Ageing and the relationship between functional status and self-rated health in elderly men

Migration status, physical limitations and associated self-rated health: a study of older Indian adults

BACKGROUND

Migrant status with mobility impairment becomes a double burden for health and wellbeing of older adults. This study examined the independent relationships and multitude effects between migrant status, functional and mobility impairments and poor self-rated health (SRH) among older Indian adults.

METHODS

This study utilised nationally representative Longitudinal Ageing Study in India wave-1 (LASI) data, including a sample of 30,736 individuals aged 60 years and above. The main explanatory variables were migrant status, difficulty in activities of daily living (ADL), difficulty in instrumental activities of daily living (IADL) and mobility impairments; and the outcome variable was poor-SRH. Multivariable logistic regression and stratified analyses were used to fulfil the study objectives.

RESULTS

Overall, about 23% of older adults reported poor-SRH. Reporting poor-SRH was more prevalent (28.03%) among recent migrants (less than ten years). The prevalence of reporting poor-SRH was significantly higher among older adults who had mobility impairment (28.65%), difficulty in ADL or IADL (40.82% & 32.57%). Migrant older adults (regardless of duration) who had mobility impairment had significantly greater odds of reporting poor-SRH compared with non-migrant older adults who did not have mobility impairment. Similarly, older respondents who had problems in ADL and IADL with migration status had higher odds of reporting poor-SRH than their non-migrant counterparts with no such problems.

CONCLUSIONS

The study revealed the vulnerability of migrant older adults with functional and mobility disability, as well as those with limited socioeconomic resources and suffering from multimorbidity on rating their perceived health. The findings can be utilised to target outreach programmes and provision of services for migrating older individuals with mobility impairments and enhance their perceived health and ensure active ageing.

Development and Validation of a Physical Food Security Tool for Older Adults

BACKGROUND

Current measures of food insecurity focus on economic access to food, but not on the physical aspect of food insecurity that captures the inability to access food or prepare meals. This is particularly relevant among the older adult population who are at a high risk of functional impairments.

OBJECTIVES

To develop a short-form physical food security (PFS) tool among older adults using statistical methods based on the Item Response Theory (Rasch) model.

METHODS

Pooled data from adults aged ≥60 y of the NHANES (2013-2018) (n = 5892) were used. The PFS tool was derived from the physical limitation questions included in the physical functioning questionnaire of NHANES. Item severity parameters, fit and reliability statistics, and residual correlation between items were estimated using the Rasch model. The construct validity of the tool was assessed by examining associations with the Healthy Eating Index (HEI)-2015 scores, self-reported health, self-reported diet quality, and economic food insecurity, using weighted multivariable linear regression analysis, controlling for potential confounders.

RESULTS

A 6-item scale was developed, which had adequate fit statistics and high reliability (0.62). It was categorized based on raw score severity into high, marginal, low, and very low PFS. Very low PFS was associated with respondent's self-reported poor health (OR = 23.8; 95% CI: 15.3, 36.9; P < 0.0001), self-reported poor diet (OR = 3.9; 95% CI: 2.8, 5.5; P < 0.0001), low and very low economic food security (OR = 6.08; 95% CI: 4.23, 8.76; P < 0.0001), and with lower mean HEI-2015 index score, in comparison to older adults with high PFS (54.5 compared with 57.5, P = 0.022).

CONCLUSIONS

The proposed 6-item PFS scale captures a new dimension of food insecurity that can inform on how older adults experience food insecurity. The tool will require further testing and evaluation in larger and different contexts to demonstrate its external validity.

What Predict Self-rated Health: A Cross-sectional Study Among Men and Women with Non-cardiac Chest Pain

The study aimed to determine different lifestyle and clinical factors that predict self-rated health (SRH) in non-cardiac chest pain (NCCP) patients. In this cross-sectional study, 360 NCCP patients filled out questionnaires about depression, somatization, body sensation, type D personality, and pain intensity. In addition, participants' lifestyle and socio-demographic data were obtained. Multiple regression analyses revealed that among men, pain intensity (OR 1.07; 95% CI 1.03, 1.12), depression (3.10; 1.38, 9.18), somatization (1.18; 1.08, 1.29) and sleep quality (6.23; 1.42, 27.27) were associated with self-rated health. In women NCCP patients, depression (2.44; 1.05, 6.82) pain intensity (1.05; 1.01, 1.10), and physical activity (2.21; 1.07, 5.55) were associated with SRH. The results on the predicting factors of SRH in NCCP patients provide potential insights for more advanced clinical management of NCCP. In addition, they can be applied to improve health policies and promote healthy behaviors among NCCP patients.

Haplotype of ESR1 and PPARD Genes Is Associated with Higher Anthropometric Changes in Han Chinese Obesity by Adjusting Dietary Factors-An 18-Month Follow-Up

The obesity genetic effect may play a major role in obesogenic environment. A combined case-control and an 18-month follow-up were carried out, including a total of 311 controls and 118 obese cases. All participants were aged in the range of 20-55 y/o. The body mass index (BMI) of obese cases and normal controls was in the range of 27.0-34.9 and 18.5-23.9 kg/m², respectively. The rs712221 on Estrogen receptor1 (ESR1) and rs2016520 on Peroxisome proliferator-activated receptor delta (PPARD) showed significant associations with obesity. The TT (odds ratio (OR): 2.42; 95% confidence interval (CI): 1.46-4.01) and TT/TC (OR: 2.80; 95% CI: 1.14-6.85) genotypes on rs712221 and rs2016520 had significantly higher obesity risks, respectively. Moreover, the synergic effect of these two risk SNPs (2-RGH) exhibited an almost geometrical increase in obesity risk (OR: 7.00; 95% CI: 2.23-21.99). Obese individuals with 2-RGH had apparently higher changes in BMI increase, body weight gain and dietary fiber intake but a lower total energy intake within the 18-month follow-up.

