Validity and reliability of self-reported health of persons aged 70 and older

Social networks as a protective factor for worsened self-perceived health status related to self-perceived changes in loneliness and health conditions in adults aged 50+ during the COVID-19 outbreak

The coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, leading millions of people to change their lifestyles, especially older individuals who are the most at-risk population. Social isolation, the main preventive action to slow the pandemic's spread, reduced and drastically limited social connections, increasing older individuals' loneliness and stress, and worsening their health. We examined the connection between self-perceived changes in loneliness, the existence and type of social contact (face-to-face/electronic), and health conditions on self-perceived changes in health status during the outbreak, analyzing 51,778 individuals aged 50 plus from the Survey of Health, Ageing and Retirement in Europe (SHARE) database Wave 8 beta (June-August 2020). We found that the odds for worsened self-perceived health status were 249% higher among individuals who reported increased loneliness compared to the non-increase group and were lower in individuals with face-to-face contact (31%) or electronic contact (54%) during the outbreak. In addition, the odds for worsened self-perceived health status were higher for individuals with hypertension (17%), cancer (19%), chronic lung disease (25%), heart problems (27%), and other illnesses (32%). Based on the results obtained, electronic contact has shown a stronger connection as a protective factor for worsened self-perceived health since the outbreak compared to face-to-face interactions. Thus, adopting a policy that encourages the usage of electronic communications could reduce the burden on the healthcare system, particularly during pandemics, while improving patient health outcomes and minimizing pandemic-related health risks. This approach is especially important for older individuals, for whom any departure from home can cause an additional risk of exposure to the virus.

Reliability and predictive validity of two scales of self-rated health in China: results from China Health and Retirement Longitudinal Study (CHARLS)

Background

Despite the widespread use of the single item self-rated health (SRH) question, its reliability has never been evaluated in Chinese population.

Methods

We used data from the China Health and Retirement Longitudinal Study, waves 1–4 (2011–2019). In wave 1, the same SRH question was asked twice, separated by other questions, on a subset of 4533 subjects, allowing us to examine the test–retest reliability of SRH. In addition, two versions of SRH questions (the WHO and US versions) were asked (n = 11,429). Kappa (κ), weighted kappa (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\kappa}_{w}$$\end{document}κw), and polychoric correlation coefficient (ρ) were used for reliability assessment. Cox proportional-hazards models were estimated to assess the predictive validity of SRH measurement for mortality over 7 years of follow up. To do so, relative index of inequality (RII) and slope index of inequality (SII) were estimated for each SRH scale.

Results

There was moderate to substantial test–retest reliability (κ = 0.54, \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\kappa}_{w}$$\end{document}κw=0.63) of SRH; 31% of respondents who used the same scale twice changed their ratings after answering other questions. There was strong positive association between the two SRH measured by the two scales (ρ > 0.8). Compared with excellent/very good SRH, adjusted hazard ratios (HR) of death are 2.30 (95% CI, 1.70–3.13) for the US version and 1.86 (95% CI, 1.33–2.60) for the WHO version. Using slope indices of inequality, the WHO version estimated slightly larger mortality differences (RII = 3.50, SII = 15.53) than the US version (RII = 3.25, SII = 14.80).

Conclusions

In Chinese middle-aged and older population, the reliability of SRH is generally good, although the two commonly used versions of SRH scales could not be compared directly. Both indices predict mortality, with similar predictive validity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14218-1.

Association of multi-morbidity, social participation, functional and mental health with the self-rated health of middle-aged and older adults in India: a study based on LASI wave-1

Self-rated health (SRH) is a well-established measure in public health to administer the general health of an individual. It can also be used to assess overall health status’ relationship with the social, physical, and mental health of a person. In this study, we examine the association of SRH and various socio-economic & health-related factors such as multi-morbidity status, mental health, functional health, and social participation. Data used in this paper is collated from the first wave of Longitudinal Ageing Study in India (LASI) 2017-18. A total of 65,562 older adults aged 45 or above are considered in our study. Various indices (multimorbidity, social participation, functional and mental health) have been created to measure factors influencing the SRH of an individual. Overall, in the study population, around 18.4% of people reported poor SRH. Dominance Analysis results show that the contribution of multimorbidity in predicting poor SRH is highest, followed by functional health, mental health, and social participation. In a developing country like India, there is a dire need for policies having a holistic approach regarding the health and well-being of the older population.

