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.

Discrimination ability of comorbidity, frailty, and subjective health to predict mortality in community-dwelling older people: Population based prospective cohort study

OBJECTIVE

To investigate the added value of comorbidity, frailty, and subjective health to mortality predictions in community-dwelling older people and whether it changes with increasing age.

PARTICIPANTS

36,751 community-dwelling subjects aged 50-100 from the longitudinal Survey of Health, Ageing, and Retirement in Europe.

METHODS

Mortality risk associated with Comorbidity Index, Frailty Index, Frailty Phenotype, and subjective health was analysed using Cox regression. The extent to which health indicators modified individual mortality risk predictions was examined and the added ability to discriminate mortality risks was assessed.

MAIN OUTCOME MEASURES

Three-year mortality risks, hazard ratios, change in individual mortality risks, three-year area under the receiver operating characteristic curve (AUC).

RESULTS

Three-year mortality risks increased 41-folds within an age span of 50years. Hazard ratios per change in health indicator became less significant with increasing age (p-value<0·001). AUC for three-year mortality prediction based on age and sex was 76·9% (95% CI 75·5% to 78·3%). Information on health indicators modified individual three-year mortality risk predictions up to 30%, both upwards and downwards, each adding <2% discriminative power. The added discrimination ability of all health indicators gradually declined from an extra 4% at age 50-59 to <1% in the oldest old. Trends were similar for one-year mortality and not different between sexes, levels of education, and household income.

CONCLUSION

Calendar age encompasses most of the discrimination ability to predict mortality. The added value of comorbidity, frailty, and subjective health to mortality predictions decreases with increasing age.