Trajectories of self-rated health in an older general population and their determinants: the Lifelines Cohort Study

OBJECTIVES

Poor self-rated health (SRH) is a strong predictor of premature mortality in older adults. Trajectories of poor SRH are associated with multimorbidity and unhealthy behaviours. Whether trajectories of SRH are associated with deviating physiological markers is unclear. This study identified trajectories of SRH and investigated the associations of trajectory membership with chronic diseases, health risk behaviours and physiological markers in community-dwelling older adults.

STUDY DESIGN AND SETTING

Prospective general population cohort.

PARTICIPANTS

Trajectories of SRH over 5 years were identified using data of 11 600 participants aged 65 years and older of the Lifelines Cohort Study.

OUTCOME MEASURES

Trajectories of SRH were the main outcome. Covariates included demographics (age, gender, education), chronic diseases, health-risk behaviour (physical activity, smoking, drinking) and physiological markers (body mass index, cardiovascular function, lung function, glucose metabolism, haematological condition, endocrine function, renal function, liver function and cognitive function).

RESULTS

Four stable trajectories were identified, including excellent (n=607, 6%), good (n=2111, 19%), moderate (n=7677, 65%) and poor SRH (n=1205, 10%). Being women (OR: 1.4; 95% CI: 1.0 to 1.9), low education (OR: 2.1; 95% CI: 1.5 to 3.0), one (OR: 10.4; 95% CI: 7.4 to 14.7) or multiple chronic diseases (OR: 37.8; 95% CI: 22.4 to 71.8), smoking (OR: 1.8; 95% CI: 1.0 to 3.2), physical inactivity (OR: 3.1; 95% CI: 1.8 to 5.2), alcohol abstinence (OR: 2.2; 95% CI: 1.4 to 3.2) and deviating physiological markers (OR: 1.5; 95% CI: 1.1 to 2.0) increase the odds for a higher probability of poor SRH trajectory membership compared with excellent SRH trajectory membership.

CONCLUSION

SRH of community-dwelling older adults is stable over time with the majority (65%) having moderate SRH. Older adults with higher probabilities of poor SRH often have unfavourable health status.

Effect of self-rated health status on functioning difficulties among older adults in Ghana: Coarsened exact matching method of analysis of the World Health Organization's study on global AGEing and adult health, Wave 2

BACKGROUND

Functional difficulty assessment has been proven as a key factor in the health evaluation of adults. Previous studies have shown a reduction in health and functional difficulties with increasing age. This analysis was conducted to quantify the effect of poor self-rated health on functional difficulty among older adults in Ghana.

METHOD

This analysis was based on the World Health Organization Study on Global AGEing and Adult Health in Ghana for older adults 50 years and above. Fifteen standard functioning difficulty tools were extracted and used for the analysis. Three predictive models with the Coarsened Exact Matching method involving Negative Binomial, Logistics and Ordered logistic regression were performed using Stata 14.

RESULTS

Overall, the prevalence of poor Self-rated health was 34.9% and that of functional difficulties among older adults in Ghana was 69.4%. Female sex, increasing age, being separated, having no religious affiliation, not currently working and being underweight were associated with and significantly influence poor Self-rated health [AOR(95%CI)p-value = 1.41(1.08-1.83)0.011, 3.85(2.62-5.64)0.000, 1.45(1.08-1.94)0.013, 2.62(1.68-4.07)0.000, 2.4(1.85-3.12)0.000 and 1.39(1.06-1.81)0.017 respectively]. In addition, poor Self-rated health and geographical location (rural vs. urban)significantly influence functioning difficulties among older adults in Ghana as predicted by the three models [Negative Binomial: PR(95%CI) = 1.62(1.43-1.82), Binary logistic: AOR(95%CI) = 3.67(2.79-4.81) and ordered logistic: AOR(95%CI) = 2.53(1.14-2.03)].

CONCLUSION

Poor SRH is more pronounced among older adult females in Ghana. Some determinants of poor SRH include; age, geographical location (urban vs. rural), marital status, religion, and employment status. This provides pointers to important socio-demographic determinants with implications on the social function of older adults in line with the theme of the national aging policy of 2010, 'ageing with security and dignity' and ultimately in the national quest to achieve the Sustainable Development Goals by 2030.

Dietary patterns and risk of self-reported activity limitation in older adults from the Three-City Bordeaux Study

Few studies have been interested in the relationship between dietary patterns and activity limitation in older adults yet. We analysed the association between dietary patterns and the risk of self-reported activity limitation - that is mobility restriction, limitation in instrumental activities in daily living (IADL) and in activities in daily living (ADL) - in community-dwellers aged 67+ years initially free of activity limitation in 2001-2002 and re-examined at least once over 10 years - that is 583 participants for mobility restriction, 1114 for IADL limitation and 1267 for ADL limitation. At baseline, five sex-specific dietary clusters were derived by hybrid clustering method from weekly frequency of intake of twenty food and beverage items. Self-reported mobility restriction, limitations in IADL and in ADL were assessed using the Rosow-Breslau, the Lawton-Brody and the Katz scales, respectively. Associations between dietary clusters and the risk of each activity limitation were assessed using Cox proportional hazard models. In models adjusted for socio-demographic and health-related covariates, compared with the 'Healthy' cluster the 'Biscuits and snacking' cluster was associated with a higher risk of mobility restriction (hazard ratio (HR)=3·0; 95 % CI 1·6, 5·8) and limitation in IADL (HR=2·1; 95 % CI 1·1, 4·2) in men and limitation in ADL in women (HR=2·3; 95 % CI 1·3, 4·0). In this French cohort of community-dwellers aged 67+ years, some unhealthy dietary patterns may increase the risk of activity limitation all along the disablement process in older adults.

Self-rated health and endogenous selection into primary care

This study assesses the causal effects of primary care utilization on subjective health status in Turkey using individual-level data from the 2012 Health Research Survey. Employing recursive bivariate ordered models that take into account the possibility that selection into healthcare might be correlated with the respondent's self-reported health status, we find that selection into primary care is endogenously determined and that the utilization of primary care significantly improves self-rated health after controlling for sociodemographics, socioeconomic status, health behaviors and risk factors, and access to healthcare. We show that the causal association between healthcare utilization and health status is robust to the use of objective measures of health and specific types of care, suggesting that the use of a single-item question on self-rated health and binary measures of preventive care utilization is valid.