Lack of Social Support and Its Role on Self-Perceived Health in a Representative Sample of Spanish Adults. Another Aspect of Gender Inequality

Self-perceived health has been used as a good estimator of health status and receiving affection can be a determining factor for good self-perceived health. The aim of the present study was to assess whether lack of social support (measured through Duke scale, which ranges from 11 to 55) was associated with poorer health status measured as self-perceived health, and whether that association was different between women and men. A cross-sectional study was conducted using data from the 2017 Spanish National Health Survey. A descriptive study was performed, and logistic regression models were applied using self-perceived health as a dependent variable. Mean Duke score was 47.6 for men and 47.9 for women (p = 0.016). Moreover, 36.3% of women and 27.6% of men reported poor self-perceived health (p < 0.001). The multivariate analysis revealed that lower scores in Duke-UNC social support scale were associated with poorer health status. That association was higher in women than in men. Poor self-perceived health was also associated with low level of education and obesity, especially among women. There was gender inequality as regards health status associated with lack of social support. These results can help design prevention strategies to improve health.

Age-Friendly Features in Home and Community and the Self-Reported Health and Functional Limitation of Older Adults: the Role of Supportive Environments

This study aims to identify age-friendly community features that are associated with better health for older adults. This cross-sectional study utilized the 2015 AARP Age-Friendly Communities (AFC) Survey, which includes 66 home and community features that fall within the eight domains specified by the World Health Organization (WHO)'s age-friendly cities guidelines. Two measures of health (self-rated health and functional limitations) were examined using multi-level linear and logistic regressions. Both a greater perceived availability of age-friendly features in communities and a good person-environment fit were associated with better self-rated health and a lower likelihood of reporting functional limitations. The domains of outdoor spaces and buildings, transportation, and social participation and inclusion were consistently associated with these outcomes. Promoting age-friendliness in outdoor spaces and buildings, transportation, and social participation and inclusion domains by providing green spaces, neighborhood safety programs, transportation options, and social opportunities may be the most effective way to support healthy and active aging.

Do Welfare Regimes Moderate Cumulative Dis/advantages Over the Life Course? Cross-National Evidence from Longitudinal SHARE Data

OBJECTIVES

This study aimed to examine the cumulative disadvantage of different forms of childhood misfortune and adult-life socioeconomic conditions (SEC) with regard to trajectories and levels of self-rated health in old age and whether these associations differed between welfare regimes (Scandinavian, Bismarckian, Southern European, and Eastern European).

METHOD

The study included 24,004 respondents aged 50-96 from the longitudinal SHARE survey. Childhood misfortune included childhood SEC, adverse childhood experiences, and adverse childhood health experiences. Adult-life SEC consisted of education, main occupational position, and financial strain. We analyzed associations with poor self-rated health using confounder-adjusted mixed-effects logistic regression models for the complete sample and stratified by welfare regime.

RESULTS

Disadvantaged respondents in terms of childhood misfortune and adult-life SEC had a higher risk of poor self-rated health at age 50. However, differences narrowed with aging between adverse-childhood-health-experiences categories (driven by Southern and Eastern European welfare regimes), categories of education (driven by Bismarckian welfare regime), and main occupational position (driven by Scandinavian welfare regime).

DISCUSSION

Our research did not find evidence of cumulative disadvantage with aging in the studied life-course characteristics and age range. Instead, trajectories showed narrowing differences with differing patterns across welfare regimes.

[Socioeconomic inequalities in health among the elderly population in Spain]

OBJECTIVE

To examine socioeconomic inequalities in health in the older population in Spain.

METHOD

A systematic search and review of the literature published between 2000 and 2017 in English and Spanish was conducted in Social Science Citation Index, Sociology Database, Scopus, PubMed and Embase. Primary and secondary studies analysing these inequalities in Spain were included. Two researchers were responsible for the selection of the studies and the extraction of the information (first author, year of publication, region, design, population/sample, socioeconomic and health indicators used, and main results).

RESULTS

A total of 89 articles were included, corresponding to 87 studies. Of the studies, 81.6% were cross-sectional, 88.5% included only non-institutionalised population and 35.6% were carried out at a national level. The studies analysed social inequalities in the following health indicators: functional status (n=29), morbidity (n=19), self-perceived health (n=18), mental and emotional health (n=10), cognitive status (n=7), quality of life (n=9), mortality (n=15) and life expectancy (n=2). Socioeconomic inequalities were detected in all of them, although the magnitude varied depending on the socioeconomic and health indicator used. The educational level and the ecological indexes were the indicators that detected more inequalities in health. The impact of inequalities by sex was different in functional status, morbidity, self-perceived health, mental and emotional health and mortality.

