Self-rated health and its association with mortality in older adults in China, India and Latin America-a 10/66 Dementia Research Group study

Self-Rated Health and its Impact on Survival of Older Adults

Background

Self -rated health (SRH) is a subjective assessment of health status that results from asking a question as "How do you assess your health?". The aim of this study was to determine the value of SRH for survival of older adults.

Materials and Methods

This cohort study was conducted among a population aged 60 years and over living in the north region of Iran. The participants' characteristics including demographic information, life-style behaviors, medical history, body mass index, depressive symptoms, cognitive function, and social support were examined. SRH was categorized into two groups (1. poor or fair and 2. good or excellent). All of the study population were followed up again after 5 years to determine the survival condition.

Results

Totally, 1475 elderly people were included. Good or excellent SRH showed a significant association with male gender, to be married, higher physical activity, less co-morbid chronic disorders, no depressive symptoms, normal cognitive function, higher social support, smoking (P < 0.001), and normal body mass index (BMI) (P = 0.021); however, no significant association with age (P < 0.083) was observed. Out of 944 elderly people expressing good or excellent SRH, 85 (9%) persons died after 5-year follow-up (P < 0.001). Cox regression analysis revealed that SRH had a significant impact on mortality of older adults (adjusted hazard ratio = 1.447; 95% confidence interval: 1.008-2.076; P = 0.045).

Conclusion

Considering health-related characteristics including age, gender, number of drugs the participant was taking, physical activity, BMI, and social support, SRH showed a significant effect on 5-year survival of older adults.

Differences between subjective and disability health expectancies across ages in older adults

Health expectancies (HEs) have become a key indicator for monitoring healthy aging. So far, they have mainly been calculated based on functional rather than subjective health measures. Yet, by integrating several dimensions (medical, social, and cultural), subjective health is also an important measure of an older person's health status. In this study, we first estimated HEs using self-rated health (SRH), by age and sex. Second, we compared these results to those obtained when using a disability measure. We used pooled data from three prospective population-based cohorts including adults aged 65 years and over, living in Southwestern France (N = 4468). SRH was assessed using a single question and disability was measured using the Lawton scale. Healthy/Unhealthy Life Expectancies (HLE/UHLE) and Disability/Disability-Free Life Expectancies (DLE/DFLE) were estimated using the Interpolated Markov Chain program (IMaCh), separately in men and women. Women lived longer than men, with similar HLE but longer UHLE at all ages. The proportion of HLE in total LE decreased with age for both sexes and for women, it became smaller than the proportion of UHLE from age 73 onward. In both sexes, while the DLE was shorter than the UHLE in the youngest, a reversal was observed with advancing age. This change occurred earlier in women. Our study supports that SRH and disability showed different aging patterns, with sex and age differences. From a public health perspective, SRH and disability indicators appeared not interchangeable as they uncovered complementary but different information on the needs of aging people.

Self-rated health and sociodemographic inequalities among Venezuelan adults: a study based on the National Survey of Living Conditions (ENCOVI 2021)

Self-rated health is an indicator that can be easily identified in health surveys, widely used to measure physical, social, mental, and health aspects of the population, and predict premature mortality. In Venezuela, this information only began to be collected recently, in the National Survey of Living Conditions (ENCOVI). In this context, our study aims to analyze the demographic and socioeconomic factors associated with non-positive self-rated health among Venezuelan adults. The ENCOVI 2021 (n = 16,803) was used as a data source, assessing a probability stratified sample with questions about health, education, emigration, and other social and economic aspects. Crude and adjusted prevalence ratio analyses were performed using Poisson regression models with robust variance. The prevalence of fair/bad self-rated health among Venezuelans was 17.8%. The results indicated a strong association between outcome prevalence and age group, 3.81 times higher (95%CI: 3.29-4.41) among individuals aged 60 or more when compared to individuals aged 18 to 29 years. Also, participants experiencing severe food insecurity had a prevalence 2 times higher (95%CI: 1.61-2.47) than those who did not have any level of food insecurity. Factors such as poverty, education, recent emigration of family members, and sex also showed a significant influence, also when analyzed independently. The results show that special attention should be dedicated to the health of individuals facing hunger and of the older people.

Health Perceptions, Multimorbidity, and New Fractures and Mortality Among Patients With a Fracture

Importance

A high proportion of patients who sustain a fracture have multimorbidity. However, the association of multimorbidity with postfracture adverse outcomes, such as subsequent fractures and premature mortality, has not been widely explored.

Objective

To examine the association of multimorbidity and self-rated health with subsequent fractures and mortality after fracture.

Design, Setting, and Participants

This prospective cohort study included participants from New South Wales, Australia, in the Sax Institute's 45 and Up Study (n = 267 357). Participants were recruited from July 2005 to December 2009 and followed up from the date of the incident fracture until subsequent fracture, death, or the end of the study (April 2017), whichever occurred first, with questionnaire data linked to hospital admission and medication records. Data analysis was reported between March and September 2023.

Exposures

Charlson Comorbidity Index (CCI) score and self-rated health (SRH).

Main Outcomes and Measures

The main outcomes were subsequent fracture or mortality after an incident fracture. Associations between SRH measures and subsequent fracture and mortality were also assessed. All analyses were stratified by sex given the different fracture and mortality risk profiles of females and males.

Results

Of 25 280 adults who sustained incident fractures, 16 191 (64%) were female (mean [SD] age, 74 [12] years) and 9089 (36%) were male (mean [SD] age, 74 [13] years). During a median follow-up time of 2.8 years (IQR, 1.1-5.2 years), 2540 females (16%) and 1135 males (12%) sustained a subsequent fracture and 2281 females (14%) and 2140 males (24%) died without a subsequent fracture. Compared with a CCI score of less than 2, those with a CCI score of 2 to 3 had an increased risk of subsequent fracture (females: hazard ratio [HR], 1.16 [95% CI, 1.05-1.27]; males: HR, 1.25 [95% CI, 1.09-1.43]) and mortality (females: HR, 2.19 [95% CI, 1.99-2.40]; males: HR, 1.89 [95% CI, 1.71-2.09]). Those with a CCI score of 4 or greater had greater risks of subsequent fracture (females: HR, 1.33 [95% CI, 1.12-1.58]; males: HR, 1.48 [95% CI, 1.21-1.81]) and mortality (females: HR, 4.48 [95% CI, 3.97-5.06]; males: HR, 3.82 [95% CI 3.41-4.29]). Self-rated health was also significantly associated with subsequent fracture and mortality. Those reporting the poorest health and quality of life had the highest subsequent fracture risks, and their mortality risks were even higher.

Conclusions and Relevance

In this cohort study, both CCI and SRH measures were associated with increased risk of subsequent fractures and mortality after fracture, underscoring the importance of managing the care of patients with comorbidities who sustain a fracture.

Leisure Attitude, Self-Rated Health, and Psychological Well-Being in Older Adults: A Moderated Mediation Model

Purpose

A positive leisure attitude among older adults may have a beneficial effect on psychological well-being, both directly and indirectly by fostering a more positive perception of one's health. This paper presents a correlational design that explores associations among leisure attitude, self-rated health, and psychological well-being, and analyzes the potential moderating role of gender in these relationships.

Patients and Methods

The sample was selected using simple random probability sampling (N= 409; 61.9% female; Mean age = 72.9; SD = 8.43¸ Range of age 53 to 93 years). Diverse sociodemographic information was collected, and leisure attitudes, self-perceived health, and psychological well-being (positive affect and emotional ties) were assessed.

Results

The results revealed a positive effect of leisure attitude on self-rated health and psychological well-being, with self-rated health fully mediating the association between the behavioral component of leisure attitude and psychological well-being. Furthermore, the moderating effect of gender on the relationship between self-rated health and psychological well-being was stronger among men.

Conclusion

Positive cognitive and emotional perceptions of leisure among older adults seem to benefit psychological well-being and improve self-rated health, thereby contributing to healthy ageing.

The sex difference in self-rated health among older Turkish and Moroccan migrants in the Netherlands: an exploratory study of contributing determinants

BACKGROUND

Although being a woman and having a migration background are strong predictors of poor self-rated health among (older) adults, research on the sex difference in self-rated health among (older) migrants remains limited. This study therefore aims to investigate this topic and explore the contributing role of determinants of self-rated health.