Comparison of two health measurements among older adults

The aims of this study were to develop composite indices for measuring the life relative independence of older adults and to compare the results with the self-rated health status to evaluate the reliability. The life relative independence measures were developed using a representative cross-sectional survey of 2336 samples in Taiwan. The results indicated that older adults have poor social health and economic security, the life relative independence is more effective in health evaluation than the self-rated health status and psychological health is associated with independence. This study provides an improved understanding of scenarios of independence for older adults.

The Prevalence of Chronic Conditions and Poor Health Among People With and Without Vision Impairment, Aged ≥65 Years, 2010-2014

PURPOSE

To examine the prevalence of 13 chronic conditions and fair/poor health among people aged ≥65 years in the United States with and without vision impairment.

DESIGN

Cross-sectional study from the 2010-2014 National Health Interview Survey.

METHODS

We examined hypertension, heart disease, high cholesterol, stroke, arthritis, asthma, chronic obstructive pulmonary disease, cancer, weak/failing kidneys, diabetes, hepatitis, depression, and hearing impairment. We used logistic regression to show the association between vision impairment and chronic conditions and the association between vision impairment and poor health for those with chronic conditions.

RESULTS

People aged ≥65 years with vision impairment reported greater prevalence of chronic conditions compared to people without vision impairment. After controlling for covariates (age, sex, education, race, smoking, physical activity, and obesity), people with vision impairment were more likely than those without to report chronic conditions (hypertension: OR [odds ratio] 1.43; heart disease: OR 1.68; high cholesterol: OR 1.26; stroke: OR 1.99; arthritis; OR 1.71; asthma: OR 1.56; chronic obstructive pulmonary disease: OR 1.65; cancer: OR 1.23; weak/failing kidneys: OR 2.29; diabetes: OR 1.56; hepatitis: OR 1.30; depression: OR 1.47; hearing impairment: OR 1.91) (all P < .05). Among older people with chronic conditions, those with vision impairment and chronic conditions compared to people without vision impairment and chronic conditions were 1.66-2.98 times more likely to have fair/poor health than those without vision impairment (all P < .05).

CONCLUSION

Higher prevalence of chronic conditions is strongly associated with vision impairment among the older people and poor health is strongly associated with vision impairment and chronic conditions.

Circulating Estrogen Levels and Self-Reported Health and Mobility Limitation in Community-Dwelling Men of the Framingham Heart Study

Background

Self-rated health is a commonly used global indicator of health status. Few studies have examined the association of self-rated health and mobility with estrone and estradiol in men. Accordingly, we determined the cross-sectional, incident, and mediating relations between circulating estrone and estradiol levels with self-rated health, mobility limitation, and physical performance in community-dwelling men.

Methods

The cross-sectional sample included 1,148 men, who attended Framingham Offspring Study Examinations 7 and 8. Estrone and estradiol levels were measured using liquid chromatography tandem mass spectrometry at Examination 7. Self-reported mobility limitation and self-rated health were assessed at Examinations 7 and 8. Additionally, short physical performance battery, usual walking speed, and grip strength were assessed at Examination 7.

Results

In incident analysis, estradiol levels at Examination 7 were associated with increased odds of fair or poor self-rated health at Examination 8, after adjusting for age, body mass index, comorbidities, and testosterone levels; in an individual with 50% greater estradiol than other, the odds of reporting "fair or poor" self-rated health increased by 1.78 (95% confidence interval: 1.25-2.55; p = .001). Neither estrone nor estradiol levels were associated with any physical performance measure at baseline.

Conclusions

Higher circulating levels of estradiol are associated with increased risk of incident fair/poor self-rated health in community-dwelling men. The mechanisms by which circulating levels of estradiol are related to self-rated health in men need further investigation.

Implicit health associations across the adult lifespan

OBJECTIVE

Explicit reports of one's health self-concept (e.g. rate your overall health) are commonly used in research and clinical practice. These measures predict important health outcomes, but rely on conscious introspection so may not fully capture the different components of the health self-concept (e.g. more automatic components) that relate to actual health. This study examined the health-implicit association test (health-IAT), and how it may add to our prediction of health from self-reports.

DESIGN

1004 participants (ages 18-85) completed this web-based study with the health-IAT (assessing self-healthy implicit associations) and explicit assessments of health.

MAIN OUTCOME MEASURES

Self-reported measures of physical functioning.

RESULTS

The health-IAT was valid and reliable. Older age was correlated with stronger self-healthy implicit associations. Although the health-IAT did not incrementally predict self-reported markers of physical functioning when only controlling for explicit health self-concept, it was an incremental predictor once age was entered for all four models tested.

CONCLUSIONS

The health-IAT appears to be a valid and reliable new measure that assesses implicit self-concept relating to physical health. Results reveal the potential value of assessing implicit health self-concept in both research and practice, especially when taking into account age.

How’s Your Health at Home: Frail Homebound Patients Reported Health Experience and Outcomes

Pour notre sondage, nous avons utilisé une méthodologie mixte basée sur le Web (How’s Your Health – Frail) pour examiner la santé des adultes fragiles (78% âgés de 80 ans et plus) inscrits à un programme de soins primaires à domicile à Vancouver, au Canada. Soixante pour cent des répondants admissibles ont participé, représentant plus d’un quart (92/350, 26,2%) de tous les individus qui reçoivent le service. Malgré des niveaux élevés de co-morbidité et de dépendance fonctionnelle, 50% ont jugé leur santé aussi bonne, très bonne ou excellente. Les ratios de cotes ajustés pour l’auto-évaluation de sa santé positive étaient de 7,50, 95 pour cent d’intervalle de confiance (IC) [1,09, 51,81] et 4,85, 95% CI [1,02, 22,95] pour l’absence de symptômes gênants et le pouvoir de parler à la famille ou amis, respectivement. Des réponses narratives aux questions sur la fin de vie et la vie avec une maladie sont également décrites. Les résultats suggèrent que l’accent mis sur la gestion des symptômes, et le soutien des contacts sociaux, peut améliorer la santé des personnes âgées fragiles.

