Self-perceived health status in older adults: regional and sociodemographic inequalities in Spain

Self-Reported Health Inequalities among Older Adults in Saudi Arabia

Considering the rising life expectancy, the growing population of older adults poses challenges in providing adequate healthcare services. Self-reported health is an important indicator of overall health, predicting morbidity and mortality. This study investigated self-reported health inequalities among older adults in Saudi Arabia and the underlying factors contributing to establishing such inequalities. The study utilized data from the 2018 Saudi Family Health Survey, focusing on 2023 respondents aged ≥60 years with complete data. Univariate, bivariate, and multivariate logistic regression analyses were employed to explore socio-economic factors linked to health inequalities. Additionally, concentration curves and indices were used to assess the magnitude of health inequalities among older adults. The findings indicate a higher prevalence of self-reported poor health among respondents aged ≥70 years and those with chronic diseases. Age, education, income level, marital status, and insurance coverage were other factors significantly linked to reporting poor health. Inequality analysis revealed a concentration of poor health among less educated individuals (concentration index = -0.261, p < 0.01). Both income- and education-based indices highlighted a concentration of poor health among men with lower income and education levels. Addressing healthcare inequalities among older adults requires targeted policy efforts, focusing on those aged ≥70, unmarried individuals, those without insurance coverage, those with chronic illnesses, and those with lower education levels. Targeted interventions for these groups can address their unique healthcare needs and promote equitable health outcomes.

A nationwide study on sleep complaints and associated factors in older adults: ELSI-Brazil

Sleep problems, such as difficulty falling asleep, staying asleep, early awakening with failure to continue sleep, and altered sleep-wake cycle, are common in the general population. This cross-sectional study with 6,929 older adults (≥ 60 years) aimed to estimate the prevalence of different types of sleep problems, their associated factors, and the population-attributable fraction of associated factors among older adults. The outcome variables consisted of self-reported sleep problems: insomnia (initial, intermediate, late, and any type of insomnia), poor sleep quality, and daytime sleepiness. The independent variables were sociodemographic and behavioral characteristics and health conditions. The prevalence proportions were initial insomnia (49.1%), intermediate insomnia (49.2%), late insomnia (45.9%), any type of insomnia (58.6%), poor sleep quality (15.6%), and daytime sleepiness (38.4%). Female sex, presence of two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health were positively associated with the sleep problems investigated. Consuming alcohol once a month or more was inversely associated with initial insomnia. Population attributable fraction estimates ranged from 3% to 19% considering two or more chronic diseases, not eating the recommended amount of fruits and vegetables, and regular and bad/very bad self-rated health. High prevalence of self-reported sleep problems was evinced in older adults. These results can be useful to guide public health services in the creation of informational, evaluative, and screening strategies for sleep problems in older Brazilian adults.

Aging and self-reported health in 114 Latin American cities: gender and socio-economic inequalities

Background

Understanding how urban environments influence people’s health, especially as individuals age, can help identify ways to improve health in the rapidly urbanizing and rapidly aging populations.

Objectives

To investigate the association between age and self-reported health (SRH) in adults living in Latin-American cities and whether gender and city-level socioeconomic characteristics modify this association.

Methods

Cross-sectional analyses of 71,541 adults aged 25–97 years, from 114 cities in 6 countries (Argentina, Brazil, Colombia, Chile, El Salvador, and Guatemala), as part of the Salud Urbana en America Latina (SALURBAL) Project. We used individual-level age, gender, education, and self-reported health (SRH) data from harmonized health surveys. As proxies for socioeconomic environment we used a city-level socioeconomic index (SEI) calculated from census data, and gross domestic product (GDP) per-capita. Multilevel Poisson models with a robust variance were used to estimate relative risks (RR), with individuals nested in cities and binary SRH (poor SHR vs. good SRH) as the outcome. We examined effect modification by gender and city-level socioeconomic indicators.