METHODS

Cross-sectional data from 360 Turkish-Dutch and Moroccan-Dutch adults aged 55-65 as part of the Longitudinal Aging Study Amsterdam (LASA) were used. Self-rated health (good versus poor) was measured by a single item question. Univariate age-adjusted logistic regression analysis was used to investigate the sex difference in self-rated health and the contribution of sex differences in sensitivity (strength of the association) and/or exposure (prevalence) to socio-demographic, social, lifestyle or health-related determinants of self-rated health.

RESULTS

Women had a 0.53 times lower odds (95%CI:0.40-0.82, p = 0.004) on good self-rated health compared to men. Women more often having a lower education level, living alone and having a higher prevalence of depressive symptoms, chronic diseases and especially functional limitations contributed to the lower self-rated health among women. In contrast, men were more sensitive to the impact of memory complaints, depressive symptoms, visual difficulties and functional limitations.

CONCLUSIONS

Older Turkish-Dutch and Moroccan-Dutch women have a significant lower self-rated health compared to men. Women having a higher exposure to both socio-demographic and health-related determinants of self-rated health, which contributed to the sex difference. Future research should take these differences in self-rated health and determinants between women and men into account when investigating health among older migrants.

Self-rated health among adolescents from vulnerable areas and their sociodemographic, lifestyle and contextual factors: A multilevel analysis

PURPOSE

Understanding self-rated health in young people can help orient global health actions, especially in regions of social vulnerability. The present study analysed individual and contextual factors associated with self-rated health in a sample of Brazilian adolescents.

DESIGN AND METHODS

Cross-sectional data from 1272 adolescents (aged 11-17; 48.5% of girls) in low human development index (HDI) neighbourhoods were analysed (HDI from 0.170 to 0.491). The outcome variable was self-rated health. Independent variables relating to individual factors (biological sex, age and economic class) and lifestyle (physical activity, alcohol, tobacco consumption and nutritional state) were measured using standardised instruments. The socio-environmental variables were measured using neighbourhood registered data where the adolescents studied. Multilevel regression was used to estimate the regression coefficients and their 95% confidence intervals (CI).

RESULTS

Good self-rated health prevalence was of 72.2%. Being male (B: -0.165; CI: -0.250 to -0.081), age (B: -0.040; CI: -0.073 to -0.007), weekly duration of moderate to vigorous physical activity (B: 0.074; CI: 0.048-0.099), body mass index (B: -0.025; CI: -0.036 to -0.015), number of family healthcare teams in the neighbourhood (B: 0.019; CI: 0.006-0.033) and dengue incidence (B: -0.001; CI: -0.002; -0.000) were factors associated with self-rated health among students from vulnerable areas.

CONCLUSIONS/PRACTICAL IMPLICATIONS

Approximately three in every 10 adolescents in areas of social vulnerability presented poor self-rated health. This fact was associated with biological sex and age (individual factors), physical activity levels and BMI (lifestyle) and the number of family healthcare teams in the neighbourhood (contextual).

Stress at Work and Well-being Before and During the COVID-19 Pandemic: A 1-Year Longitudinal Study in Switzerland

OBJECTIVE

The aim of the study is to analyze the development of conditions at work and health-related variables (notably exhaustion) in Switzerland longitudinally before and during the COVID-19 pandemic.

METHODS

Questionnaire data were collected from a population-based sample of 1,553 employees in February 2020 and 1 year later. Health and well-being associated with ( a ) working conditions in general and ( b ) COVID-19-specific predictors such as worries about being infected and conditions for working at home were analyzed using analysis of (co)variance and multiple regression.

RESULTS

Conditions at work and well-being were stable overall, even indicating slight improvements, notably for men compared with women. Both an index representing stressors and resources at work in general (Job Stress Index) and a COVID-19-related demand index showed consistent effects on health and the effect of COVID-19-related demands was stronger if the Job Stress Index deteriorated than when it improved.

The Moderating Role of Self-Rated Oral Health on the Association Between Oral Health Status and Subjective Well-Being: Findings From Chinese Older Adults in Hawai'i and Taiwan

This paper aims to address the research questions of whether individual's oral health status is associated with subjective well-being, as well as if there is possible moderating role of self-rated oral health among two groups of Chinese older adults (≥55 years old) in Honolulu, Hawai'i and Taichung, Taiwan. Using survey data collected in 2018 (N = 430, Honolulu) and in 2017 (N = 645, Taichung), ordinary least square regressions were applied. Results showed that, for both samples, oral health status was negatively and significantly associated with subjective well-being, and both associations were moderated by self-rated oral health. In addition, the moderating effects were more salient for the Honolulu sample, who enjoyed higher levels of self-rated oral health and life satisfaction. These results suggest the significant associations of both oral health status and self-rated oral health on individual health and well-being for Chinese older adults residing in different cultural contexts.

Prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in living arrangements: a cross-sectional study

BACKGROUND

Older adults with different living arrangements may have different mental health statuses and different factors that influence their mental health. The aim of the present study is to investigate the prevalence and determinants of depressive symptoms among community-dwelling older adults in China based on differences in their living arrangements.

METHODS

Participants were 6,055 older adults from the 2015 China Health and Retirement Longitudinal Study. Depressive symptoms and their determinants were evaluated using the 10-item Center for Epidemiologic Studies Depression Scale and multivariate logistic regression analysis, respectively.

RESULTS

The prevalence of depressive symptoms among older adults living alone, as a couple, and with children was 47.8%, 33.2%, and 39.5%, respectively. The common risk factors for depressive symptoms were shorter sleep duration, poorer activities of daily living, and poorer self-rated health. Women, those with lower educational levels, and those suffering from chronic diseases had a higher risk of depressive symptoms among older adults living as a couple and those living with children. Smoking and participation in economic activities were also risk factors of depressive symptoms among older adults living with children and those living alone, respectively.

CONCLUSIONS

The findings suggest that older adults living as couples had the lowest prevalence of depressive symptoms, while those living alone had the highest prevalence of depressive symptoms. The determinants of depressive symptoms differed by living arrangement; hence, they should be considered in future interventions.

Effects of leisure activities and general health on the survival of older people: a cohort study in China

Objective

This study aimed to examine the influence of physical and cognitive leisure activities on the survival of older adults in China, while also exploring the potential mediating and moderating effects of general health.

Methods

This study utilized the China Longitudinal Healthy Longevity Survey (CLHLS) datasets spanning from 2008 to 2018, and 10,347 eligible participants were included. The primary study outcome was all-cause mortality, and independent variables included physical leisure activities (PLA), cognitive leisure activities (CLA), and self-rated general health. Three sets of covariates were adjusted, including socio-demographic characteristics, health behaviors, and health status.

Results

The longest survival time was the older people participating in PLA & CLA (mean = 50.31 months), while those participating in neither exhibited the lowest (mean = 29.60 months). Significant differences in survival status were observed in different types of leisure activities participation (Log-rank test, Chi-square = 576.80, p < 0.001). Cox regression indicated that PLA (HR = 0.705, 95% CI: 0.651-0.764), CLA (HR = 0.872, 95% CI: 0.816-0.933), and the both PLA & CLA (HR = 0.700, 95% CI: 0.656-0.747) were protective factors for the survival. Additionally, general health significantly moderated the relationship between PLA and reduced mortality risk (Coefficient = -0.089, p = 0.042). While CLA indirectly influenced the survival through general health (Coefficient = -0.023, p < 0.001). For the older people participating in PLA and CLA, general health played mediating (Coefficient = -0.031, p < 0.001) and moderating (Coefficient = -0.026, p = 0.013) role in the relationship between leisure activities and survival.

Conclusion

Leisure activities and self-rated general health were important predictors of survival of the older adults, and general health exhibited a mediator and moderator in the relationship between leisure activities and survival status.

Social environment characteristics are related to self-rated health in four Latin America countries: Evidence from the SALURBAL Project

We investigated the associations of social and built environment and demographic features of urban areas with self-rated health among adults living in four Latin American countries. We estimated multilevel models with harmonized data from 69,840 adults, nested in 262 sub-cities and 112 cities, obtained from the Salud Urbana en América Latina project. Poor self-rated health was inversely associated with services provision score at the sub-city-level and with social environment index at the city-level. We did not identify associations of built environment and demographic features with self-rated health. Approaches and policies to improve health in Latin American should be urban context-sensitive.