CONCLUSION

There are socioeconomic inequalities in health among the elderly population and their magnitude varies by sex in some of the health indicators. The increase in educational level and the maintenance of sufficient pensions can be key policies that contribute to the reduction of inequalities in this population group.

Correlates of Poor Self-Assessed Health Status among Socially Disadvantaged Populations in Poland

Self-assessment of health is recommended as valuable source of information about subjective health status. The present study was performed to evaluate the correlates of self-rated health status among beneficiaries of social care in Poland. This assessment could be crucial for the implementation of targeted preventive measures among this valuable population. The study population consisted of 1710 beneficiaries of social care from the Piotrkowski District. The relationship between self-rated health status and its correlates (sociodemographic, lifestyle factors, and health conditions) was examined using logistic regression, with a poor health rating as the outcome. Overall, 11% of respondents declared poor self-assessed health status. Men more often rated health status as poor (15%) as compared to women (8.5%) (p < 0.001). The odds of a poor assessment of health increased with age, being unemployed or disabled/retired (OR = 2.34 95%CI (1.34–4.19) or OR = 9.07 95%CI (3.68–22.37), respectively), and additionally with poor life satisfaction (OR = 5.14 95% CI (1.94–13.64)). Regarding lifestyle characteristics, only binge drinking was associated with poor health status assessment (OR = 12.62 95%CI (3.71–42.87)). In addition, having any illness or health problems decreased health status (OR = 4.26 95%CI (1.36–13.31)). Socially-disadvantaged populations, especially men who poorly rated their health status, still constituted a large percentage of the population, which is an important public health problem. Increasing knowledge about the correlates of health status will allow greater prevention strategies to be developed for the population.

Impact of a Knowledge Translation Intervention on Physical Activity and Mobility in Older Adults (the Move4Age Study): Randomized Controlled Trial

Background

The McMaster Optimal Aging Portal (the Portal) was launched in 2014 as a knowledge translation (KT) tool to increase access to evidence-based health information.

Objective

The purpose of this study was to understand if and how dissemination of mobility information through the Portal impacts physical activity (PA) in older adults.

Methods

In this randomized controlled trial, participants (n=510) were assigned to a 12-week mobility-focused KT intervention or self-serve control group. The intervention included weekly email alerts and a study-specific social media hashtag linking to mobility-focused Portal materials. The control group was able to access the Portal on their own but did not receive targeted KT strategies. Participants completed questionnaires (including the Rapid Assessment of Physical Activity to quantify PA) at baseline, end of the study, and 3-month follow-up.

Results

Participants were predominantly female (430/510, 84.3%), mean age 64.7 years, with no baseline differences between groups. Over half (277/510, 54.3%) of the participants were classified as “active” at baseline. There was no significant between-group difference in the PA category. Overall, both groups increased their PA with improvements maintained at 3-month follow-up (P<.001). In planned subgroup analyses, the KT intervention had a significant effect for those with poor or fair baseline self-rated health (P=.03).

Conclusions

No differences were found between those who received the targeted intervention and a control group with self-serve access to the Portal, except in subgroups with low self-rated health. Both groups did report increases in PA that were sustained beyond participation in a research study. Findings suggest that different KT strategies may be needed for different types of users, with more intense interventions being most impactful for certain groups (ie, those with lower self-rated health).

Trial Registration

ClinicalTrials.gov NCT02947230; https://clinicaltrials.gov/ct2/show/NCT02947230

Is the single self-rated health item reliable in India? A construct validity study

Introduction

In high-income countries, the self-rated health (SRH) item is used in health surveys to capture the population’s general health because of its simplicity and satisfactory validity and reliability. Despite scepticism about its use in low-income and middle-income countries, India implemented the SRH item in many of its demographic and population health surveys, but evidence of its validity is lacking. The objective was to assess the construct validity of the SRH item in India.

Methods

Data for 4492 men and 4736 women from the Indian sample of the World Health Survey (2003) were used. Overall, 43 health status indicators were grouped into health dimensions (physical, mental and functional health, chronic diseases, health behaviours) and the SRH item was regressed on these indicators by using sex-stratified multivariable linear regressions, adjusted with demographic and socioeconomic variables.