A mixed-methods investigation of successful aging among older women engaged in sports-based versus exercise-based leisure time physical activities

This mixed-methods study compares active older women in different physically based leisure activities and explores the difference in subjective ratings of successful aging and quantifiable predictors of success. A survey was administered to 256 women, 60-92 years of age, engaged in a sports- or exercise-based activity. Quantitative data were analyzed through ANOVA and multiple regression. Qualitative data (n = 79) was analyzed using the approach associated with means-end theory. While participants quantitatively appeared similar in terms of successful aging, qualitative interviews revealed differences in activity motivation. Women involved in sports highlighted social/psychological benefits, while those involved in exercise-based activities stressed fitness outcomes.

Risk Factors for Six Types of Disability among the Older People in Thailand in 2002, 2007, and 2011

Background. There is an important need to characterize risk factors for disability in Thailand, in order to inform effective prevention and control strategies. This study investigated factors associated with risk of 6 types of disability in Thailand's ageing population in 2002, 2007, and 2011. Methods. Data came from the Cross-Sectional National Surveys of Older Persons in Thailand conducted by the National Statistical Office (NSO) in 2002, 2007, and 2011. Stratified two-stage sampling was employed. Interviews of 24,835, 30,427, and 34,173 elderly people aged 60 and above were conducted in the respective study years. Prevalence of disabilities was measured, and factors associated with disability risk were assessed with probability-weighted multiple logistic regression. Results. Disability prevalence decreased slightly over the study period. The characteristics with greatest positive impact on disability prevalence were not working over the past week (average impact: 61.2%), age (53.7% per decade), and suffering from one or more chronic illnesses (46.3%). Conclusions. The strong observed positive impact of not working on disability prevalence suggests that raising the mandatory retirement age might result in some reduction of disability risk. Also, the observed positive impact of living with others (versus alone) on disability risk was somewhat unexpected.

Self-rated Health by Educational Level in Persons with and without Health Problems

The objective of this study was to determine whether differences in self-rated health by educational level vary as a function of the presence or absence of health problems. For this purpose, 12,800 people were studied from the 1995 and 1997 Spanish national health surveys to estimate the percentage of less-than-good and less-than-fair health for each educational level. The association between self-rated health and educational level was stronger in persons without health problems than in those who had health problems. The probable explanation for these results is that persons with different educational levels have different conceptions about what constitutes health.

How Much Should We Expect? Family Caregiving of AIDS Patients in Rural Uganda

The aim of this study was to measure the burden of care for family caregivers of AIDS patients. A cross-sectional exploratory design was used to describe the care experiences of family caregivers of AIDS care recipients. A questionnaire was used to interview 120 family caregivers of AIDS patients from four rural areas in western Uganda. The questions asked were related to 12 domains of family caregiving. Care burden scores of caregivers were calculated. It was found that care burden scores were high in all domains except those regarding relationships within the families and substance abuse. Serious work overload and low health status were reported. The high burden of caregiving puts family caregivers at risk for decreased health status and increased social isolation and depression.

Advancing Symptom Science Through Use of Common Data Elements

BACKGROUND

Use of common data elements (CDEs), conceptually defined as variables that are operationalized and measured in identical ways across studies, enables comparison of data across studies in ways that would otherwise be impossible. Although healthcare researchers are increasingly using CDEs, there has been little systematic use of CDEs for symptom science. CDEs are especially important in symptom science because people experience common symptoms across a broad range of health and developmental states, and symptom management interventions may have common outcomes across populations.

PURPOSES

The purposes of this article are to (a) recommend best practices for the use of CDEs for symptom science within and across centers; (b) evaluate the benefits and challenges associated with the use of CDEs for symptom science; (c) propose CDEs to be used in symptom science to serve as the basis for this emerging science; and (d) suggest implications and recommendations for future research and dissemination of CDEs for symptom science.

DESIGN

The National Institute of Nursing Research (NINR)-supported P20 and P30 Center directors applied published best practices, expert advice, and the literature to identify CDEs to be used across the centers to measure pain, sleep, fatigue, and affective and cognitive symptoms.

FINDINGS

We generated a minimum set of CDEs to measure symptoms.

CONCLUSIONS

The CDEs identified through this process will be used across the NINR Centers and will facilitate comparison of symptoms across studies. We expect that additional symptom CDEs will be added and the list will be refined in future work.

CLINICAL RELEVANCE

Symptoms are an important focus of nursing care. Use of CDEs will facilitate research that will lead to better ways to assist people to manage their symptoms.

Self-Rated Health Among Very Old People in European Countries: An Explorative Study in Latvia and Sweden

Objectives: To explore and gain insight into factors related to self-rated health (SRH) among very old people in two European countries. Methods: The study was based on Latvian (n = 301) and Swedish (n = 397) data from the baseline of the Enabling Autonomy, Participation, and Well-Being in Old Age: The Home Environment as a Determinant for Healthy Ageing Survey Study. Besides descriptive statistics, ordinal regression analysis was used to analyze demographic, physical and mental health-related, functional and environmental factors related to SRH in each sample. Results: In both samples, participants with worse perceived physical mobility and more symptoms were significantly more likely to have worse SRH. There were more diverse results regarding other factors in terms of opposite relations to SRH, comparing the two samples. Discussion: Preventive measures and health care should focus on improving and supporting mobility and physical health among older people. Especially in countries with low scores on indicators of health such as Latvia, to minimize health inequalities. More attention should be paid to factors to improve the general health status of the population.

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.

Effects of leisure education on self-rated health among older adults

This study examined whether a leisure education program could promote leisure autonomy and self-rated health (SRH) among older adults. A pretest-posttest randomized experimental design was conducted. Subjects were randomly assigned to either an experimental group (n = 30) or a control group (n = 30). Data related to leisure autonomy and SRH were collected shortly before and after the experiment. Pretest and posttest data were analyzed using an analysis of covariance. The results indicated that the average posttest scores of leisure autonomy and SRH in the experimental group were significantly higher than those in the control group. Implications of the results are discussed.