Prediction model of quality of life using the decision tree model in older adult single-person households: a secondary data analysis

Background

Attention is drawn to the subjective health status and quality of life of older adult single-person households, whose number is gradually increasing as factors including low fertility, increased life expectancy, aging, and household miniaturization interact.

Objective

The study was to identify predictors that affect the quality of life of single-person households aged 65 years or older and living in South Korea.

Methods

A secondary data analysis design was used. Data included physical, mental, social, and demographic characteristics, subjective health status, and quality of life parameters of 1,029 older adult single-person households surveyed by the Korea Health Panel in 2019. For analysis, the predictive model was evaluated using split-sample validation and the ROC curve. The area under the curve after the decision tree analysis was calculated. Final nodes predicting the quality of life of older adult single-person households were derived.

Results

Significant predictors were identified in this order: subjective health status, chronic disease, income, and age. Subjective health status was the most important factor influencing quality of life (△ p < 0.001, x2 = 151.774). The first combination that perceived high quality of life of older adult single-person households was the case of high subjective health status and no chronic disease, followed by the case of high subjective health status, presence of chronic disease, and high income.

Conclusion

This study confirmed that subjective health status and chronic disease are essential factors for quality of life among the four related indicators of quality of life presented by the OECD. In nursing practice, nurses need to pay attention the factors influencing quality of life of older adult single-person households. Especially, nursing practice for older adult single-person households needs to be focused on improving subjective health status and on relieving chronic disease.

Exploring the natural history of intrinsic capacity impairments: longitudinal patterns in the 10/66 study

BACKGROUND

intrinsic capacity (IC) is a construct encompassing people's physical and mental abilities. There is an implicit link amongst IC domains: cognition, locomotion, nutrition, sensory and psychological. However, little is known about the integration of the domains.

OBJECTIVES

to investigate patterns in the presentation and evolution of IC domain impairments in low-and-middle-income countries and if such patterns were associated with adverse outcomes.

METHODS

secondary analyses of the first two waves of the 10/66 study (population-based surveys conducted in eight urban and four rural catchment areas in Cuba, Dominican Republic, Puerto Rico, Venezuela, Peru, Mexico and China). We applied latent transition analysis on IC to find latent statuses (latent clusters) of IC domain impairments. We evaluated the longitudinal association of the latent statuses with the risk of frailty, disability and mortality, and tested concurrent and predictive validity.

RESULTS

amongst 14,923 participants included, the four latent statuses were: high IC (43%), low deterioration with impaired locomotion (17%), high deterioration without cognitive impairment (22%), and high deterioration with cognitive impairment (18%). A total of 61% of the participants worsened over time, 35% were stable, and 3% improved to a healthier status.Participants with deteriorated IC had a significantly higher risk of frailty, disability and dementia than people with high IC. There was strong concurrent and predictive validity. (Mortality Hazard Ratio = 4.60, 95%CI 4.16; 5.09; Harrel's C = 0.73 (95%CI 0.72;0.74)).

CONCLUSIONS

half of the study population had high IC at baseline, and most participants followed a worsening trend. Four qualitatively different IC statuses or statuses were characterised by low and high levels of deterioration associated with their risk of disability and frailty. Locomotion and cognition impairments showed other trends than psychological and nutrition domains across the latent statuses.

Assessment of the Concurrent Validity of the ICF Core Set to Classify the Physical Health of Community-Dwelling Older Adults in Relation to Self-Rated Health

BACKGROUND AND PURPOSE

The present study aimed to assess the concurrent validity of the International Classification of Functioning, Disability and Health (ICF) core set to classify physical health of older adults in relation to self-rated health.

METHODS

This is a methodological study conducted in Santa Cruz, Rio Grande do Norte (RN) state, in Northeastern Brazil, with 101 community-dwelling older adults. The participants rated their health status, which was classified into 3 groups: very good, fair, and poor/very poor. An interview was then conducted using self-reported and objective measurements to classify physical health according to the ICF core set. It consists of 30 categories, 14 of which belong to the body function (b) component, 4 to body structures (s), 9 to activities and participation (d), and 3 related to environmental factors (e). To analyze the compromised and problematic categories in the ICF, an impairment index was created for each component. The relationship between self-rated health and the impairment indexes was assessed using the multinomial logistic regression test adjusted for age, sex, schooling, and perception of income sufficiency.

RESULTS

A greater likelihood of poor or very poor self-rated health was found in older individuals with the highest impairment index in (b) (odds ratio [OR] = 1.18; P < .001); (s) (OR = 1.11; P ≤ .001); (d) capacity (OR = 1.09; P = .02); and (d) performance (OR = 1.08; p = 0.01).

CONCLUSION

The results suggest that the ICF core set is a valid instrument to assess the physical health of older adults, since it is associated with self-rated health and shows potential for use in clinical practice and scientific research, with universal language regarding functionality and physical health in older adults.

Isolated and combined association of excessive screen time and physical inactivity with negative self-rated health in adolescents

OBJECTIVE

The aim of this study was to analyze isolated and combined associations of physical inactivity excessive screen time with negative self-rated health, according to sex, among school adolescents.

METHODS

In this cross-sectional study conducted with 2,517 adolescents in Amazonas State, participants were asked about their self-rated health with the following question: How do you rate your health? Responses were dichotomized into positive (excellent and good) and negative (regular, bad, and terrible). Information on sex, age group, family income, physical activity, and screen time (watching TV, using a computer, or playing video games) was collected through a self-administered questionnaire. Adolescents simultaneously classified as physically inactive (<60 min/day) and having excessive screen time (>2 h/day) were considered to have two risk factors. Data was analyzed using binary logistic regression.

RESULTS

Out of every 10 adolescents, 2 had a negative self-rated health. After adjusting for age and family income, there were no isolated or combined associations between physical inactivity or excessive screen time and negative self-rated health in girls. In boys, negative self-rated health was associated with insufficient levels of physical activity (odds ratio [OR]: 2.39; 95% confidence interval [CI]: 1.03-5.59) and with the accumulation of two risk factors (OR: 1.61; 95%CI 1.10-2.34).

CONCLUSIONS

Being insufficiently active and the combination of physical inactivity and excessive screen time become exposure factors to the negative self-rated health of adolescent boys.

Decomposition analysis of health inequalities between the urban and rural oldest-old populations in China: Evidence from a national survey

The number of Chinese oldest-old (aged 80+) is growing rapidly and some studies have shown that the health status is unequal among older persons in different regions. However, to the best of our knowledge, no study to date has analyzed health inequalities among the oldest-old in urban and rural areas in China. This study therefore aimed to examine the correlation between health inequalities among the oldest-old in urban and rural areas of China. From the 8th wave of the Chinese Longitudinal Health Longevity Survey (CLHLS), we selected 8124 oldest-old participants who met the requirements of the study. Chi-square tests were used to analyze the distribution characteristics of indicators and a logistic model was performed to determine the factors associated with different self-rated health (SRH). The Fairlie model was adopted to decompose the causes and related contributions to health inequality. Our results found that of the Chinese oldest-old, 46.57% were in good health. Urban residents reported significantly better SRH than rural residents (50.17% vs. 45.13%). Variables associated with good and poor SRH had different distribution characteristics. The logistic model suggested that marital status, alcohol consumption, and annual income were important factors underlying the SRH differences. Our decomposition analysis indicated that 76.64% of the SRH differences were caused by observational factors, and validated that the difference in SRH between urban and rural areas was significantly (P<0.05) associated with exercise status (45.44%), annual income (37.64%), social activity status (3.75%), age (-5.27%), and alcohol consumption (-2.66%). Therefore, socioeconomic status and individual lifestyle status were the main factors underlying the health inequality between urban and rural Chinese oldest-old.

Exploring association between food insecurity and depression among older adults in India

Background

Depression is a significant health concern that is yet to be recognised as an important public health challenge in India. Furthermore, given the critical condition of food insecurity among older people in India, it is likely that they are more vulnerable to depression. The interplay of depression among older people resulting from food insecurity is an under-explored phenomenon in the Indian context. Therefore, this study examines the association between food insecurity and depression among older people in India.