Results

Respondents (participation rate 95.6%; mean age 38.9 years) rated their health as very good (21.8%), good (36.4%), moderate (26.6%), bad (13.2%) or very bad (2.0%). Among men, the adjusted explained SRH variance by health dimensions ranged between 18% and 41% (physical 33%, mental 32%, functional health 41%, chronic diseases 23%, health behaviours 18%). In multivariable models, the overall explained variance increased to 45%. The 43 health status indicators were associated with SRH and their effect sizes were in the expected direction. Among women, results were similar (overall explained variance 48%).

Conclusion

The SRH item has satisfactory construct validity and may be used to monitor health status in demographic and population health surveys of India.

Gender and the structure of self-rated health across the adult life span

Despite the widespread use of self-rated health (SRH) in population health studies, the meaning of this holistic health judgment remains an open question. Gender differences in health, an issue of utmost importance in population research and policy, are often measured with SRH; the comparisons could be biased if men and women differ in how they form their health judgment. The aim of this study is to examine whether men and women differ in how health inputs predict their health rating across the adult life span. We use the 2002-2015 National Health Interview Survey data from US-born respondents aged 25-84. Ordered logistic models of SRH as a function of 24 health measures including medical conditions and symptoms, mental health, functioning, health care utilization, and health behaviors, all interacted with gender, test how the measures influence health ratings and the extent to which these influences differ by gender. Using a Bayesian approach, we then compare how closely a select health measure (K6 score) corresponds to SRH levels among men and women. We find little systematic gender difference in the structure of SRH: men and women use wide-ranging health-related frames of reference in a similar way when making health judgments, with some exceptions: mid-life and older men weigh physical functioning deficits and negative health behaviors more heavily than women. Women report worse SRH than men on average but this only holds through mid-adulthood and is reversed at older ages; moreover, the female disadvantage disappears when differences in socio-economic and health covariates are considered. Our findings suggest that the meaning of SRH is similar for women and men. Both groups use a broad range of health-related information in forming their health judgment. This conclusion strengthens the validity of SRH in measuring gender differences in health.

Determinants of self-perceived health for Canadians aged 40 and older and policy implications

BACKGROUND

Perceived health status indicates people's overall perception of their health, including both physical and psychological dimensions. The aim of this study was to examine the determinants of self-perceived health for Canadians aged 40 and older using data from the Canadian Community Health Survey (2010).

METHODS

Multiple logistic regression models were employed to identify factors associated with self-perceived health in two age groups: Adults aged 65+ and Adults aged 40-64.

RESULTS

We found that higher income was significantly associated with better health status while chronic conditions and stress were associated with worse health status. In the 40-64 and 65+ age groups, individuals in the highest income bracket were 4.65 and 1.94 times, respectively, more likely to report better health than individuals in the lowest income bracket. The difference in the level of income associated health inequities between the two age groups point to the need for understanding the reasons behind lower inequities among seniors and how much the social protections provided by the Canadian government to seniors contribute to lowering inequities.

CONCLUSIONS

Though Canada has a national public health insurance system providing coverage to all Canadians, health inequities associated with income persist providing further evidence of the importance of the social determinants of health. Examining the extent of these inequities and what factors influence them helps direct policy attention. In addition to documenting inequities, this paper discusses policy options for reducing the identified inequities.

Determinants of self-perceived health for Canadians aged 40 and older and policy implications

BACKGROUND

Perceived health status indicates people's overall perception of their health, including both physical and psychological dimensions. The aim of this study was to examine the determinants of self-perceived health for Canadians aged 40 and older using data from the Canadian Community Health Survey (2010).

METHODS

Multiple logistic regression models were employed to identify factors associated with self-perceived health in two age groups: Adults aged 65+ and Adults aged 40-64.

RESULTS

We found that higher income was significantly associated with better health status while chronic conditions and stress were associated with worse health status. In the 40-64 and 65+ age groups, individuals in the highest income bracket were 4.65 and 1.94 times, respectively, more likely to report better health than individuals in the lowest income bracket. The difference in the level of income associated health inequities between the two age groups point to the need for understanding the reasons behind lower inequities among seniors and how much the social protections provided by the Canadian government to seniors contribute to lowering inequities.

CONCLUSIONS

Though Canada has a national public health insurance system providing coverage to all Canadians, health inequities associated with income persist providing further evidence of the importance of the social determinants of health. Examining the extent of these inequities and what factors influence them helps direct policy attention. In addition to documenting inequities, this paper discusses policy options for reducing the identified inequities.