Chiropractic use and changes in health among older medicare beneficiaries: a comparative effectiveness observational study

OBJECTIVE

The purpose of this study was to investigate the effect of chiropractic on 5 outcomes among Medicare beneficiaries: increased difficulties performing activities of daily living (ADLs), instrumental ADLs (IADLs), and lower body functions, as well as lower self-rated health and increased depressive symptoms.

METHODS

Among all beneficiaries, we estimated the effect of chiropractic use on changes in health outcomes among those who used chiropractic compared with those who did not, and among beneficiaries with back conditions, we estimated the effect of chiropractic use relative to medical care, both during a 2- to 15-year period. Two analytic approaches were used--one assumed no selection bias, whereas the other adjusted for potential selection bias using propensity score methods.

RESULTS

Among all beneficiaries, propensity score analyses indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, and depressive symptoms, although there were increased risks associated with chiropractic for declines in lower body function and self-rated health. Propensity score analyses among beneficiaries with back conditions indicated that chiropractic use led to comparable outcomes for ADLs, IADLs, lower body function, and depressive symptoms, although there was an increased risk associated with chiropractic use for declines in self-rated health.

CONCLUSION

The evidence in this study suggests that chiropractic treatment has comparable effects on functional outcomes when compared with medical treatment for all Medicare beneficiaries, but increased risk for declines in self-rated health among beneficiaries with back conditions.

Self-rated health and associated factors among older South Africans: evidence from the study on global ageing and adult health

Background

Population ageing has become significant in South African society, increasing the need to improve understandings of health and well-being among the aged.

Objective

To describe the self-reported ratings of overall health and functioning, and to identify factors associated with self-rated health among older South Africans.

Design

A national population-based cross-sectional survey, with a sample of 3,840 individuals aged 50 years and older, was completed in South Africa in 2008. Self-reported ratings of overall health and functioning were measured using a single self-reported health state covering nine health domains (used to generate the Study on Global Ageing and Adult Health (SAGE) composite health state score). Disability was measured using the World Health Organization Disability Assessment Schedule II (WHODAS-II) activities of daily living (ADLs), instrumental activities of daily living (IADLs), perceptions of well-being, and the World Health Organization Quality of Life index/metric (WHOQoL).

Results

Overall, more than three quarters (76.8%) of adults rated their health as moderate or good. On balance, men reported very good or good health more often than women (p<0.001). Older people (aged 70 years and above) reported significantly poorer health status than those aged 50–59 (adjusted odds ratio (AOR) 1.52; 95% confidence interval (CI) 1.00–2.30). Indians and Blacks were significantly more likely to report poorer health status at (AOR=4.01; 95% CI 1.27–12.70) and (AOR=0.42; 95% CI 0.18–0.98; 30 p <0.045), respectively, compared to Whites. Respondents with primary education (AOR=1.83; 95% CI 1.19–2.80) and less than primary education (AOR=1.94; 95% CI 1.37–2.76) were more likely to report poorer health compared to those with secondary education. In terms of wealth status, those in low wealth quintile (AOR=2.02; 95% CI 1.14–3.57) and medium wealth quintile (AOR=1.47; 95% CI 1.01–2.13) were more likely to report poorer health status than those in high wealth quintile. Overall, the mean WHODAS-II score was 20%, suggesting a low level of disability. The mean WHOQoL score for females (Mean=51.5; SD=12.2) was comparable to that of males (Mean=49.1; SD=12.6).

Conclusions

The depreciation in health and daily functioning with increasing age is likely to increase demand for health care and other services as people grow older. There is a need for regular monitoring of the health status of older people to provide public health agencies with the data they need to assess, protect, and promote the health and well-being of older people.

Walking Ability and Its Relationship to Self-Rated Health in Later Life

This study investigated the relationship between self-assessed overall health (SRH) and walking ability among older adults (n = 239) gauged using three well-established measures of walking ability ("normal" and "fast" walking speeds, and perceived walking difficulty). Logistic regression models adjusted for health, behavioral, and sociodemographic variables were used to estimate the relationship between the three measures of walking ability and SRH. Walking ability was significantly associated with SRH; notably, only normal walking speed discriminated between participants in all three SRH comparisons (good versus poor/bad, good versus fair, or excellent versus good). Health care providers, family, and friends should be attentive to reduced walking speed or complaints about difficulty walking because these are harbingers of health decline.

Perceived motor ability and selection, optimization, and compensation: effects of age and institutionalization

The authors examined the mediation effect of the perceived motor ability (PMA) on the direct "effects" of age (third vs. fourth age) and residential status (institutionalized vs. communitarians) on selection, optimization, and compensation (SOC) strategies. With a non-probabilistic sample of 107 elders (Mdn = 80 years) from urban areas, and controlled for cognitive impairment and depression, the authors analysed the structural component of the path model with latent constructs that represents those relationships. This was made only after the structural validity of the constructs had been assured. Constructs were operationalized through the PMA questionnaire and a 16-item version of the SOC questionnaire. Only age had direct effects on the constructs: lower PMA and lower SOC of the elders in the fourth age. Authors also verified that the PMA mediation effect was partial.

Correlates of subjective health across the aging lifespan: understanding self-rated health in the oldest old

OBJECTIVES

To examine the determinants of self-rated health (SRH) in different age groups of older adults, including the oldest old.

METHODS

Variables assessing physical health, difficulty with self-care, depressive symptoms, and cognitive impairment were pooled and harmonized from three Australian longitudinal studies of ageing (N = 5,222). The association of these with SRH was examined in older adults aged 60 to 64 years, 65 to 74 years, 75 to 84 years, and 85 years and older.

RESULTS

SRH was not associated with cognitive impairment or difficulty with self-care in the oldest old, and its association with physical health was diminished compared with younger groups. Depression showed a significant relationship in all age groups, conferring an approximately fourfold increase in the likelihood of poorer SRH.