Methods

The study used data from the Longitudinal Ageing Study in India (LASI). Food insecurity was measured with a set of questions formed into dichotomous variable and depression was measured with Center for Epidemiological Studies Depression (CES-D scale). Binary logistic regression was performed to confirm the findings.

Results

Results showed that older adults who reported food insecurity were more likely to be depressed (OR= 1.20; C.I.=1.03-1.25) than their younger counterparts. Furthermore, older adults who were independent for Activity of Daily Living (ADL) were less likely (OR= 0.73; C.I.=0.53-1.00) to report depression, whereas, female (OR= 1.12; C.I.=1.00-1.26) and never married (OR= 2.11; C.I.=1.18-3.79) older adults were more likely to be depressed than their respective counterparts.

Conclusion

It is important to integrate mental health with food insecurity. Future studies may consider including mental health services with food assistance programs or vice versa.

Self-rated physical health, health-risk behaviors, and disparities: A cross-sectional study of youth in the slums of Kampala, Uganda

Self-rated physical health (SRPH) has been extensively used to assess health status. In this study, we examine how youth living in the slums of Kampala perceive their physical health and the psychosocial correlates of poor health. Cross-sectional data from the 2014 Kampala Youth Survey (N = 1,134) of youth ages 12-18 years was used to conduct the analyses. Chi-square tests and logistic regression analyses were conducted to determine associations between SRPH, demographic and psychosocial characteristics. Overall, 72% of youth rated their health as 'excellent' or 'good.' Poor SRPH was associated with older age and lower education, but not with sex. Also, orphans (OR = 2.03; 95%CI:1.51-2.72), those who lived on the streets (OR=3.09; 95%CI:2.30-4.15), who did not have electricity (OR = 2.83;95%CI:2.12-3.78), who initiated alcohol use early (OR = 2.08; 95%CI:1.47-2.94), who frequently get drunk (OR = 5.67; 95%CI:2.69-11.96), who were HIV positive (OR = 2.18; 95%CI:1.47-3.23), who had been injured due to their drinking (OR = 2.09; 95%CI:1.44-3.03), who thought about hurting themselves (OR = 2.09; 95%CI:1.60-2.73), and those who often felt lonely (OR = 2.54; 95%CI:1.61-4.02) had higher odds of poor SRPH compared to their peers without these characteristics. Poor SRPH may serve as a marker for multiple health-risk behaviors and severe health disparities among youth in vulnerable and resource-limited settings.

Expecting the best or fearing the worst: Discrepancies between self-rated health and frailty in an ageing Irish population

OBJECTIVES

Ageing populations have the propensity to rate their health status more inaccurately than their younger counterparts. As a result, we (1) devised a metric which categorized older adults into groups based on the discrepancy between their self-rated health (SRH) and Frailty Index (FI) scores, and (2) investigated which factors predict group membership.

DESIGN

A cross-sectional design was employed using data from The Irish Longitudinal Study of Ageing (TILDA).

METHODS

A health asymmetry metric was derived: this categorized 6907 participants (aged 50+ years) into three groups: 'health pessimistic' where participants underestimated their healthiness, 'health realistic' where participants accurately assessed their health, and 'health optimistic' where participants overestimated their healthiness. A multinomial logistic regression modelled the ability of a set of sociodemographic, psychosocial, and health behaviour variables in predicting membership of these categories.

RESULTS

A significant proportion of the study population were categorized as 'health realistic' (~69%). The prevalence rates of health optimistic individuals increased in older age groups, and conversely, health pessimistic rates decreased in older age groups. Most notably, psychosocial factors significantly predicted being health pessimistic: such as anxiety (OR = 1.03), loneliness (OR = 1.04), and decreased social connectedness (OR = 0.87). However, less clear sociodemographic, psychosocial, and health behaviour associations were found for being health optimistic.

CONCLUSION

Health asymmetry is a useful method of identifying at-risk individuals for inaccurate SRH. The ability of this metric to predict clinical mental health outcomes should be investigated.

The Long-Term Associations of Objective and Subjective Health Status on Mortality

Background

The aim of this study was to reveal the longitudinal associations of health status (HS) and Self-rated Health (SRH) on mortality.

Methods

Data from the Korea Longitudinal Study of Ageing were used in this study. The baseline data (2006) included 10,239 participants. The Cox proportional hazard model was used to verify the hypothesis.

Results

The mortality was high when the health status was Bad and higher when the SRH was Bad. The HS-Bad-SRH-Bad group had the highest mortality. Middle-aged people with diseases had higher mortality than older people who perceived themselves as in Bad health. For older people, mortality was high for SRH-Bad people of all health statuses.

Conclusion

The results predict a high rate of mortality for middle-aged and older people with a combination of HS-Bad and SRH-Bad, with SRH being relatively more influential in mortality.

Age-Friendly Communities and Older Adults’ Health in the United States

As age-friendly community (AFC) initiatives grow, it will be essential to determine whether older adults who live in an AFC have better health than those who live in other environments. This study uses data from the 2017 AARP AFC Surveys and the AARP Livability Index to assess whether AFCs promote the health of older adults. We analyze data for 3027 adults aged 65 and older who reside in 262 zip code areas. Following AARP guidelines, we allocated the sample into two groups: an AFC group (livability score of 51+; n = 2364) and a non-AFC (score ≤ 50, n = 663). The outcome variable was self-rated health (M = 3.5; SD = 1.1; range: 1–5). We used an inverse probability weighting approach to evaluate whether older adults who live in an AFC reported better self-rated health than those who live in a non-AFC. Findings showed that older adults who lived in an AFC had better self-rated health than those in a non-AFC (b = 0.08, p = 0.027). Compared to non-Hispanic Whites, Black and Hispanic older adults reported worse self-rated health. Inasmuch as living in an AFC can promote the well-being of older adults, policymakers and practitioners should continue to develop and sustain high-quality, accessible built and social environments.

The association between self-rated health and all-cause mortality and explanatory factors in China's oldest-old population

Background

Self-rated health (SRH) is considered a condensed summary of information about bodily conditions that involves people’s biological, cognitive, and cultural status, but has been under-studied in the oldest old population. This study aimed to investigate the association between SRH and all-cause mortality among the oldest-old population in China and to explore potential explanatory factors in this association.

Methods

The study was based on the Chinese Longitudinal Healthy Longevity Survey (CLHLS) from 1998 to 2018 and included 30 222 participants aged 80 years or older (ie, the oldest old) in the analysis. We used Cox models to assess the association between SRH and mortality in this population and its subgroups, and used the Percentage Excess Risk Mediated approach to identify potential contributing factors.

Results

After adjustment of confounders, people with “good” “neutral”, and “bad/very bad” SRH were significantly associated with 8% (95% confidence interval (CI) = 3%-13%), 23% (95% CI = 18%-29%), and 52% (95% CI = 44%-61%) higher hazard of mortality respectively, compared with those with “very good” SRH. The significant SRH-mortality associations were exclusive to men and those with at least primary education. The adjustment of “regular physical activity”, “leisure activity”, “activities of daily living (ADL)”, and “cognitive function” all led to noticeable attenuation to the SRH-mortality association, with “leisure activity” causing the most attenuation (64.9%) in the “Good SRH” group.

Conclusions

Self-rated health is significantly associated with all-cause mortality among the oldest old population in China, particularly among men and the educated, and is considerably explained by regular physical activity, leisure activity, ADL, and cognitive function. We advocate the use of SRH as a simple and efficient tool in research and (potentially) health care practices.

Multimorbidity and depression among older adults in India: Mediating role of functional and behavioural health

Researchers have long been concerned about the association between depression and the prevalence of multiple chronic diseases or multimorbidity in older persons. However, the underlying pathway or mechanism in the multimorbidity-depression relationship is still unknown. Data were extracted from a baseline survey of the Longitudinal Ageing Survey of India (LASI) conducted during 2017–18 (N = 31,464; aged ≥ 60 years). Depression was assessed using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). Multivariable logistic regression was used to examine the association. The Karlson–Holm–Breen (KHB) method was adopted for mediation analysis. The prevalence of depression among older adults was nearly 29% (men: 26% and women 31%). Unadjusted and adjusted estimates in binary logistic regression models suggested an association between multimorbidity and depression (UOR = 1.28; 95% CIs 1.27–1.44 and AOR = 1.12; 95% CIs 1.12–1.45). The association was particularly slightly strong in the older men. In addition, the association was mediated by functional health such as Self Rated Health (SRH) (proportion mediated: 40%), poor sleep (35.15%), IADL disability (22.65%), ADL disability (21.49%), pain (7.92%) and by behavioral health such as physical inactivity (2.28%). However, the mediating proportion was higher among older women as compared to older men. Physical inactivity was not found to be significant mediator for older women. The findings of this population-based study revealed that older people with multimorbidity are more likely to suffer depressive symptoms in older ages, suggesting the need for more chronic disease management and research. Multimorbidity and depression may be mediated by certain functional health factors, especially in older women. Further longitudinal research is needed to better understand the underlying mechanisms of this association so that future preventive initiatives may be properly guided.