Variables Predictive of Poor Postdischarge Outcomes for Hospitalized Elders in Heart Failure

Heart failure (HF) affects more than one million older Americans. As the population ages, the incidence of HF will increase. The purpose of this study was to identify variables that profile elders hospitalized with HF who are at high risk for poor postdischarge outcomes. A total of 103 patients were enrolled in the study. A low serum sodium and a fair or poor self-reported health status predicted all-cause readmission. A low serum sodium predicted HF-related readmissions. Four or more HF symptoms and index admission to an urban hospital predicted physician office visits. Admission to a community hospital predicted emergency department visits, and the number of coexisting medical conditions indicated an increased risk for an emergency department visit. The findings indicate that it is possible to profile hospitalized elders with HF who are at risk for poor postdischarge outcomes.

Self-perceived health in functionally independent older people: associated factors

Background

Self-perceived health (SPH) is a powerful indicator of the health status of elderly people. This issue has been widely studied in oldest populations considering altogether functionally independent and dependent individuals. The objective of this study was to describe SPH and to identify the main factors that have an impact on SPH in a sample of functionally independent community-dwelling older adults.

Methods

For this cross-sectional study, face-to-face interviews were carried out with non-institutionalized functionally independent older individuals in a northern region of Spain. Participants were asked: “Overall, you would say that your health is excellent, very good, good, fair or poor?”. SPH responses were grouped in two categories: good and poor. Binary logistic regression was used to identify factors associated with poor SPH.

Results

A sample of 634 individuals was studied, of whom 55 % were women. The mean age was 74.8 (SD 6.7) years. About 18 % of the respondents rated their health as poor. In the multivariate model adjusted for age and sex, reported poor health was significantly associated with polypharmacy (≥3 drugs per day) (OR: 5.76, 95 % CI: 3.60–9.18), the presence of sensory impairment (OR: 1.87, 95 % CI: 1.15–3.04), bad sleep quality (OR:1.82, 95 % CI: 1.02–3.28), a bad nutrition pattern (OR: 2.37, 95 % CI: 1.08–5.21), not engaging in cognitively stimulating activities (OR: 4.08, 95 % CI: 1.64–10.20), or group social activities (OR: 2.62, 95 % CI: 1.63–4.23).

Conclusions

The study indicates that several health and social variables are strongly related to SPH in independent community-dwelling older adults. This finding highlights the need for thorough assessment of factors related to SPH in older independent adults, this being essential to develop health-related programmes for promoting active and healthy ageing and to delay the onset of dependence in this population.

More attention to pain management in community-dwelling older persons with chronic musculoskeletal pain

BACKGROUND

persistent pain is a major problem in older people, but little is known about older persons' opinion about the treatment of persistent pain.

OBJECTIVE

the objective of this study was to investigate the factors associated with older participants having chronic musculoskeletal pain and hoping persistently that physician would pay more attention to the pain management.

METHODS

this 3-year follow-up study was a part of large population-based Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. The population sample (n = 1000) of the GeMS study was randomly selected from older inhabitants (≥75 years) of Kuopio city, Finland, and participants were interviewed annually in the municipal health centre or in the participant's current residence by three study nurses. The current substudy included participants with chronic musculoskeletal pain (n = 270). Participants were asked specifically whether they hoped that more attention would be paid to pain management by the physician.

RESULTS

at baseline, 41% of the community-dwelling older participants with chronic musculoskeletal pain hoped the physician would pay more attention to pain management. Of those participants, 49% were still continuing to hope after 1 year and 31% after 2 years. A persistent hope to receive more attention to pain management was associated with poor self-rated health (OR: 2.94; 95% CI: 1.04-8.30), moderate-to-severe pain (OR: 3.46; 95% CI: 1.42-8.44), and the daily use of analgesics (OR: 4.16; 95% CI: 1.08-16.09).

CONCLUSION

physicians need to take a more active role in the process of recognising, assessing and controlling persistent pain in older people.

Accelerometer-determined physical activity and self-reported health in a population of older adults (65-85 years): a cross-sectional study

Background

The link between physical activity (PA) and prevention of disease, maintenance of independence, and improved quality of life in older adults is supported by strong evidence. However, there is a lack of data on population levels in this regard, where PA level has been measured objectively. The main aims were therefore to assess the level of accelerometer-determined PA and to examine its associations with self-reported health in a population of Norwegian older adults (65–85 years).

