objective indicators such as the decline of function, specific factors, such as social support, health literacy, and productive aging, also have an impact on the health outcomes of the elderly. However, the interrelationships among these factors and their potential mechanisms in the context of urbanization remain unclear. Thus, this study was the first to explore the interrelationships among social support, health literacy, productive aging, and self-rated health in older adults living in a newly urbanized community in China.We aimed to investigate the mediating effect of social support on the associations between health literacy, productive aging, and self-rated health among elderly Chinese adults in a newly urbanized community to provide reference data for future health interventions for the elderly.This cross-sectional study was conducted between June and August 2013. Questionnaires on social support, health literacy, productive aging, and self-rated health were administered to 992 elderly residents. Structural equation models were used to examine the relationships among these 4 variables. Statistical analyses were performed using IBM SPSS Statistics 21.0 and Mplus 7.0.The mean scores for social support, health literacy, productive aging, and self-rated health were 34.5 ± 5.8, 13.6 ± 4.4, 11.3 ± 3.0, and 3.4 ± 0.7, respectively. Social support was directly related to self-rated health (β=0.119, 95% confidence interval [CI]: 0.041-0.198), while productive aging and health literacy had indirect associations with self-rated health via social support (β=0.071, 95% CI: 0.054-0.216; β=0.049, 95% CI: 0.066-0.183). Both productive aging (β=0.214, 95% CI: 0.047-0.381) and health literacy had direct associations with social support (β=0.327, 95% CI: 0.175-0.479), while health literacy had a direct association with productive aging (β=0.676, 95% CI: 0.604-0.748). Productive aging mediated the relationship between health literacy and social support.Overall, improving health outcomes among older adults requires enhancement of social support, along with consideration of productive aging and health literacy.

Multidimensional Intergenerational Instrumental Support and Self-Rated Health Among Older Adults in Rural China: Trajectories and Correlated Change Over 11 Years

OBJECTIVES

This study investigated the dynamic relationship between multidimensional intergenerational instrumental support and health over time. This approach is of theoretical, methodological, and practical significance in gerontological research.

METHOD

Data came from The Well-Being of Older People in Anhui Province in 2001, 2003, 2006, 2009, and 2012. Of the 1,636 participants at baseline, a working sample of 1,557 older adults was used. Trajectories and correlated change were estimated using parallel latent growth curve modeling with maximum likelihood estimation.

RESULTS

"Received household-chore help" decreased over time, whereas "received personal-care help" increased over time. "Provided household-chore help" and "provided personal-care help" increased and then decreased over time. Increasing receipt of "household-chore help" and "personal-care help" were associated with faster decline in health over time.

DISCUSSION

Findings suggest distinctive patterns of changes for different dimensions of intergenerational instrumental support and their relationship with changes in perception of health over time in later life.

Funcionalidade familiar de idosos brasileiros residentes em comunidade

Resumo Objetivo Avaliar a funcionalidade familiar de idosos brasileiros; testar a influência de fatores determinantes. Métodos Estudo transversal com 2.052 idosos, a partir de dados coletados da linha base referente ao estudo “Aging, Gender and Quality of Life (AGEQOL)”, responderam questionários sobre funcionamento familiar; atividades básicas e instrumentais de vida diária (AVD e AIVD); estado cognitivo; e características sociodemográficas. Modelos multivariados de regressão ordinal e análise de correspondência múltipla identificaram fatores associados à boa funcionalidade familiar. Resultados A maior parte dos idosos gozava de boa funcionalidade familiar (76,3%), era casada e vivendo com cônjuge (55,5%), tinha mais de seis filhos e netos (85,4% e 76,7%, respectivamente) e independente para AIVD (71,5%). Análise de correspondência resultou em três grupos: alta, moderada e baixa funcionalidade familiar e perfil de idosos com distintas condições socioeconômicas. Conclusão Infere-se dos resultados implicações para a prática e política de atenção à família com membros idosos segundo seu funcionamento e distintas condições de vida e saúde das pessoas idosas.