Results

Overall, 31.4% of the sample reported poor SRH. After adjusting for individual-level education, men had a lower risk of poor SRH (RR = 0.76; CI 0.73–0.78) compared to women, and gender modified the association between age and poor SRH (p-value of interaction < 0.001). In gender stratified models, the association between older age and poor SRH was more pronounced in men than in women, and in those aged 25–65 than among those 65+ (RR/10 years = 1.38 vs. 1.10 for men, and RR/10 years = 1.29 vs. 1.02 for women). Living in cities with higher SEI or higher GDP per-capita was associated with a lower risk of poor SRH. GDP per-capita modified the association between age (25–65) and SRH in men and women, with SEI the interaction was less clear.

Conclusions

Across cities in Latin America, aging impact on health is significant among middle-aged adults, and among men. In both genders, cities with lower SEI or lower GDP per-capita were associated with poor SRH. More research is needed to better understand gender inequalities and how city socioeconomic environments, represented by different indicators, modify exposures and vulnerabilities associated with aging.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13752-2.

Exploring the most important factors related to self-perceived health among older men in Sweden: a cross-sectional study using machine learning

OBJECTIVE

To evaluate which factors are the most strongly related to self-perceived health among older men and describe the shape of the association between the related factors and self-perceived health using machine learning.

DESIGN AND SETTING

This is a cross-sectional study within the population-based VAScular and Chronic Obstructive Lung disease study (VASCOL) conducted in southern Sweden in 2019.

PARTICIPANTS

A total of 475 older men aged 73 years from the VASCOL dataset.

MEASURES

Self-perceived health was measured using the first item of the Short Form 12. An extreme gradient-boosting model was trained to classify self-perceived health as better (rated: excellent or very good) or worse (rated: fair or poor) using self-reported data on 19 prevalent physician-diagnosed health conditions, intensity of 9 symptoms and 9 demographic and lifestyle factors. Importance of factors was measured in SHapley Additive exPlanations absolute mean and higher scores correspond to greater importance.

RESULTS

The most important factors for classifying self-perceived health were: pain (0.629), sleep quality (0.595), breathlessness (0.549), fatigue (0.542) and depression (0.526). Health conditions ranked well below symptoms and lifestyle variables. Low levels of symptoms, good sleep quality, regular exercise, alcohol consumption and a body mass index between 22 and 28 were associated with better self-perceived health.

CONCLUSIONS

Symptoms are more strongly related to self-perceived health than health conditions, which suggests that the impacts of health conditions are mediated through symptoms, which could be important targets to improve self-perceived health. Machine learning offers a new way to assess composite constructs such as well-being or quality of life.

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.

[Self-perceived health in Spanish and Portuguese young seniors after the great recession according to the European Health Survey: A cross-sectional study]

OBJECTIVE

The aim of this study is to describe self-perceived health (SPH) in Spanish and Portuguese population aged between 65 and 74years old and to analyze other associated factors measured in the European Health Interview Survey (EHIS) in 2014.

DESIGN

Retrospective secondary data analysis from EHIS 2014.

SETTING

Community based.

PARTICIPANTS

Young seniors, people aged 65-74years old surveyed and with available data from two countries.

MAIN MEASUREMENTS

For each country and sex, SPH, sociodemographic variables, clinical chronic conditions, lifestyles and utilization of health care resources were described. A multiple logistic regression (very good or good SPH versus remaining levels) with robust estimators was used to assess the country effect adjusted by sociodemographic factors, clinical factors and/or lifestyles.

RESULTS

Good SPH showed variation by country (52.9% Spain vs. 19% Portugal; P<.001) and gender (44% men vs. 31.3% women; P<.001). Both countries had high prevalence of multimorbidity (64.7% Spain vs. 76.3% Portugal; P<.001) and the distribution of chronic diseases was similar with the only exception of depression (13.2% Spain vs. 20.3% Portugal; P<.001). Regarding individual factors related with good SPH we found Spanish nationality (OR: 4.52; 95%CI: 4.05-5.04), male gender (OR: 1.10; 95%CI: 1.101-2.21), education level, completing primary school (OR: 1.28; 95%CI: 1.24-1.31) or achieving tertiary level (OR: 2.43; 95%CI: 1.14-5.17) and physical activity of two or more days per week (OR: 1.87; 95%CI: 1.39-2.5). Factors with a negative impact on SPH were multimorbidity (OR: 0.19; 95%CI: 0.12-0.31) and depression (OR: 0.32; 95%CI: 0.25-0.41).