DISCUSSION

As old age progresses, self-reports of poor health become most closely related to psychological symptoms. This explains some of the paradoxes of past literature and offers important insights for health professionals working with the oldest old.

Estimates of prospective change in self-rated health in older people were biased owing to potential recalibration response shift

OBJECTIVE

Evidence shows that self-rated health (SRH) remains remarkably stable during aging. Individuals may change their conceptualization of health or revise their standard of good health when facing health decline. Although this "response shift" phenomenon is potentially beneficial to the individual, it also challenges comparison of SRH assessments over time. The present study investigates this response shift.

STUDY DESIGN AND SETTING

Data come from two waves (T1 and T2) of the Longitudinal Aging Study Amsterdam (N: 1,274; age: 55-89 years; mean follow-up: 3.6 years). Linear regression models were used for predicting SRH at T1 and T2. To capture changes in individual health standards, we administered a then-test at T2, asking respondents to retrospectively rate their health at T1 again.

RESULTS

No support was found for a changed conceptualization of SRH after health decline: predictive models for SRH at T1 and T2 were not significantly different. In the subgroup that reported identical SRH at T1 and T2, participants who experienced incident diseases were three times more likely to retrospectively overrate health at T1 with the then-test, suggesting that they had a lowered health standard.

CONCLUSION

Older people's concept of health remains stable when they encounter significant health problems, but they potentially lower their standard of good health over time.

Determinants of changes in self-rated health among Finnish war veterans: results from the Veteran Project 1992 and 2004 surveys

Self-rated health is a strong predictor of mortality, morbidity, future functional capacity and the quality of life. Measures of self-rated health have been collected fairly regularly since the 1980s, but few of them focus on self-rated health among the elderly war veterans. The aim of this study was to examine changes in self-rated health among Finnish war veterans from 1992 to 2004 and to analyze the independent determinants associated with changes in veterans' self-rated health. The study population was 4999 veterans living in Finland, who participated in data collection of both the Veteran Project 1992 and 2004. Logistic regression models were used to identify independent predictors for changes in self-rated health. Analyses were conducted separately for men with and without disability and for women. During the follow-up, self-rated health improved or remained unchanged among 88.8% of the men without disability, 90.5% of the men with disability and 87.9% of the women. Determinants for declined self-rated health were a new cardiovascular disease (CVD) among all veteran groups, increased walking difficulties among men without disability and women, a new neurological disease and institutionalization among men without disability, and a new musculoskeletal disease among men with disability. In conclusion, the majority of veterans rated their health improved or unchanged during the follow-up. The importance of mobility impairments and cardiovascular, musculoskeletal and neurological diseases as the predictors of declined self-rated health were confirmed.

An Interaction Effect of Leisure Self-determination and Leisure Competence on Older Adults’ Self-rated Health

This study examined whether there was an interaction effect of leisure self-determination and leisure competence on older adults’ self-rated health (SRH), controlling for self-efficacy. Three hundred eighty-nine older adults living in Keelung City, Taiwan were systematically selected as participants. Data were collected by a face-to-face questionnaire survey which included measures of self-efficacy, leisure self-determination, leisure competence, and SRH scales. The data were analyzed using multiple regression analysis. The results showed a significant reinforcement interaction effect of leisure self-determination and leisure competence on SRH among the participants after controlling for self-efficacy. Implications of the results are further discussed.

The Relationship between Physical Health and Psychological Well-Being among Oldest-Old Adults

The purpose of this study was to evaluate the relationship between physical health and psychological well-being among oldest-old adults. Structural equation modeling was performed to examine health influences on psychological well-being among 306 octogenarians and centenarians from the Georgia Centenarian Study. Latent variables were created to reflect subjective health, as measured by self-ratings of health and objective health, as measured by physical health impairment (i.e., health problems, past and present diseases, hospitalization) and biomarkers (i.e., hemoglobin and albumin). Psychological well-being was measured by positive and negative affect. There were significant direct effects of subjective health on affect and significant indirect effects of objective health through subjective health on positive affect and negative affect. Subjective health took the role of a mediator between objective health and psychological well-being. These results highlight the status and perceptions of health as a critical indicator for well-being in extreme old age.

Self-rated health among persons with spinal cord injury: what is the role of physical ability?

OBJECTIVES

Self-rated health (SRH) is a powerful concept that has greatly advanced our understanding of health and health outcomes. The SRH measure has become increasingly common in health research. Yet, puzzles remain about what shapes SRH ratings. The absence of knowledge is particularly acute in the context of disability. The aim of this study was to examine the relationship between SRH and self-rated physical ability in a sample of individuals with spinal cord injury (SCI).

METHODS

Data from 140 eligible participants drawn from a study of life in the community after SCI were analyzed. The study, cross-sectional in design, was conducted in a large urban city in the mid-western United States. Basic statistics such as ANOVA and chi-square tests were performed as appropriate, and a multiple linear regression analysis modeled the relationship between SRH and physical ability adjusting for potential confounding variables.

RESULTS

Self-rated physical ability was significantly associated with SRH after controlling for relevant covariates (P < 0.001). An analysis of the interaction between physical ability and level of injury revealed that the relationship was significant for persons with paraplegia but not for persons with tetraplegia.

CONCLUSIONS

This study provides evidence that self-rated physical ability is an important factor associated with SRH for persons with SCI, but that the strength of the relationship depends on level of injury (paraplegia vs. tetraplegia). The challenge for future research is to replicate the study using a more comprehensive measure of physical ability and to ask how beliefs in one's ability to do those activities that are most meaningful and desired shape SRH. Only in this way will our understanding of the physical ability-SRH relationship be clarified.

Self-assessed disability and self-rated health among rural villagers in Peru: a brief report

CONTEXT

Risks for poor self-rated overall health in rural areas of developing nations have not been thoroughly investigated.

PURPOSE

The objective of this study was to assess potential risk factors for poor self-rated health among rural villagers in Peru.

METHODS

A door-to-door survey of villagers residing in the Pampas Grande region in Peru, which is in the Andes Mountains, yielded complete data for 337 adults.

