[Self-perception of health and mortality in elderly from a rural community]

Health self-perception is associated with life-styles and comorbidities and its effect on mortality is confounded by age. A population based study

Background

Health self-perception (HSP) is the individual and subjective concept that a person has of their state of health. Despite its simplicity, HSP is considered a valid and relevant indicator employed in epidemiological research and in professional practice as an overall measure of health.

Objectives

(1) To describe and analyze the associations between HSP and demographic variables, lifestyle and diseases prevalent in a population and (2) to investigate the relationship between HSP and mortality.

Materials and methods

In a primary care setting, we conducted a longitudinal study of a random populational sample of a Galician municipality, stratified by decade of life. A total of 1,516 adults older than 18 years, recruited by the 2013-2015 AEGIS study, were followed-up for more than 5 years. During the clinical interview, data were collected on lifestyle and prevalent diseases. The HSP was grouped into 2 categories (good/poor). The statistical analysis consisted of a logistic regression, Kaplan-Meier curves and Cox regression.

Results

A total of 540 (35.6%) participants reported poor HSP. At the end of the follow-up, 78 participants had died (5.1%). The participants with increased age and body mass index and chronic diseases (anxiety, depression, ischemic heart disease, diabetes, and cancer) presented a poorer subjective health. A high level of physical activity and moderate alcohol consumption were associated with better HSP. A poorer HSP was associated with increased mortality, an association that disappeared after adjusting for the rest of the covariates (HR, 0.82; 95% CI 0.50-1.33).

Conclusion

(1) Health self-perception is associated with age, lifestyle, and certain prevalent diseases. (2) A poorer HSP is associated with increased mortality, but this predictive capacity disappeared after adjusting for potential confounders such as age, lifestyle, and prevalent diseases.

[Health inequalities in self-perceived health among older adults in Spain]

OBJECTIVE

Recent publications have concluded that there are social health inequalities in people older than 65 years in Spain, especially among women and people with low socioeconomic status. Self-perceived health is an indicator that is related to the possibility of chronic disease, the use of health services, and mortality. The aim of this study was to assess inequalities in self-perceived health in relation to age, gender, socioeconomic factors, and functional dependence.

METHODS

A systematic review was conducted following the PRISMA criteria. An exhaustive search was performed in PubMed, WOK, Science Direct, EMBASE, IME, Cochrane, JSTOR, Ovid, Proquest, the BMJ Group and in Spanish doctoral theses up to April 2013. The quality of the studies was assessed by two independent editors through the Berra Tool.

RESULTS

A total of 20 documents were selected. These studies were in agreement in the deterioration of self-perceived health among older people (except the oldest), in those with functional dependence, lower socioeconomic status, and in women.

CONCLUSIONS

This review shows that, among older people, inequalities in self-perceived health due to socioeconomic status and gender have persisted in time. Future research is needed to cast light on the factors determining the persistence of these inequalities among older people, so that specific health policies can be designed for this sector of the population.

The older the better: are elderly study participants more non-representative? A cross-sectional analysis of clinical trial and observational study samples

OBJECTIVE

Study participants can differ from the target population they are taken to represent. We sought to investigate whether older age magnifies such differences, examining age-trends, among study participants, in self-rated level of activity compared to others of the same age.

DESIGN

Cross-sectional examination of the relation of participant age to reported 'relative activity' (ie, compared to others of the same age), a bidirectionally correlated proxy for relative vitality, in exemplars of randomised and observational studies.

SETTING

University of California, San Diego (UCSD) PARTICIPANTS: 2404 adults aged 40-79 including employees of UCSD, and their partners (San Diego Population Study, observational study). 1016 adults (aged 20-85) not on lipid medications and without known heart disease, diabetes, cancer or HIV (UCSD Statin Study, randomised trial).

MEASUREMENTS

Self-rated activity relative to others' age, 5-point Likert Scale, was evaluated by age decade, and related via correlation and regression to a suite of health-relevant subjective and objective outcomes.

RESULTS

Successively older participants reported successively greater activity relative to others of their age (greater departure from the norm for their age), p<0.001 in both studies. Relative activity significantly predicted (in regression adjusted for age) actual activity (times/week exercised), and numerous self-rated and objective health-predictors. These included general self-rated health, CES-D (depression score), sleep, tiredness, energy; body mass index, waist circumference, serum glucose, high-density lipoprotein-cholesterol, triglycerides and white cell count. Indeed, some health-predictor associations with age in participants were 'paradoxical,' consistent with greater apparent health in older age-for study participants.

CONCLUSIONS

Study participants may not be representative of the population they are intended to reflect. Our results suggest that departures from representativeness may be amplified with increasing age. Consequently, the older the age, the greater the disparity may be between what is recommended based on 'evidence, ' and what is best for the patient.

TRIAL REGISTRATION

UCSD Statin Study-Clinicaltrials.gov # NCT00330980 (http://ClinicalTrials.gov).

[Quality of life in noninstitutionalized persons older than 65 years in two health care districts in Madrid]

AIM

To describe self-perceived health status and quality of life in noninstitutionalized persons older than 65 years in two health care districts in Madrid (central Spain).

DESIGN

Descriptive study based on home interviews by investigators trained in the administration of the questionnaires.

SETTING

Health care districts 2 and 4 in Madrid; community level.

PARTICIPANTS

Of a sample of 2002 persons older than 65 years residing in private homes, we obtained 911 valid questionnaires.

MAIN MEASURES

Description and stratification by age group and sex, for sociodemographic variables, economic resources, social and familial support, physical and mental health, functional capacity and results on the EuroQol and Nottingham Health Profile (NHP) questionnaires.

RESULTS

Mean age, 74.7 years (95% CI, 74.3%75.1%); women, 59.7% (95% CI, 56.4%-62.9%); no formal education, 41% (95% CI, 37.7%-44.2%); social classes I and II, 38.3% (95% CI, 35.1%-41.6%). Self-perceived health status good or very good, 52.1% (95% CI, 48.8%-55.4%), 57.5% (95% CI, 52.2%-62.6%) in men and 48.4% (95% CI, 44.2%-52.7%) in women. Mean scores on the NHP were: energy, 21.1 (95% CI, 18.9%23.2%); pain, 25.6 (95% CI, 23.6%27.6%); physical mobility, 28 (95% CI, 26.4%29.7%); sleep, 31.8 (95% CI, 29.4%34.1%); emotional reaction, 24.5 (95% CI, 22.8%26.3%); social isolation, 10.9 (95% CI, 9.6%12.1%). The percentages of persons with problems according to the EuroQol instrument were: mobility, 21.3% (95% CI, 18.7%-24.1%); self-care, 7.7% (95% CI, 6.1%-9.7%); usual activities, 19.9% (95% CI, 17.4%-22.7%); pain/discomfort, 38.2% (95% CI, 35%-41.4%); anxiety/depression, 27% (95% CI, 24.1%-30%). Both the NHP and the EuroQol instrument identified more problems in women than in men, and in persons older than 80 years compared to persons younger than 80 years.

CONCLUSIONS

Women had a worse perceived health status and quality of life than men. Persons older than 80 years scored worse on the NHP and the EuroQol, but did not perceive their health status to be worse.