Methods

This was a part of a national multicenter study. Participants for the initial study were randomly selected from the national population registry, and the current study included those of the initial sample aged 65–85 years. The ActiGraph GT1M accelerometer was used to measure PA for seven consecutive days. A questionnaire was used to register self-reported health. Univariate analysis of variance with Bonferroni adjustments were used for comparisons between multiple groups.

Results

A total of 560 participants had valid activity registrations. Mean age (SD) was 71.8 (5.6) years for women (n = 282) and 71.7 (5.2) years for men (n = 278). Overall PA level (cpm) differed considerably between the age groups where the oldest (80–85 y) displayed a 50% lower activity level compared to the youngest (65–70 y). No sex differences were observed in overall PA within each age group. Significantly more men spent time being sedentary (65–69 and 70–74 years) and achieved more minutes of moderate to vigorous PA (MVPA) (75–79 years) compared to women. Significantly more women (except for the oldest), spent more minutes of low-intensity PA compared to men. PA differed across levels of self-reported health and a 51% higher overall PA level was registered in those, with “very good health” compared to those with “poor/very poor health”.

Conclusion

Norwegian older adults PA levels differed by age. Overall, the elderly spent 66% of their time being sedentary and only 3% in MVPA. Twenty one percent of the participants fulfilled the current Norwegian PA recommendations. Overall PA levels were associated with self-reported health.

Predictors of Self-Reported Health Among Older African-American Central City Adults

Relationships between holistic factors and self-reports of health were examined. Ninety-two African-American older adults were sampled. Comorbid health conditions, higher pain intensity ratings, and more depressive symptoms were significantly related to lower self-rated health scores while age, marital status, education, and spiritual factors were not significantly related.

Factors Associated with Perceived Health of Very Old Inhabitants of Japan

BACKGROUND

Perceived health or self-rated subjective health of the oldest inhabitants of Japan was studied to identify its associated impact on their lives.

OBJECTIVE

The health status of the aged was evaluated to elucidate the correlation between their health complaints and perceived health status as expressed on a comprehensive rating scale.

METHODS

A health questionnaire including the Todai Health Index (THI) was applied to 529 inhabitants of Central Japan, aged 85 years or older. THI is a symptom checklist composed of 130 questions. Twelve scale scores and two discriminant function values were calculated. Response rate was 99.8% (528/529). Other items included sex, age, prevalence of chronic disease and its treatment, marital status, academic career, and friendship. A question 'How is your health?' with five ordinal response options was used to assess perceived health.

RESULTS

The mean values of THI scale scores of lie and aggression of poor (poor or extremely poor) perceived health were significantly lower than those of good (extremely good or good) perceived health. The mean values of other THI scale scores of poor perceived health except impulsiveness and nervousness in male subjects were significantly higher than those of good perceived health. Spearman's rank correlation coefficients between perceived health score and THI scale scores were all statistically significant. Furthermore, multiple logistic regression analysis was conducted to identify significant factors predicting perceived health. THI scale scores of physical symptoms, depressive state, and irregular daily life were significant. Odds ratios and 95% confidence intervals in parentheses on each factor were 1.15 (1.07-1.23), 1.14 (1.02-1.30), and 1.15 (1.02-1.30), respectively.

CONCLUSIONS

Poor perceived health was significantly associated with irregular lifestyle, physical and mental complaints. Perceived health reflects the health status of the oldest inhabitants of Japan.

Effects of teaching resourcefulness skills to elders

The objective of this study was to examine the effects of learned resourcefulness training (LRT) on health of elders in retirement communities (RCs). In a clinical trial, 46 elders in four randomly selected RCs received resourcefulness training and were compared to 43 elders in four RCs who participated in a focused reflection reminiscence (FRR) group. The two groups were similar at baseline. Repeated measures analysis of variance revealed no changes on anxiety or depression over time; however, both were significantly correlated with functional status (r's = 0.29 and 0.35, p's < 0.01), self-assessed health (r's = -0.18 and -0.26, p's < 0.05), and resourcefulness (r's = -0.24 and -0.21, p's < 0.05). Although main effects for group were not significant, interaction effects of group and time on self-assessed health and functional status were found. These findings suggest that although teaching resourcefulness to groups of elders in RCs may have beneficial effects on improving their perception of health and functioning over time, significant effects on mental health may not be apparent.