FINDINGS

Adjusting for age and gender using multiple logistic regression analysis revealed that having self-reported disabilities was inversely and independently related to good self-rated health (OR 0.48 [95% CI, 0.26-0.88]). Joint pain also was related to self-rated health (OR 0.23 [95% CI, 0.13-0.41]).

CONCLUSIONS

Increasing access to affordable, effective analgesics may reduce this disparity. Health agencies should consider these actions as possible planning priorities for the region.

Self-rated health among spinal cord injury survivors: directions for future research

Aim:

This study was conducted to further the understanding of self-rated health (SRH) in persons with spinal cord injury (SCI).

Methods:

A review of the literature identified four published studies and the National Spinal Cord Injury Statistical Center (NSCISC) database that have evaluated SRH in persons with SCI. This article discusses the SRH findings across the studies and the NSCISC database, and compares these to the broader SRH literature.

Findings:

People with SCI do not rate their health very differently from able-bodied persons and, for the most part, rate their health positively. SRH ratings for persons with SCI may be inextricably linked to age and secondary conditions.

Conclusions:

The analysis suggests that SRH as a concept has been underused in studies with people with SCI. Given the literature that points to the power of SRH to predict many important health outcomes, the authors urge greater consideration of the SRH measure in disability and rehabilitation research and suggest directions for conceptual and measurement development.

Health and Happiness for Elderly Institutionalized Canadians

Cette étude explore les facteurs déterminants de l'autoévaluation de la santé et du bonheur chez les aîné(e)s vivant en établissement d'après l'Enquête nationale sur la santé de la population de 1994/95. On a établi des modèles distincts de régression de logistique ordinale pour l'autoévaluation de la santé et du bonheur dans un sous-échantillonnage de 780 aîné(e)s vivant en établissement. Les résultats indiquent que les aîné(e)s canadien(ne)s vivant en établissement évaluent leur santé et leur bonheur à divers degrés et que l'on peut prédire les variations en fonction des caractéristiques démographiques, des facteurs de maladie, de l'invalidité et de l'intégration sociale. Une évaluation positive de la santé et du bonheur est toujours associée à un plus grand âge, à un degré réduit de maladie chronique, à un faible degré perçu de difficultés de mémoire et à moins de douleur. Alors que la bonne santé se joint à un plus grand degré d'instruction et de liberté de déplacement, le bonheur se relie à un meilleur réflexe d'agrippement, à une plus forte fréquentation des activités communes de l'établissement et de la communauté et à un horaire plus flexible. Ces résultats entraînent des conséquences importantes puisque plusieurs des facteurs relevés peuvent être modifiés par des programmes de rééducation ou des interventions infirmières.

Self-rated health status transition and long-term care need, of the oldest Chinese

OBJECTIVES

The objectives of this paper are: (1) to estimate the transition probabilities among self-rated health status for the oldest Chinese aged 80 and above; (2) to project the future need of long-term care due to changes in demography and health status among the oldest Chinese.

METHODS

Self-rated health data collected in Chinese Longitudinal Healthy Longevity Survey conducted in 1998, 2000 and 2002 were used to estimate the self-rated health status transition probabilities, and to project future long-term care need by calculating the number of unhealthy person-years.

RESULTS

The majority of the oldest Chinese's health status remains unchanged or worsens within 2 years. The number of unhealthy person-years rises regardless of gender, and the absolute number and increase rate of females are higher than those of males. Under the assumption that average care expenditure is 15 US dollars per hour in 2010, the long-term care expenditure will increase from 8352 million dollars in 2010 to 42,530 million dollars in 2050, a growth of more than 400% over the next 40 years.

CONCLUSIONS

Long-term care need for the oldest Chinese will rise rapidly in the next decades, which should stimulate increased governmental and public awareness of their need.

The interaction of obesity and psychological distress on disability

BACKGROUND

Prior research has shown that psychological problems interact with various chronic medical conditions to amplify disability, but no study has investigated this effect in obesity. The aim of this study was to evaluate the synergistic interaction of psychological distress and obesity on functional disability in an adult community sample.

METHODS

Cross-sectional data were obtained from the 2005 Canadian Community Health Survey, a nationally representative sample of 53,416 respondents aged 18 years or older. Our outcome measures were self-reported disability days and self-rated health. Our covariates of interest were non-specific psychological distress (Kessler K10 scale) and body mass index (BMI). Odds ratios of disability measures were estimated by psychological distress and weight status from logistic regressions, adjusted for sociodemographic and clinical variables.

RESULTS

Disability status was more frequent in individuals with obesity and psychological distress than in those with either obesity or psychological distress alone. Adjusted odds ratios increased progressively across BMI and psychological distress categories. Significant interactions were found for (a) obesity class I (BMI between 30.0 and 34.9 kg m(-2)) and high psychological distress; and (b) obesity class II-III (BMI > 35 kg m(-2)) and moderate to high distress.

CONCLUSION

The results suggest a strong association between psychological distress, obesity and disability. Addressing psychological distress in obese individuals might reduce the public health burden of comorbid obesity and psychological distress by tackling disability.

Relationship between dynamic balance measures and functional performance in community-dwelling elderly people

BACKGROUND

Poor balance control, mobility restrictions, and fall injuries are serious problems for many older adults.

OBJECTIVE

The purpose of this study was to evaluate a new dynamic standing balance assessment test for identifying individuals at risk for falling in a group of community-dwelling older adults.

DESIGN

This was a cross-sectional observational study of 72 community-dwelling older adults who were receiving rehabilitation in a geriatric day hospital.

METHOD

A Dynamic Balance Assessment (DBA) test protocol was developed based on the concept of the Sensory Organization Test and the Clinical Test of Sensory Interaction and Balance. The DBA consists of 6 tasks performed on a normal floor surface and repeated on a sponge surface. A flexible pressure mat was used to record the foot's center of pressure (COP) on both surfaces, and loss of balance was recorded. Balance performance also was evaluated using the Berg Balance Scale, the Timed "Up & Go" Test, gait speed, and the Six-Minute Walk Test. Participants were classified as "fallers" or "nonfallers" based on a self-report.