Family relations, sense of coherence, happiness and perceived health in retired Taiwanese: Analysis of a conceptual model

AIM

A growing awareness of the rapidly increasing aged population in the world has led to growing attention to mental health in late life. Happiness has been emphasized as an important indicator of physical health and is predicted by a sense of coherence. However, the mechanism of influence of family relations on sense of coherence, happiness and perceived health is unknown. The present study aimed to analyze a conceptual model of the relationships among family relations, sense of coherence, happiness and perceived health in retired persons.

METHODS

A total of 142 retired participants were recruited from social service centers in Taipei, Taiwan. A structured questionnaire measuring the relationships among family relations, sense of coherence, happiness and perceived health was filled in by each respondent. Data were analyzed using structural equation modeling.

RESULTS

The results showed that family relations is positively correlated with happiness, sense of coherence and perceived health. The results also showed that good family relations and a sense of coherence predict greater happiness. The results from structure equation modeling showed that the relationship between family relations and perceived health is completely mediated by happiness and a sense of coherence, but only the indirect effect of happiness is significant. The results also showed that family relations is partially mediated by the sense of coherence to happiness.

CONCLUSIONS

In caring for retired older people, medical professionals need to increase their family relations and sense of coherence simultaneously, and then promote happiness in their interventions. Geriatr Gerontol Int 2018; 18: 154-160.

The impact of social engagement on health-related quality of life and depressive symptoms in old age - evidence from a multicenter prospective cohort study in Germany

BACKGROUND

Thus far, only a few longitudinal studies investigated the impact of social engagement on health-related quality of life (HRQoL) and depressive symptoms in old age. Therefore, we aimed to examine the impact of social engagement on HRQoL and depressive symptoms in late life.

METHODS

Individuals aged 75 years and over at baseline were interviewed every 1.5 years in a multicenter prospective cohort study in Germany. While HRQoL was quantified by using the Visual Analogue Scale (EQ VAS) of the EQ-5D instrument, depressive symptoms was assessed by using the Geriatric Depression Scale (GDS). Individuals reported the frequency ("never" to "every day") of social engagement (e.g., engagement in the church, as a volunteer, in a party, or in a club) in the last four weeks. Fixed effects regressions were used to estimate the effect of social engagement on the outcome variables.

RESULTS

After adjusting for age, marital status, functional status and chronic diseases, fixed effects regressions revealed that the onset of social engagement markedly increased HRQoL and considerably decreased depressive symptoms in the total sample and in women, but not men.

CONCLUSIONS

Our findings corroborate the relevance of social engagement for HRQoL and depressive symptoms in old age. Encouraging the individuals to start, maintain and expand social engagement in late life might help to maintain and improve HRQoL and decrease depressive symptoms.

Examining the relationship between encouragement and health-related quality of life among Muslims

This study examines the relationship between encouragement and health-related quality of life (HRQOL) among a sample of American Muslims, in tandem with the potential mediating effects of depression and spirituality. To conduct this cross-sectional study, a model was developed and tested using structural equation modeling (SEM) with a community sample of Muslims (N = 284). The results indicate that encouragement has a direct, positive effect on HRQOL. Neither depression nor spirituality mediated the relationship between encouragement and HRQOL. Rather, both variables exhibited a direct, independent effect on HRQOL. In addition, spirituality exhibited an indirect effect on HRQOL through attenuating depression. The findings underscore the importance of encouragement as a pathway to enhance HRQOL among Muslims in post-9/11 America. The results also suggest that spirituality can play a significant role in fostering HRQOL among Muslims, both directly and indirectly by reducing the effects of depression on HRQOL.

Sources of social support associated with health and quality of life: a cross-sectional study among Canadian and Latin American older adults

OBJECTIVES

To examine whether the association between emotional support and indicators of health and quality of life differs between Canadian and Latin American older adults.