DISCUSSION

Good SPH is higher in Spanish young seniors compared to Portuguese. Having higher level of education achieved and practicing regular physical exercise were two most important factors increasing good SPH.

Self-rated health inequalities in the intersection of gender, social class and regional development in Spain: exploring contributions of material and psychosocial factors

Background

Inequalities in health across social class, gender and regional context in Spain are well-known; however, there is a lack of research examining how these dimensions of inequality interact. This study explores self-rated health (SRH) inequalities across intersectional positions of gender, social class and region, and the contribution of material and psychosocial factors to these inequalities.

Methods

Participants were drawn from the cross-sectional 2015 National Living Conditions Survey of Spanish residents aged 19–88 years (N = 27,215; 77% response rate). Eight intersectional positions were formed by combining dichotomous variables of gender, social class and regional development. Poisson regression was used to estimate intersectional inequalities in SRH as prevalence ratios, and the contributions of material and psychosocial factors.

Results

Results showed both cumulative and heterogeneous inequalities within and across intersectional positions. Inequalities in the intersection of social class and regional development were best explained by the joint contributions of material and psychosocial factors, while gender inequalities within non-manual social class were better explained by material factors alone.

Conclusions

The results illustrate the complexity of interacting inequalities in health and their underpinnings in Spain. Local and national policies taking this complexity into account are needed to broadly improve equity in health in Spain.

[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.

Frailty, profile and cognition of elderly residents in a highly socially vulnerability area

This study aimed to associate frailty with sociodemographic profile and cognition of elderly people living in highly socially vulnerable contexts registered at a Social Assistance Referral Centers in a city of inland São Paulo. This is a cross-sectional and quantitative study with 48 elderly. Data was collected with a sociodemographic interview, the Edmonton Frail Scale and the Montreal Cognitive Assessment, and was analyzed with the Jonckheere-Terpstra test, Spearman's correlation and logistic regression (α = 5.0%). This study was approved under Opinion Nº 72182. Of the 48 elderly interviewed, 33.4% were non-frail, 20.8% were apparently vulnerable and 45.8% were frail at some level (mild, moderate or severe). Women (OR = 4.64) and nonwhites (OR = 3.99) were more likely of being frail. The realms with the greatest influence in the determination of frailty were cognition, independence and functional performance, general health and mood, although gender (p = 0.0373) and ethnicity (p = 0.0284) had a significant association. Worth highlighting is that considering the frailty profile of the elderly warrants the development of specific care strategies for this segment of the population in a vulnerable area, preventing futures complications.

[Social inequalities in health among the elderly population: review of indicators used in Spain]

OBJECTIVE

To identify the indicators of social position used to evaluate inequalities in health among the population aged 65 and over in Spain.

METHOD

A systematic search of the literature published in English and Spanish since 2000 in health and social databases was carried out. Primary and secondary studies analyzing these inequalities in Spain were included. The indicators used were identified, as well as the advantages and limitations pointed out by the authors. The main findings were synthesized in a review of the literature.

RESULTS

We included 87 studies, described in 89 articles. The socioeconomic indicators employed were both individual and ecological. Among the former, educational level was the most analyzed socioeconomic variable (n=73). Other individual variables used were occupation (n=17), objective economic level (n=16), subjective economic level (n=4), housing and household material wealth (n=6), relationship with work activity (n=5), and mixed measures (n=5). Among the ecological indicators, simple (n=3) and complex indices (n=7) were identified. The latter had been constructed based on several indicators, such as educational level and unemployment. Inequalities in multiple health indicators were analyzed, self-perceived health being the only indicator assessed according to all the socioeconomic indicators described.

CONCLUSIONS

A wide variety of indicators is identified for the evaluation of social inequalities in health among the elderly population. There have not been sufficiently assessed from a gender perspective; this is a line of interest for future research.