Balance and prospective falls in patients with rheumatoid arthritis

Background

Postural control is associated with fall risk. Patients with rheumatoid arthritis (RA) have a higher risk to fall than healthy subjects. The objective of this study was to identify associations between variables of postural control with prospective falls in patients with RA.

Methods

For the baseline, the balance performance of 289 men and women with RA, ages 24–85 years, was evaluated by SPPB, FICSIT-4 and Romberg tests. Postural sway for Romberg, semitandem, tandem and one-leg stands were measured with the Leonardo Mechanograph®. Self-reported disability was assessed using the Health Assessment Questionnaire (HAQ) and the Activity-specific Balance Confidence Scale (ABC-scale). Falls were reported in quarterly reports over a year. Univariate and multiple logistic regression analysis were used to explore any associations with falling. Receiver-operating characteristics were determined, and the area under the curve is reported.

Results

A total of 238 subjects completed the 1-year follow-up, 48 (20.2%) experienced at least one fall during the observational period. Age (OR = 1.04, CI 1.01–1.07), HAQ (OR = 1.62, 1.1–2.38), FICSIT-4 scoring 0–4 (OR = 2.38, 1.13–5.0), and one-leg standing (OR = 2.14, 1.06–4.31) showed significant associations with falls. With regard to the SPPB and ABC-scale, no statistically significant associations with falls were found. The quartiles containing the worst results of medio-lateral sway of Romberg (OR = 2.63, CI 1.03–6.69), total sway of semitandem (OR = 3.07, CI 1.10–8.57) and tandem (OR = 2.86, CI 1.06–7.69), and area of sway of semitandem (OR = 2.80, CI 1.11–7.08) stands were associated with falls.

Conclusions

The assessment of a one-leg stand seems to be a good screening tool to discriminate between high and low risk of falls in RA patients in clinical practice. A low FICSIT-4 score and several sway parameters are important predictors of falls.

Trial registration

The study has been registered at the German Clinical Trials Register and the WHO International Clinical Trials Registry Platform (ICTRP) since 16 March 2017 (DRKS00011873).

Risk factors and clustering of mortality among older adults in the India Human Development Survey

With wide socioeconomic mortality differential among older adults in India, a constant question of death clustering across high-risk families and communities arises. The present study uses a follow-up survey from India to investigate the socioeconomic, demographic and health predictors of old-age mortality clustering. Data of 16,964 older adults nested within 12,981 households from 2352 communities were used from India Human Development Survey (IHDS) round-I (2005) who were further tracked down in round-II (2012). Bivariate association between the determinants of old-age mortality was investigated using the log-rank test. The multivariate analysis involved estimating the random-intercept Weibull proportional hazard model with three levels-individual (level 1), family (level 2) and community (level 3). We analyzed the sensitivity of multivariate results to unobservable variable and selection biases using the e-value method. The empirical analysis confirms that the risk of mortality is significantly heterogeneous between the families. The health status of older adults and the family's socioeconomic status in the early years emerged as prominent predictors of a longer lifespan. With a strong association between household income and mortality hazard risk, the present study urges early life interventions as those started in late-life might have negligible impact on keeping the older adults alive and healthy.

Measuring older people's socioeconomic position: a scoping review of studies of self-rated health, health service and social care use

Background

The challenges of measuring socioeconomic position in older populations were first set out two decades ago. However, the question of how best to measure older people’s socioeconomic position remains pertinent as populations age and health inequalities widen.

Methods

A scoping review aimed to identify and appraise measures of socioeconomic position used in studies of health inequalities in older populations in high-income countries. Medline, Scopus, EMBASE, HMIC and references lists of systematic reviews were searched for observational studies of socioeconomic health inequalities in adults aged 60 years and over, published between 2000 and 2020. A narrative synthesis was conducted.

Findings

One-hundred and thirty-eight studies were included; 20 approaches to measuring socioeconomic position were identified. Few studies considered which pathways the chosen measures of socioeconomic position intended to capture. The validity of subjective socioeconomic position measures, and measures that assume shared income and educational capital, should be verified in older populations. Incomplete financial data risk under-representation of some older groups when missing data are socially patterned. Older study samples were largely homogeneous on measures of housing tenure, and to a lesser extent, measures of educational attainment. Measures that use only two response categories risk missing subtle differences in older people’s socioeconomic circumstances.

Conclusion

Poor choice of measures of socioeconomic position risk underestimating the size of health inequalities in older populations. Choice of measures should be shaped by considerations of theory, context and response categories that detect subtle, yet important, inequalities. Further evidence is required to ascertain the validity of some measures identified in this review.

Multimorbidity and use of health services in the oldest old in Brazil

OBJECTIVE

To estimate the prevalence of multimorbidity in long-lived Brazilian individuals (age ≥80 years) and to associated it with the use of health services.

METHODS

Cross-sectional population-based study with data from the 2019 National Survey of Health (n=6,098). Frequencies of use of services were estimated for older people with multimorbidity and according to sex, health insurance ownership, and self-rated health. The prevalence rates, crude and adjusted prevalence ratios, and the respective 95% confidence intervals were calculated.

RESULTS

The average age of the older adults was 85 years and about 62% were women; the prevalence of multimorbidity was 57.1%, higher in women, in those who have health insurance, and who reside in the southern region of the country (p<0.05). In the oldest old with multimorbidity, the use of services in the last 15 days reached 64.6%, and more than 70% were hospitalized in the last year or did not carry out activities in the previous two weeks for health reasons. Differences were observed for the indicators of service use in relation to sex, health insurance ownership, and self-rated health, according to multimorbidity.

CONCLUSION

Indicators for the use of health services were higher in older individuals who have two or more chronic diseases, regardless of sociodemographic conditions and self-rated health, showing the impact of multimorbidity per se in determining the use of services among the oldest old.

Longitudinal validity of self-rated health: the presence and impact of response shift

Objective: This paper aimed to examine the longitudinal validity of self-rated health (SRH) and whether it would be affected by possible changes in evaluation standards (i.e., response shift) over time.Design: Data are from a longitudinal survey of a nationally representative sample in China. Analytical sample was restricted to respondents aged 45 and above (n = 15,893). Individual fixed effects models were used to analyze changes in ratings on health anchoring vignettes and self-rated health over time.Main outcome measures: SRH at two time points with a -two-year span.Results: Both SRH and anchoring vignettes ratings displayed changes over a two-year span for all the studied age groups. Compared with the self-assessed change in health ("How would you rate your health as compared to that of last year?"), changes in SRH reported over time displayed a more stable and optimistic pattern. SRH responded to doctor diagnosed chronic disease and changes in functional limitation, before and after adjusting for evaluation standards.Conclusion: SRH is responsive to the newly diagnosed chronic disease and functional limitation, regardless of whether we consider response shift within the same respondents over time.

Neighbourhood green space and health disparities in the global South: Evidence from Cali, Colombia

Increasing attention has been given to the role of green space in reducing health disparities. However, robust evidence to support decision making is lacking in the global South. We investigate the relationship between green space and health as well as its underlying mechanism in Cali, Colombia. Results indicate that neighbourhood greenness is associated with enhanced self-rated 'good' health and reduced physical and mental distress. The health benefits of green space appear to be stronger for people living in wealthier neighbourhoods than those in poor neighbourhoods. Results highlight the importance of considering health disparities for future green infrastructure planning in the global South context.

Concept analysis of perceived health from the perspective of rural adults in China

PURPOSE

This paper aims to clarify the concept of perceived health from the perspective of rural adults in China.