DESIGN

Cross-sectional analysis of the International Mobility in Aging Study (IMIAS). Social support from friends, family members, children and partner was measured with a previously validated social network and support scale (IMIAS-SNSS). Low social support was defined as ranking in the lowest site-specific quartile. Prevalence ratios (PR) of good health, depression and good quality of life were estimated with Poisson regression models, adjusting for age, gender, education, income and disability in activities of daily living.

SETTING

Kingston and Saint-Hyacinthe in Canada, Manizales in Colombia and Natal in Brazil.

PARTICIPANTS

1600 community-dwelling adults aged 65-74 years, n=400 at each site.

OUTCOME MEASURES

Likert scale question on self-rated health, Center for Epidemiological Studies Depression Scale and 10-point analogical quality-of-life (QoL) scale.

RESULTS

Relationships between social support and study outcomes differed between Canadian and Latin American older adults. Among Canadians, those without a partner had a lower prevalence of good health (PR=0.90; 95% CI 0.82 to 0.98), and those with high support from friends had a higher prevalence of good health (PR=1.09; 95% CI 1.01 to 1.18). Among Latin Americans, depression was lower among those with high levels of support from family (PR=0.63; 95% CI 0.48 to 0.83), children (PR=0.60; 95% CI 0.45 to 0.80) and partner (PR=0.57; 95% CI 0.31 to 0.77); good QoL was associated with high levels of support from children (PR=1.54; 95% CI 1.20 to 1.99) and partner (PR=1.31; 95% CI 1.03 to 1.67).

CONCLUSIONS

Among older adults, different sources of support were relevant to health across societies. Support from friends and having a partner were related to good health in Canada, whereas in Latin America, support from family, children and partner were associated with less depression and better QoL.

Health Impact Index. Development and Validation of a Method for Classifying Comorbid Disease Measured against Self-Reported Health

The objective of this study was to develop a method of classifying comorbid conditions that accounts for both the severity and joint effects of the diseases. The Tromsø Study is a cohort study with a longitudinal design utilizing a survey approach with physical examinations in the Tromsø municipality from 1974 to 2008, where in total 40051 subjects participated. We used Tromsø 4 as reference population and the Norwegian Institute of Public Health (FHI) panel as validation population. Ordinal regression was used to assess the effect of comorbid disease on Self-Reported Health (SRH). The model is controlled for interaction between diseases, mental health, age, and gender. The health impact index estimated levels of SRH. The comparison of predicted and observed SRH showed no significant differences. Spearman’s correlation showed that increasing levels of comorbidity were related to lower levels of SRH (R_S = -0.36, p <.001). The Charlson Comorbidity Index(CCI) was also associated with SRH (r = -.25, p <.001). When focusing on only individuals with a comorbid disease, the relation between SRH and the Health Impact Index (HII) was strengthened (r = -.42, p <.001), while the association between SRH and CCI was attenuated (r = -.14, p <.001). CCI was designed to control for comorbid conditions when survival/mortality is the outcome of interest but is inaccurate when the outcome is SRH. We conclude that HII should be used when SRH is not available, and well-being or quality of survival/life is the outcome of interest.

Self-Rated Health and Associated Factors in Older Turkish Adults With Type 2 Diabetes: A Pilot Study

PURPOSE

To evaluate self-rated health (SRH) and determine its associations with participant characteristics, glycemic control, family support, and health-related quality of life in older Turkish adults with type 2 diabetes.

METHOD

This cross-sectional study included 113 adults aged 60 years or older with type 2 diabetes. Data were collected by using an information form, the Perceived Social Support From Family Scale, and the Nottingham Health Profile. SRH was assessed by a single-item question. Glycemic control was measured by glycosylated hemoglobin levels.

RESULTS

Ninety-seven patients (85.8%) evaluated their health as fair or poor. The glycemic target level (glycosylated hemoglobin <7.5%) was achieved in 47.8% of the patients. Female gender, a low or moderate family income, and lower levels of family support were associated with poorer SRH.

CONCLUSIONS/IMPLICATIONS

The majority of the participants considered their health to be fair or poor. Better understanding of risk factors associated with SRH may provide more effective interventions to improve health outcomes.