The Disease Burden Morbidity Assessment in older adults and its association with mortality and other health outcomes

The objective of this study was to assess how disease burden caused by chronic conditions is related to mortality (predictive validity) and other health outcomes (convergent validity). This was studied in 625 community-dwelling adults living in Spain aged 65 years and older. Disease burden was measured with the Disease Burden Morbidity Assessment (DBMA). The association with 5-year mortality was assessed using a Cox model and Kaplan-Meier curves. For convergent validity, mean age, sex ratio, patient-centered outcomes and healthcare utilization were compared for high and low DBMA scores (< 10 vs. ≥ 10). Also, a multivariable linear regression model was used to evaluate the DBMA as a function of these variables. Mean DBMA score in our sample was 7.5. After 5 years, 35 participants had died (5.5%). The Cox model displayed a hazard ratio of 1.07, and the Kaplan-Meier curves showed lower survival for high DBMA scores. Among participants with high DBMA scores, low self-perceived health, disability and female sex were more frequent, and this group showed lower mean scores for quality of life (Personal Wellbeing Index), affect balance (Scale of Positive and Negative Experience) and physical activity (Yale Physical Activity Survey), higher mean age and higher healthcare utilization than persons with low DBMA scores. In the multivariable regression, all variables but age were significantly associated with the DBMA. In conclusion, the DBMA showed satisfactory predictive and convergent validity. In our aging society, it can be applied to better understand and improve care for older persons with multiple chronic conditions.

Geographical Differences in Perceived Health Status Among Older Adults in Ghana: Do Gender and Educational Status Matter?

Studies have constantly reported mixed evidence on the associations between rural/urban differences and self-rated health (SRH) status among older populations. More importantly, the roles of other relevant sociodemographic characteristics such as gender and educational levels in these associations are mostly overlooked. The current study examines the geographical differences in SRH of older cohorts in Kumasi Metropolis and Bosomtwe District of Ghana. Data from a Spatial Health and Healthcare Study (SHHS) were analyzed using chi-square test and ordinal logistic regression models. Although the study discovered a statistically significant difference in SRH between the rural and urban samples, the multivariate analysis found insignificant effect in SRH between urban and rural samples after adjusting for theoretically relevant covariates. However, the interactions indicated that this association significantly strengthens for rural dwellers who were highly educated. Moreover, age, average monthly income, reporting sickness in the past 90 days, and not noticing any change in health status in retrospective to 12 months were independent predictors of SRH. Effective interventions through collaborative efforts by the Ghanaian sociopolitical structure and micro-level dynamics are needed to ensure holistic improvements in health outcomes among vulnerable older persons.

Association of sleep quality with excessive daytime somnolence and quality of life of elderlies of community

Background

The progressive increase in the elderly population contributes to the fact that studies on human aging have important attention of health professionals and government agents, since they present a great challenge regarding public health. Our objective is to characterize the profile of older people with poor sleep quality and analyze possible associations with excessive daytime somnolence, quality of life and functional mobility.

Methods

This is a cross-sectional descriptive study, involving elderlies of the community, with the questionnaires Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, WHOQOL-OLD and application of the Timed Up and Go test - TUG. Descriptive statistics, Student’s t test for paired samples and Pearson’s correlation coefficient (p ≤ 0.05) were used.

Results

We recruited 131 elderly people, predominantly female (87%); mean age 68 ± 7 years, low per capita income (84.8% ≤ 2 minimum wage), low education (86.3% ≤ 3 years of study), and mostly staying with relatives (67.9%), married (39.7%) or amassed (35.9%). Seventy-one percent of the sample is above normal weight, 90.1% of women have an abdominal circumference ≥ 80 cm and a high prevalence of chronic and psychosocial diseases was identified in the self-report, and the risk of obstructive sleep apnea in 38.2%. The mean PSQI, Epworth Sleepiness Scale, WHOQOL-OLD and TUG were equal to, respectively, 11.2 ± 3.2; 8.32 ± 2.2; 84.8 ± 10.2 and 8.97 ± 2. An association of sleep quality with excessive daytime somnolence and quality of life, while not with functional mobility, was observed.

Conclusion

The results of the present study allowed to identify a sleep quality associated with excessive daytime somnolence and quality of life and also to characterize the profile of elders with poor sleep quality.