METHODS

Walker and Avant's concept analysis was applied.

FINDINGS

Perceived health from rural adults in China is a subjective assessment of their health status, which is deeply affected by Chinese traditional culture and being in a rural environment.

CONCLUSIONS

Most rural adults in China could perceive their health as good or poor, however, rural areas have disadvantages in health care, geographical location, and educational resources compared with urban counterparts, which may lead to some unscientific health attitudes and lifestyles and hinder their healthcare-seeking behaviors.

IMPLICATION FOR NURSING PRACTICE

To help nurses understand better the concept of perceived health with the rural background, which is different from urban areas. Perceived health provides rich information resources for nurses to carry out holistic care, and to lead rural adults in China to form a correct and positive attitude and lifestyle as possible.

Links Between Mortality and Socioeconomic Characteristics, Disease Burden, and Biological and Physical Functioning in the Aging Chinese Population

OBJECTIVES

Determinants of mortality may depend on the time and place where they are examined. China provides an important context in which to study the determinants of mortality at older ages because of its unique social, economic, and epidemiological circumstances. This study uses a nationally representative sample of persons in China to determine how socioeconomic characteristics, early-life conditions, biological and physical functioning, and disease burden predict 4-year mortality after age 60.

METHODS

We used data from the China Health and Retirement Longitudinal Study. We employed a series of Cox proportional hazard models based on exact survival time to predict 4-year all-cause mortality between the 2011 baseline interview and the 2015 interview.

RESULTS

We found that rural residence, poor physical functioning ability, uncontrolled hypertension, diabetes, cancer, a high level of systemic inflammation, and poor kidney functioning are strong predictors of mortality among older Chinese.

DISCUSSION

The results show that the objectively measured indicators of physical functioning and biomarkers are independent and strong predictors of mortality risk after accounting for several additional self-reported health measures, confirming the value of incorporating biological and performance measurements in population health surveys to help understand health changes and aging processes that lead to mortality. This study also highlights the importance of social and historical context in the study of old-age mortality.

Online Multi-Domain Geriatric Health Screening in Urban Community Dwelling Older Malaysians: A Pilot Study

Introduction: With a rapidly aging population, the Malaysian health care system needs to develop solutions to address the lack of resources that are required for the assessment of the older person. The complex nature of geriatric syndromes coupled with the occurrence of multiple comorbid illnesses with aging, make geriatric assessment a resource intensive process. Digital health solutions could play an important role in supporting existing health care systems, especially in low and middle income countries, with limited speciality services in geriatrics.

Objective: This is a pilot study aimed at screening for geriatric syndromes through self-administered online surveys in urban community dwelling older Malaysians and assessing the pattern of geriatric syndromes in relation to the frailty status of the study participants.

Methods: This is a cross-sectional pilot study conducted between July-September 2020. Community dwelling adults aged 60 years and over were invited to take part in an online survey. Information on sociodemographic variables, comorbidities, and the self-reported results of geriatric syndromes (frailty, sarcopenia, anorexia of aging, urinary incontinence, falls, and cognitive impairment), were collected through the survey.

Results: Data was collected for 162 participants over a period of 2 months. The mean (SD) age of the respondents was 66.42 (5.25) years with 64.9% females. Majority of the respondents were of Chinese ethnic origin (67.9%) and had tertiary level of education (75.9%). The average time taken by participants to complete the survey was 16.86 min. Urinary incontinence was the highest reported geriatric syndrome (55.1%) followed by falls (37.6%), anorexia of aging (32.8%), cognitive impairment (27.8%), and sarcopenia (8.3%). Frailty was detected in 4.5% of the study population. Loss of weight in the previous year was the highest reported component of the frailty assessment tool. The presence of sarcopenia, anorexia of aging, poor/fair self-rated health, urinary incontinence, and multimorbidity were significantly higher in older adults who were frail or prefrail.

Conclusion: Screening for geriatric syndromes through online surveys is a feasible approach to identify older adults in the community who are likely to benefit from geriatric assessment. However, the demographic profile of the older population that are accessible through such digital platforms is limited.

Physical Disorders and Poor Self-Rated Health in Adults Living in Four Latin American Cities: A Multilevel Approach

Considering that urban environments may affect self-rated health through behavioral and psychosocial mechanisms, the aim of this study was to investigate the association between self-rated health and perceived urban environment characteristics among adults living in four Latin American cities. Data is from a population-based survey by Development Bank of Latin America, encompassing adults between 20 and 60 years old in Buenos Aires, Lima, Mexico City, and Panama City. Self-rated health was measured using a single question and the response options were categorized as poor and good. The explanatory variables were empirical Bayes estimates of self-reported area physical disorder, social disorder, access to services, and access to leisure spaces derived from the survey. The covariates were: individual age, sex, education, wealth index, and length of residency in the neighborhood; and an area social environment index. Multilevel logistic regressions with two levels (individual and sub-city areas) were fitted. Poor self-rated health was reported by 34.73% (95% CI: 33.17 to 36.29) of the participants and was associated with physical disorder (OR = 1.16 per SD; 95% CI: 1.02 to 1.32). Our findings suggest that public policies to promote population health should consider area urban environment factors, especially those associated with disorder.

Health literacy as a predictor of emergency department visits and self-rated health among Chinese immigrants: findings from an Australian survey

OBJECTIVES

Our objectives were to examine health literacy among first-generation Chinese immigrants living in Australia, identifying health literacy domains associated with emergency department (ED) visits and self-rated health (SRH).

METHODS

Chinese immigrants (n = 362, mean age = 59) were recruited from communities across New South Wales and surveyed for health literacy, ED visits in the past 12 months, and SRH using the Health Literacy Questionnaire (simplified Chinese version).

RESULTS

More than 70% of participants experienced health literacy difficulties. Health literacy was significantly lower among the following participants: older, migration at older age, recent immigrants, and those without university level education or proficient English. ED visits were independently associated with the health literacy domains lacking 'social support for health' (OR: 1.80; p = .031) and 'ability to appraise health information' (OR: 2.22; p = .005). Poor SRH was associated with the health literacy domains 'insufficient health information' (OR: 1.81; p = .025), 'inactively managing health' (OR: 1.72; p = .048), and 'lacking ability to appraise health information' (OR: 1.70; p = .048).

CONCLUSIONS

Inadequate health literacy was identified in the majority of first-generation Chinese immigrants and it had significantly association with higher prevalence of ED use and poorer SRH.

PRACTICE IMPLICATIONS

Early screening and support for health literacy is critical in Chinese immigrants.

Changes in poor self-rated health status among elderly Koreans over 10 years: Community Health Survey 2008-2017

AIM

This study investigated the change in self-rated health (SRH) status among elderly Koreans and sought influential factors affecting SRH by reference to data collected during the Korean Community Health Survey 2008-2017.

METHODS

We obtained raw data from the Korea Community Health Survey for 10 years (2008-2017), which included sociodemographic and health information on Koreans aged ≥65 years (242 552 men and 349 586 women). SRH was measured using the SRH scale and divided into not-poor and poor. Logistic regression analyses of poor SRH were performed using a weighted sampling method and interaction models (year × variables) to represent the entire Korean elderly population and estimate the changes in poor SRH over time.

RESULTS

The proportion of elderly subjects in the population increased over 10 years. After adjusting for all confounding variables, the weighted adjusted odds ratios for poor SRH decreased consistently between 2008 and 2017 (men: 0.64, 95% confidence interval 0.50-0.81; women: 0.62, 0.46-0.83). The odds ratios for poor SRH were markedly higher in subjects who reported being stressed (men: 7.02, 5.89-8.38; women 6.14, 5.33-7.08) and those who lacked formal education (men: 2.42, 2.18-2.69; women 3.12, 2.59-3.75) over times.

CONCLUSIONS

Despite the increase in the proportion of the elderly, poor SRH among elderly Koreans decreased over the past 10 years. Poor SRH was associated with high-level perceived stress and a lower educational level in both elderly men and women. Geriatr Gerontol Int 2020; 20: 1190-1195.

CAUSES, mortality rates and risk factors of death in community-dwelling Europeans aged 50 years and over: Results from the Survey of Health, Ageing and Retirement in Europe 2013-2015

OBJECTIVE

To determine mortality rates and to rank the causes and predictors of mortality using a wide range of sociodemographic and clinical variables.