Self-reported health: reliability and consequences for health inequality measurement

Self-reported health (SRH) is one of the most frequently employed measures for assessing income-related health inequalities between counties. A previous study has shown that 28% of respondents changed their assessment of their health status when asked a SRH question on two occasions in the same survey (first as part of self-completed questionnaire and then in a personal interview). This study re-examines this issue using another survey where SRH was again asked twice of respondents, but this time the personal interview was first and self-completion second. We find the same variation in responses, but the predominant direction is away from the 'extreme' categories 'Excellent' and 'Poor' which is the opposite direction to the previous study. We therefore conclude that the most likely explanation is a mode of administration effect that makes people less likely to choose the extreme categories in a self-completion questionnaire, but not a personal interview. However, this effect has a relatively minor impact on measures of inequality. This is due to a large proportion of the movement (i.e. movement to the middle) not being related to income and hence does not systematically impact on the cumulative distribution of health across this measure of socio-economic status.

Correlates of subjective stress among drug court clients

Psychosocial stress is consistently found to promote initiation, intensification, and relapse in drug abuse. It would, therefore, be desirable to identify characteristics of offenders who are at heightened risk for stress-induced exacerbations of addictive behavior. In this cross-sectional, correlational, interview study, 500 clients of two Kentucky drug courts averaged 30 years of age and were predominantly male, White, employed, high school educated, single, and adjudicated in small- and medium-size cities. Five independent correlates of greater subjective stress emerged in stepwise multiple regression analysis (R2 = .395): use of escape-avoidance coping, positive reappraisal coping (inversely associated), more negative life events, better self-rated health (inversely associated), and access to social support related to work problems (inversely associated). Treatment interventions emphasizing effective coping styles and building of social support as well as managing of negative life events and perceptions of health may serve to lessen subjective stress and its consequences in drug-abusing criminal populations.

Older people specific health status and quality of life: a structured review of self-assessed instruments

OBJECTIVES

To review evidence relating to the measurement properties of older people specific self-assessed, multi-dimensional measures of health status.

DESIGN

Systematic literature searches to identify instruments. Pre-defined criteria relating to reliability, validity, responsiveness, precision and acceptability.

RESULTS

A total of 46 articles relating to 18 instruments met the inclusion criteria. Most evidence was found for the OARS Multidimensional Functional Assessment Questionnaire (OMFAQ), CARE, Functional Assessment Inventory (FAI) and Quality of Life Profile--Seniors Version (QOLPSV). Most instruments have been evaluated in single studies. Four instruments have evidence of internal consistency and test-retest reliability--LEIPAD, Philadelphia Geriatrics Centre Multilevel Assessment Inventory, Perceived Well-being Scale, Wellness Index (WI). Two instruments lack evidence of reliability--Brief Screening Questionnaire, Geriatric Quality of Life Questionnaire (GQLQ). Older people contributed to the content of the GQLQ, QOLPSV and WI. Most instruments were assessed for validity through comparisons with other instruments, global judgements of health, or clinical and socio-demographic variables. Limited evidence of responsiveness was found for five instruments--GQLQ, OMFAQ, PGCMAI, QOLPSV, Self-Evaluation of Life Scale (SELF).

CONCLUSION

Although most evidence was found for the OMFAQ this was largely for the ADL domain; evidence for reliability and responsiveness is limited. Limited evidence of reliability, validity and responsiveness was found for the PGCMAI, QOLPSV and SELF. The lack of evidence for measurement properties restricts instrument recommendation. Instrument content should be assessed for relevance before application and the concurrent evaluation of specific and widely used generic instruments is recommended. Several instruments, including the BSQ and EASY-Care, were developed recently and further evidence of instrument performance is required.

Exercise, Health, and Aging

The aims of this study were to examine the level of exercise among elderly people with regard to the current Norwegian recommendations, demographic correlates of exercise, and the relationship between exercise and subjective health among elderly men and women. A representative sample of 3,770 Norwegian men and women between 65 and 97 years of age (mean 75 years) completed a questionnaire. The response rate was 83.4 %. Results showed that 6 % of the participants exercise at the level recommended. The oldest old (>80 years), those who have an illness and use medication, and individuals with lower levels of education and income are the least active segments of the sample. After adjusting for age, marital status, income, and education, results showed that exercise at moderate intensity 3-4 days per week is a significant predictor for positive subjective health.