Effect of Health Literacy on Health Perception: An Application in Individuals at Age 65 and Older

This study has been conducted to look through the effects of health literacy levels of individuals age 65 years and older on their health perceptions. The application part of study is composed of persons being age 65 years or older who live in Burdur province and districts of Turkey. The sampling of study has been determined by a nonclustered, single-step random probability sampling method based on primary mass ratios. Thereby, totally 611 questionnaires have been implemented by means of the face-to-face interview method. As a result of the analyses carried out, the subdimensions of health literacy explain 16.3% of total variance on the importance of health, 6.4% of total variance on the center of control, 10.8% of total variance on the self-awareness, and 16.1% of total variance on the certainty. In addition, it has been identified that the correlations of health literacy subdimensions with the health perception subdimensions were statistically significant, in the same direction, at low and medium level. These results show that the health literacy sub-dimensions is an important determinant on the health perception dimensions.

Gender differences in psychosocial predictors of self-perceived health status in the elderly: Evidence from a Brazilian community study

This article aims to identify the psychosocial factors associated with self-perceived health status in the Brazilian elderly population and to present differences related to gender. The data were collected by questionnaire, including sociodemographic and behavioral questions, and scales for psychological dimensions. Self-perceived health status is related to level of education, physical activity, and self-efficacy in the total population. Regarding gender differences, self-rated health status among men is related to education level and self-efficacy and in women to level of education, physical activity, social support, and self-efficacy. These results can inform future health promotion interventions.

[Association between self-reported health and sociodemographic characteristics with cardiovascular diseases in adults]

OBJECTIVE

To assess the association of sociodemographic and self-rated health in the presence of cardiovascular diseases and the association of this perception with the type of disease.

METHODS

A cross-sectional population survey study carried out with 1,232 individuals aged between 20 and 59 years of both genders living in the metropolitan region of Maringá-PR. Data were analyzed using multiple and simple logistic regression.

RESULTS

In multivariate analysis, the age range and self-rated health were associated with cardiovascular disease, and in the univariate analysis self-rated regular health was associated with arterial hypertension, while self-rated poor health was associated to heart failure, stroke, and to acute myocardial infarction (heart attack).

CONCLUSION

The differences in association of self-rated health with these diseases can indicate how individuals with certain characteristics cope with the disease, allowing for more individualized and specific health care.

Determinants of Quality of Life in Ageing Populations: Results from a Cross-Sectional Study in Finland, Poland and Spain

Purpose

To comprehensively identify the determinants of quality of life (QoL) in a population study sample of persons aged 18–50 and 50+.

Methods

In this observational, cross-sectional study, QoL was measured with the WHOQOL-AGE, a brief instrument designed to measure QoL in older adults. Eight hierarchical regression models were performed to identify determinants of QoL. Variables were entered in the following order: Sociodemographic; Health Habits; Chronic Conditions; Health State description; Vision and Hearing; Social Networks; Built Environment. In the final model, significant variables were retained. The final model was re-run using data from the three countries separately.

Results

Complete data were available for 5639 participants, mean age 46.3 (SD 18.4). The final model accounted for 45% of QoL variation and the most relevant contribution was given by sociodemographic data (particularly age, education level and living in Finland: 17.9% explained QoL variation), chronic conditions (particularly depression: 4.6%) and a wide and rich social network (4.6%). Other determinants were presence of disabling pain, learning difficulties and visual problems, and living in usable house that is perceived as non-risky. Some variables were specifically associated to QoL in single countries: age in Poland, alcohol consumption in Spain, angina in Finland, depression in Spain, and self-reported sadness both in Finland and Poland, but not in Spain. Other were commonly associated to QoL: smoking status, bodily aches, being emotionally affected by health problems, good social network and home characteristics.

Conclusions

Our results highlight the importance of modifiable determinants of QoL, and provide public health indications that could support concrete actions at country level. In particular, smoking cessation, increasing the level of physical activity, improving social network ties and applying universal design approach to houses and environmental infrastructures could potentially increase QoL of ageing population.

The geographic pattern of Belgian mortality: can socio-economic characteristics explain area differences?

Background

Country averages for health outcomes hide important within-country variations. This paper probes into the geographic Belgian pattern of all-cause mortality and wishes to investigate the contribution of individual and area socio-economic characteristics to geographic mortality differences in men aged 45–64 during the period 2001–2011.