MATERIALS AND METHODS

It is a prospective population-based cohort study of adults living in the community, 2013-15 N = 48,691, age ≥50; deceased = 1,944. Clinical and sociodemographic data were obtained from the Survey of Health, Ageing and Retirement in Europe SHARE: Age, Gender, Marital Status, Years of Schooling, Income, Loneliness, Cognition, Self-Rated Health, Diseases, Activities of daily living ADL, and Frailty. Mortality rates were calculated. A Cox proportional hazards model were used to determine risk-adjusted mortality ratios.

RESULTS

The crude mortality rate was 18.39 (1000 person-years at risk), (99 % CI, 18.37-18.42). The factors most associated with an increased mortality risk were older age, lower self-rated health, lower cognition, male gender, ADL deficits, higher comorbidity, frailty and loneliness. The diseases with a higher mortality risk were: cancer (Hazard ratio, HR = 2.67), dementia (HR = 2.19), depressive symptoms (HR = 2.10), fractures (hip, femur) (HR = 1.57), stroke (HR = 1.55), chronic lung disease (HR = 1.52), diabetes (HR = 1.36) and heart attack (HR = 1.21).

CONCLUSIONS

The main mortality risk factors, associated independently in the eight diseases were: older age, poor self-rated health, ADL deficits, male gender, lower cognition, comorbidity and the presence of depressive symptoms, with a different influence in the European regions. The need to evaluate and treat the depressive symptoms that accompanies diseases with higher risk of mortality is stressed.

Psychosocial resources related to survival among non-robust community-dwelling older people: an 18-year follow-up study

Aim

To investigate whether psychosocial resources are associated with survival among non-robust community-dwelling older Finnish people during an 18-year follow-up.

Findings

Psychosocial resources, such as good self-rated health and regularly visiting other people, were significantly associated with better survival of non-robust older people.

Message

It is important to focus also on psychological well-being, together with physical activity and nutrition, of frail older people to remain or promoting their capacity.

Purpose

Psychosocial resources have been considered to be associated with survival among frail older adults but the evidence is scarce. The aim was to investigate whether psychosocial resources are related to survival among non-robust community-dwelling older people.

Methods

This is a prospective study with 10- and 18-year follow-ups. Participants were 909 non-robust (according to Rockwood’s Frailty Index) older community-dwellers in Finland. Psychosocial resources were measured with living circumstances, education, satisfaction with friendship and life, visiting other people, being visited by other people, having someone to talk to, having someone who helps, self-rated health (SRH) and hopefulness about the future. To assess the association of psychosocial resources for survival, Cox regression analyses was used.

Results

Visiting other people more often than once a week compared to that of less than once a week (hazard ratio 0.61 [95% confidence interval 0.44–0.85], p = 0.003 in 10-year follow-up; 0.77 [0.62–0.95], p = 0.014 in 18-year follow-up) and good SRH compared to poor SRH (0.65 [0.44–0.97], p = 0.032; 0.68 [0.52–0.90], p = 0.007, respectively) were associated with better survival in both follow-ups. Visiting other people once a week (compared to that of less than once a week) (0.77 [0.62–0.95], p = 0.014) was only associated with better 18-year survival.

Conclusions

Psychosocial resources, such as regularly visiting other people and good self-rated health, seem to be associated with better survival among non-robust community-dwelling Finnish older people. This underlines the importance of focusing also on psychosocial well-being of frail older subjects to remain or promote their resilience.

Self-rated health and objective health status as predictors of all-cause mortality among older people: a prospective study with a 5-, 10-, and 27-year follow-up

Background

Despite a non-specific nature of self-rated health (SRH), it seems to be a strong predictor of mortality. The aim of this study is to assess the association of SRH and objective health status (OH) with all-cause mortality in 70-year-old community-dwelling older people in Finland.

Methods

A prospective study with 5-, 10- and 27-year follow-ups. SRH (n = 1008) was assessed with a single question and OH (n = 962) by the Rockwood’s Frailty Index (FI). To assess the association of SRH and OH with mortality, Cox regression model was used.

Results

Of the 1008 participants, 138 (13.7%), 319 (31.6%), and 932 deceased (86.3%) during the 5-, 10- and 27-year follow-ups, respectively. In unadjusted models, subjects with poor SRH had almost eightfold risk for mortality compared to those with good SRH during the 5-year follow-up; among those with poor OH, the risk was fourfold compared to those with good OH. In the 10-year-follow up, both poor SRH and poor OH predicted about fourfold risk for mortality compared to those with good health. During the 27-year follow-up, OH was a stronger predictor of mortality than SRH. Poor SRH, compared to good SRH, showed 95% sensitivity and 34% specificity for 5-year mortality; corresponding figures for OH were 54 and 80%, respectively.

Conclusions

Single-item SRH seems to be able to capture almost the same as OH in predicting a short-term (less than 10 years) mortality risk among older adults in clinical settings. The use of SHR may also enhance the focus on patient-centered care.

Investigation of the Predictors of Self-rated Health of Economically Disadvantaged African American Men and Women: Evidence for Sponge Hypothesis

Background and aims

According to the sponge hypothesis, compared to men's self-rated health (SRH), women's SRH is more likely to reflect conditions other than chronic medical conditions (CMCs) such as psychiatric disorders (PDs). As a result, poor SRH is a weaker predictive factor for mortality risk for women than men. Most of this literature, however, is done in samples that are predominantly middleclass White. To test the sponge hypothesis among economically disadvantaged African Americans (AAs), this study compared low-income AA men and women for the effects of the number of PDs and CMCs on SRH.

Materials and Methods

This cross-sectional study recruited a non-random sample (n = 150) of economically disadvantaged AA adults with PD(s). Structured face-to-face interviews were used to collect data. SRH was measured using a single-item measure. PDs and CMCs were also self-reported. We applied linear regression models to test the interactions between SRH and the number of PDs and CMC as well as gender.

Results

The number of PDs and CMCs were associated with SRH in the pooled sample of low-income AA adults with PD(s). However, we found a significant interaction between the number of PDs and gender. This interaction suggested a stronger association between PDs and SRH for AA women than AA men. Gender did not alter the association between the number of CMCs and SRH.

Conclusion

The number of PDs is a determinant of SRH for low-income AA women but not AA men, supporting the sponge hypothesis.

Self-perception of physical health conditions and its association with depression and anxiety among Bangladeshi university students

BACKGROUND

Self-perception of physical health conditions is associated with depression and anxiety. Although some recent studies revealed a high prevalence of depression and anxiety among Bangladeshi university students, no study has yet investigated the link between self-perception of physical health and these common psychological disorders. Therefore, this study aimed to explore the association of self-perception of physical health conditions with depression and anxiety among university students in Dhaka, Bangladesh.

METHODS

A cross-sectional study was conducted between August and November 2017 among 897 undergraduate students of Jahangirnagar University, Dhaka through face-to-face interviews using a semi-structured questionnaire. Chi-square test and binary logistic regression analysis were used to examine the association between the variables.

RESULTS

13.9% of the respondents had poor self-rated health (SRH) and 49.9% had self-rated body image (SRBI) dissatisfaction. 25.6% of the students reported to be overweight/obese whereas 18.7% to be underweight. Poor and moderate SRH was found to be significantly associated with students' depression (adjusted odds ratio [AOR]: 6.700; 95% CI: 3.821-11.749 and AOR: 2.155; 95% CI: 1.582-2.934) and anxiety (AOR: 4.365; 95% CI: 2.599-7.332 and AOR: 1.776; 95% CI: 1.270-2.484). Furthermore, SRBI dissatisfaction, underweight SRBI, overweight/obese SRBI, low blood pressure and hypertension were also significantly linked with students' depression and anxiety.

CONCLUSION

Students dissatisfied with their physical health status had higher chances to suffer from depression and anxiety. The findings of this study would create room for further research and could be used to design a comprehensive health program for young students.