Seniors Say the `Darndest' Things about Exercise: Quotable Quotes that Stimulate Applied Gerontology

This review article highlights unusual narrative elements spoken by older people as they present their perspective on and involvement in exercise, sports, and physical activity. Drawn from a number of studies, the voices of elders are assembled here as quotable quotes or statements that challenge contemporary understanding and meaning. Just as elderly respondents are wondering what kind of research is going on in applied gerontology, researchers are perplexed when some elders say `the darndest things' about their health, lifestyles, and physical activity. Overall, the review serves as a collection of learnings that may help other applied gerontologists by (a) sharing some insights and challenges of doing qualitative research with elders, (b) exploring how older people make sense of the role of physical activity in their lives, and (c) showing how interpretive approaches can enrich current understanding about the lifestyles and life meaning of older adults.

Late life function and disability instrument: I. Development and evaluation of the disability component

BACKGROUND

Efforts to evaluate the effectiveness of clinical and community-based interventions designed to impact late-life disability have been hindered significantly by limitations in current instrumentation. More conceptually sound and responsive measures of disability are needed.

METHODS

Applying Nagi's disablement model, we wrote questionnaire items that assessed disability in terms of frequency and limitation in performance of 25 life tasks. We evaluated their validity and test-retest reliability with 150 ethnically and racially diverse adults aged 60 and older who had a range of functional limitations, using factor analysis and Rasch analytic techniques to examine and refine the instrument.

RESULTS

Our analyses resulted in a 16-item disability component with two dimensions, one focused on frequency of performance and the other addressing limitation in performance of life tasks, with two disability domains within each dimension. The frequency dimension consisted of a personal and a social role domain, and the limitation dimension consisted of an instrumental and a management role domain. Expected differences in summary scores of known-functional limitation groups support the validity of this instrument. Test-retest intraclass correlations of the reproducibility of each overall dimension summary score were moderate to high (intraclass correlation coefficients .68-.82).

CONCLUSIONS

The Late-Life Function and Disability Instrument has potential to assess meaningful concepts of disability across a wide variety of life tasks with relatively few items.

The validity of self-reported cost events by substance abusers. Limits, liabilities, and future directions

The following review considers data on the validity of self-reports in addict populations, and then it discusses (a) the types of cost-related questions and the assumptions underlying them that are useful to the evaluation of addictions treatment, (b) both internal and external sources of invalidity, (c) the limits on cost-related information that is gathered from administrative databases, (d) methods for assessing measure validity, and (e) the means for improving the validity of self-reports of cost events. With some important exceptions, addicts provide valid data about both medical and criminal cost events. Skilled socioeconomic researchers able to monetarize these events should be able to produce significant cost of illness, cost offset, cost-benefit, and cost-effectiveness research using self-report data.

The social environment of nursing homes and the health of older residents

This study investigated the effects of two social environment variables, social support and anomia, on the self-reported health of older nursing home residents. Three specific hypotheses were tested as well as the fit of the data to the proposed theory. A nonrandom, convenience sample of 91 nursing home residents was drawn from four nursing homes. Only whites who could speak and understand English and who were judged to be cognitively intact or only mildly cognitively impaired were included. The data were analyzed using path analysis. Only one hypothesis asserting that anomia will have direct negative effects on self-reported health was fully supported.

The accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease in the general population: a critical review

OBJECTIVE

To critically review the literature concerning the accuracy of self-reported health behaviors and risk factors relating to cancer and cardiovascular disease among the general population.

METHOD

A literature search was conducted on three major health research databases: MEDLINE, HealthPLAN, and PsychLit. The bibliographies of located articles were also checked for additional relevant references. Studies meeting the following five inclusion criteria were included in the review: They were investigating the accuracy of self-report among the general population, as opposed to among clinical populations. They employed an adequate and appropriate gold standard. At least 70% of respondents consented to validation, where validation imposed minimal demands on the respondent; and 60% consent to validation was considered acceptable where validation imposed a greater burden. They had a sample size capable of estimating sensitivity and specificity rates with 95% confidence intervals of width +/-10%. The time lag between collection of the self-report and validation data for physical measures did not exceed one month.

RESULTS

Twenty-four of 66 identified studies met all the inclusion criteria described above. In the vast majority, self-report data consistently underestimated the proportion of individuals considered "at-risk." Similarly, community prevalences of risk factors were considerably higher according to gold standard data sources than they were according to self-report data.

CONCLUSIONS

This review casts serious doubts on the wisdom of relying exclusively on self-reported health information. It suggests that caution should be exercised both when trying to identify at-risk individuals and when estimating the prevalence of risk factors among the general population. The review also suggests a number of ways in which the accuracy of individuals' self-reported health information can be maximized.