Methods

Data originate from a linkage between the Belgian census of 2001 and register data on mortality and emigration during the period 2001–2011. Mortality rate ratios (MRRs) are estimated for districts and sub-districts compared to the Belgian average mortality level using Poisson regression modelling. Individual socio-economic position (SEP) indicators are added to examine the impact of these characteristics on the observed geographic pattern. In order to scrutinize the contribution of area-level socio-economic characteristics, random intercepts Poisson modelling is performed with predictors at the individual and the sub-district level. Random intercepts and slopes models are fitted to explore variability of individual-level SEP effects.

Results

All-cause MRRs for middle-aged Belgian men are higher in the geographic areas of the Walloon region and the Brussels-Capital Region (BCR) compared to those in the Flemish region. The highest MRRs are observed in the inner city of the BCR and in several Walloon cities. Their disadvantage can partially be explained by the lower individual SEP of men living in these areas. Similarly, the relatively low MRRs observed in the districts of Halle-Vilvoorde, Arlon and Virton can be related to the higher individual SEP. Among the area-level characteristics, both the percentage of men employed and the percentage of labourers in a sub-district have a protective effect on the individual MRR, regardless of individual SEP. Variability in individual-level SEP effects is limited.

Conclusions

Individual SEP partly explains the observed mortality gap in Belgium for some areas. The percentage of men employed and the percentage of labourers in a sub-district have an additional effect on the individual MRR aside from that of individual SEP. However, these socio-economic factors cannot explain all of the observed differences. Other mechanisms such as public health policy, cultural habits and environmental influences contribute to the observed geographic pattern in all-cause mortality among middle-aged men.

Electronic supplementary material

The online version of this article (doi:10.1186/s13690-016-0135-y) contains supplementary material, which is available to authorized users.

Socio-economic position and subjective health and well-being among older people in Europe: a systematic narrative review

OBJECTIVES

Previous studies of older European populations have established that disability and morbidity vary with indicators of socio-economic position (SEP). We undertook a systematic narrative review of the literature to ascertain to what extent there is evidence of similar inequalities in the subjective health and well-being of older people in Europe.

METHOD

Relevant original research articles were searched for using Medline, Global Health, Embase, Social Policy and Practice, Cinahl, Web of Science and International Bibliography of the Social Sciences (IBSS). We included studies of SEP and indicators of subjective health and well-being (self-rated health; life satisfaction; quality of life) conducted since 1991 using population-based samples of older people in Europe and published 1995-2013.

RESULTS

A total of 71 studies were identified. Poorer SEP was associated with poorer subjective health and well-being. Associations varied somewhat depending on the SEP measure and subjective health and well-being outcome used. Associations were weaker when social support and health-related behaviours were adjusted for suggesting that these factors mediate the relationship between SEP and subjective health and well-being. Associations tended to be weaker in the oldest age groups. The patterns of associations by gender were not consistent and tended to diminish after adjusting for indicators of health and life circumstances.

CONCLUSION

The results of this systematic narrative review of the literature demonstrate the importance of social influences on later life subjective health and well-being and indicate areas which need further investigation, such as more studies from Eastern Europe, more longitudinal studies and more research on the role of mediating factors.

[Profile of the elderly who naps]

This study aimed to characterize the elderly who naps according to sociodemographic characteristics and frailty. A descriptive, cross-sectional study part of the multicenter project Frailty in the Elderly Brazilians. We evaluated 1,866 elderly people using a sociodemographic questionnaire. The frailty was assessed using the phenotype proposed by Fried. The data were analyzed with descriptive statistics. The results showed that the profile of the elderly who naps consists predominantly of women, married, retired, pre-frail, with an average age of 73 years, four years of study, with monthly family income of 3.9 minimum salary, with 4,4 children who were living with them only. The elderly reported napping on average 5.9 days per week, lasting 53.5 minutes per nap. Knowing the profile of the elderly who naps contributes to health professionals in the development of actions in relation to sleep problems of the frail/pre-frail elderly, preventing, minimizing or solving these problems.