Prevalência de diagnóstico e tipos de câncer em idosos: dados da Pesquisa Nacional de Saúde 2013

Resumo Objetivo: Estimar a prevalência de diagnóstico médico de câncer em idosos, descrever os tipos de câncer, as limitações em atividades cotidianas, autopercepção da saúde e a relação com doenças/condições crônicas. Métodos: Estudo transversal de base populacional com dados de idosos (n=11.177) que participaram da Pesquisa Nacional de Saúde (PNS/2013). Estimaram-se as prevalências e os respectivos intervalos de confiança de 95%. Resultados: A média de idade foi de 69,8 anos (IC95%:69,5-70,1) e 56,4% (IC95%:54,8-58,0) eram mulheres. O diagnóstico de câncer foi referido por 5,6% (IC95%:5,0-6,4) dos idosos, sendo maior entre homens (7,1%) que em mulheres (4,7%; p<0,001). Os três principais tipos de câncer foram, nos homens: próstata (52,4%;IC95%:43,5-61,2), pele (13,9%;IC95%:9,1-20,6) e intestino (10,6%;IC95%:4,9-21,5); nas mulheres: mama (46,9%;IC95%:40,6-53,3), pele (17,3%;IC95%:14,2-20,8) e intestino (9,8%;IC95%:6,5-14,5). Cerca de 67% foram diagnosticados após os 60 anos, 33,0% referiram limitação decorrente da doença e 16,8% (IC95%:12,4-22,4) autoavaliaram sua saúde como ruim/muito ruim. A presença de limitação foi cerca de 31% maior naqueles com diagnóstico mais recente e a autopercepção da saúde foi pior naqueles com diagnóstico inferior a 5 anos. Nos idosos com câncer, observaram-se maiores prevalências de hipertensão arterial, doenças do coração, depressão e doenças respiratórias crônicas (p<0,05). Conclusão: Os achados mostram a prevalência de câncer nos idosos brasileiros, com diferenças entre os sexos, bem como a distribuição dos principais tipos e a idade do primeiro diagnóstico. Destaca-se a importância da hipertensão arterial, doenças do coração, depressão e doenças respiratórias, além de outras condições de vida e saúde dos idosos no cuidado oncogeriátrico.

Association between Hand Grip Strength and Self-Rated Health in Middle- and Old-Aged Korean Citizens

Background

To investigate the relationship between hand grip strength (HGS) and self-rated health in middleand old-aged Korean subjects.

Methods

The data used for this study were derived from the Korean Longitudinal Study of Aging. A total of 9,132 participants were enrolled using the year 2006 as the baseline, with additional data collected throughout the followup period until 2016. Chi-square test and generalized estimating equation regression models were used for data analysis. HGS was measured in a sitting position with the elbow fixed at 90° on both sides using a dynamometer, and calculated using the values measured from both sides. Relative HGS was measured by dividing HGS by the subject’s body mass index. Self-rated health was assessed with the question “How would you rate your current health in general?” and answers were categorized as “excellent,” “moderate,” or “poor.”

Results

HGS was shown to be inversely associated with self-rated health (odds ratio [OR], 0.94; 95% confidence interval [CI], 0.93–0.94; P<0.0001). Patients aged 65 years or older with lower scores were more likely to report poor self-rated health. Similar results were obtained with relative HGS (OR, 0.40; 95% CI, 0.36–0.45; P<0.0001), but standard HGS had better model fitting (quasi-likelihood under independence model criteria=33,890).

Conclusion

HGS may be considered an index for the diagnosis of sarcopenia and may also affect self-rated health, which is a multidimensional indicator of an individual’s health status and can identify patients who may require special attention.

Healthy ageing and the prediction of mortality and incidence dependence in low- and middle- income countries: a 10/66 population-based cohort study

BACKGROUND

In the absence of a consensus on definition and measurement of healthy ageing, we created a healthy ageing index tallying with the functional ability framework provided by the World Health Organization. To create this index, we employed items of functional ability and intrinsic capacity. The current study aims to establish the predictive validity and discrimination properties of this healthy ageing index in settings in Latin American, part of the 10/66 cohort.

METHODS

Population-based cohort studies including 12,865 people ≥65 years old in catchment areas of Cuba, Dominican Republic, Venezuela, Mexico and Peru. We employed latent variable modelling to estimate the healthy ageing scores of each participant. We grouped participants according to the quintiles of the healthy ageing score distribution. Cox's proportional hazard models for mortality and sub-hazard (competing risks) models for incident dependence (i.e. needing care) were calculated per area after a median of 3.9 years and 3.7 years, respectively. Results were pooled together via fixed-effects meta-analysis. Our findings were compared with those obtained from self-rated health.

RESULTS

Participants with lowest levels, compared to participants with highest level of healthy ageing, had increased risk of mortality and incident dependence, even after adjusting for sociodemographic and health conditions (HR: 3.25, 95%CI: 2.63-4.02; sub-HR: 5.21, 95%CI: 4.02-6.75). Healthy ageing scores compared to self-rated health had higher population attributable fractions (PAFs) for mortality (43.6% vs 19.3%) and incident dependence (58.6% vs 17.0%), and better discriminative power (Harrell's c-statistic: mortality 0.74 vs 0.72; incident dependence 0.76 vs 0.70).

CONCLUSION

These results provide evidence that our healthy ageing index could be a valuable tool for prevention strategies as it demonstrated predictive and discriminative properties. Further research in other cultural settings will assist moving from a theoretical conceptualisation of healthy ageing to a more practical one.

Development of a healthy ageing index in Latin American countries - a 10/66 dementia research group population-based study

BACKGROUND

Our population is ageing and in 2050 more than one out of five people will be 60 years or older; 80% of whom will be living in a low-and-middle income country. Living longer does not entail living healthier; however, there is not a widely accepted measure of healthy ageing hampering policy and research. The World Health Organization defines healthy ageing as the process of developing and maintaining functional ability that will enable well-being in older age. We aimed to create a healthy ageing index (HAI) in a subset of six low-and-middle income countries, part of the 10/66 study, by using items of functional ability and intrinsic capacity.

METHODS

The study sample included residents 65-years old and over (n = 12,865) from catchment area sites in Cuba, Dominican Republic, Peru, Venezuela, Mexico and Puerto Rico. Items were collected by interviewing participants or key informants between 2003 and 2010. Two-stage factor analysis was employed and we compared one-factor, second-order and bifactor models. The psychometric properties of the index, including reliability, replicability, unidimensionality and concurrent convergent validity as well as measurement invariance per ethnic group and gender were further examined in the best fit model.

RESULTS

The bifactor model displayed superior model fit statistics supporting that a general factor underlies the various items but other subdomain factors are also needed. The HAI indicated excellent reliability (ω = 0.96, ωΗ = 0.84), replicability (H = 0.96), some support for unidimensionality (Explained Common Variance = 0.65) and some concurrent convergent validity with self-rated health. Scalar measurement invariance per ethnic group and gender was supported.

CONCLUSIONS

A HAI with excellent psychometric properties was created by using items of functional ability and intrinsic capacity in a subset of six low-and-middle income countries. Further research is needed to explore sub-population differences and to validate this index to other cultural settings.

Quality of sleep, health and well-being in a population-based study

OBJECTIVE

To estimate the prevalence of poor self-rated sleep and to identify the population subgroups most susceptible to the problem.

METHODS

This is a cross-sectional, population-based study developed with data from the Health Survey conducted in the city of Campinas (ISACamp 2014/2015). Data from a sample of 1,998 individuals aged 20 years or older were analyzed. The self-rated quality of sleep was analyzed according to socio-demographic characteristics, morbidities, health behaviors and feeling of well-being. The association of sleep quality with different complaints and characteristics of sleep was also analyzed. Adjusted prevalence ratios were estimed using Poisson multiple regression model allowing for the sample weights.

RESULTS

Prevalence of poor self-rated sleep was 29.1% and showed to be significantly higher in women, in individuals aged from 40 to 50 years, migrants, without occupation, physically inactive in leisure context, with common mental disorder (PR = 1.59), with greater number of health problems (PR = 2.33), poor self-rated health (PR = 1.61), and life dissatisfaction. Poor sleep was strongly associated with reports of difficulty in initiating sleep (PR = 4.17), in maintaining sleep (PR = 4.40) and with never or almost never feeling well when waking up (PR = 4.52).

CONCLUSIONS

The results identify the population subgroups with poor quality of sleep that deserve greater attention. It also highlight the need to consider, in addition to the presence of comorbidities, mental health and the feeling of well-being in the care of patients with sleep problems and in the interventions planed for promoting healthy sleep.