RESULTS

No significant differences were noted between the faller group (n=47) and the nonfaller group (n=25) for demographic variables or medications. The DBA composite scores, which were derived from analysis of COP excursions of the 6 tasks performed on the sponge surface, were able to distinguish between fallers and nonfallers. Of the clinical tests, only the Timed "Up & Go" Test was able to differentiate between the faller and nonfaller groups. Limitations A prospective study is needed to confirm the current findings and to expand testing to a larger and more diverse sample.

CONCLUSIONS

The findings indicate that analysis of the extent and amount of COP displacements during selected tasks and under different surface conditions is an appropriate method to assess dynamic standing balance controls and can discriminate between fallers and nonfallers among community-dwelling elderly people.

A pilot study on perceived stress and PTSD symptomatology in relation to four dimensions of older women's physical health

OBJECTIVES

The authors examined whether selected demographic and psychological factors would predict physical health dimensions in a sample of 53 cognitively high-functioning and ethnically diverse women (age 65-105 years).

METHOD

Predictors encompassed posttraumatic stress disorder (PTSD) symptomatology and perceived stress (of a nontraumatic nature and beyond health status) in relation to four dimensions of physical health. Age and income, well-known correlates of health in the target population, were included as potential predictors. The authors first tested the relationship between potential predictors and health dimensions via a canonical correlation analysis, and then employed full multiple regression analyses to simultaneously test the predictors in each health dimension model.

RESULTS

Perceived stress was a significant predictor of lower levels of general health (GH), but not of physical role limitations or physical functioning (PF). Conversely, PTSD symptomatology predicted more limitations in role fulfillment (and, to a lesser extent, impaired PF), but not lower levels of GH. As expected, age and income were predictive of some physical health dimensions. The hypothesized predictors failed to account for a significant portion of variance in pain scores.

CONCLUSION

PTSD symptomatology and perceived stress might influence older women's physical health dimensions differentially; additional research on larger samples is needed to corroborate these findings.

Later-Life Career Disruption and Self-Rated Health: An Analysis of General Social Survey Data

The transition from employment to retirement is changing dramatically in Canada and other industrialized societies, with a decreasing proportion of working life being spent in stable career progression. This study used a sample of 2,592 subjects, aged 45 to 64, from the 1994 General Social Survey of Canada (GSS): Cycle 9, to describe situations of later-life career disruption (LLCD) in older workers in Canada and to investigate the association between LLCD and self-rated health. Results showed that a large proportion of older Canadian workers had experienced such LLCD as job interruption and job loss. Experience of job loss and job interruption over the prior 5-year period was found to be significantly associated with poor self-rated health, after controlling for age, education, body mass index, and activity limitation. However, after excluding respondents whose LLCD was known to be due to poor health, job interruption and job loss were separately found not to be significantly associated with poor health. The complexity of the findings and the direction of causation between LLCD and self-rated health, as well as some methodology issues, are discussed. Areas of future research are indicated.

Health Status of Older Immigrants to Canada

Using the 2000/2001 Canadian Community Health Survey (CCHS), this paper examines the health status of the older (aged 55+) immigrant population relative to that of non-immigrants in order to identify areas where their health statuses diverge. First, we compare the health status of older immigrants (foreign-born) aged 55 and over in Canada to the Canadian-born in terms of age and gender using multiple measures of health status including self-assessed health. Second, we identify the factors associated with health status using the determinants of health framework. In both cases, the key questions are whether differences in health status exist and whether they are explained primarily by socio-economic, socio-demographic, or lifestyle factors that may point to problems with the Canadian health care system. Findings indicate that there is a relative comparability in the health status of older immigrants, even after controlling for age.

A pilot study on perceived stress and PTSD symptomatology in relation to four dimensions of older women's physical health

OBJECTIVES

The authors examined whether selected demographic and psychological factors would predict physical health dimensions in a sample of 53 cognitively high-functioning and ethnically diverse women (age 65-105).

METHOD

Predictors encompassed posttraumatic stress disorder (PTSD) symptomatology and perceived stress (of a nontraumatic nature and beyond health status) in relation to all dimensions of physical health of the Medical Outcome Study 36-item Short Form Health Survey (MOS SF-36); (Ware, J.E., & Sherbourne, C.D., 1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473-483). Age and income, well-known correlates of health in the target population, were included as potential predictors. The authors first tested the relationship between potential predictors and health dimensions via a canonical correlation analysis, and then employed full multiple regression analyses to simultaneously test the predictors in each health dimension model.

RESULTS

Perceived stress was a significant predictor of lower levels of general health (GH), but not of role limitations or physical functioning (PF). Conversely, PTSD symptomatology predicted more limitations in role fulfillment (and, to a lesser extent, impaired PF), but not lower levels of GH. As expected, age and income were predictive of some physical health dimensions. The hypothesized predictors failed to account for a significant portion of variance in pain scores.

CONCLUSION

PTSD symptomatology and perceived stress might influence older women's physical health dimensions differentially; additional research on larger samples is needed to corroborate these findings.

Individual well-being in middle and older adulthood: do spousal beliefs matter?

Associations between health, control beliefs, and well-being in later life are frequently conceptualized in terms of the characteristics of individuals. However, spousal interdependencies in psychosocial characteristics are also likely to be relevant for well-being. The present study investigated associations of self-rated health, control, and relationship closeness with life satisfaction and positive and negative affect in a sample of 2,235 spousal dyads. A significant proportion of variance in health, control, closeness, and well-being occurred between dyads. Individuals' self-rated health, control, and relationship closeness were associated with higher well-being. Spouses' self-rated health and control beliefs were consistently and positively associated with individuals' well-being; however, effect sizes were small. Some evidence for individual's control beliefs buffering the association between health and well-being emerged, whereas spouses' perceived control was not a significant moderator of the health-well-being association. Results highlight the importance of couple interdependencies for contextualizing health and well-being in older adulthood.