Self-reported physical health among aged adults

Normal isn't normal: On the medicalization of health

BACKGROUND

This study investigated the proportion of the U.S. population classified as healthy based on 10 common indicators, examined in two ways: (1) above or below (in the healthy direction) the sample median (termed "normal"), and (2) below diagnostic cut-off points for clinical caseness or high risk (termed "ideal").

METHODS

Data are from the 2017-March 2020 round of the National Health and Nutrition Examination Survey (NHANES). Sample sizes ranged from 3,956 to 8,961 for respective health indicators, with a total of 3,102 respondents for two weighted multi-item measures described below. Measures included the Alameda 5 health behaviors (smoking, drinking exercising, sleeping, and body mass index) and five standard biomarkers (systolic and diastolic blood pressure, resting heart rate, fasting glucose, and total cholesterol). Besides point prevalences for the normal and ideal categories for each indicator, we also calculated the proportion healthy for all 10 indicators, again calculated both ways, termed "meta-normal" and "meta-ideal."

RESULTS

The prevalence of meta-normality was 1.05%, suggesting that hardly any adult Americans are completely healthy according to population norms. Findings for meta-ideality showed that while most Americans are not clinical cases for any respective indicator, only 5.55% met the official criteria for being healthy according to all 10 indicators.

CONCLUSION

Most Americans appear healthy according to nearly all key health indicators and biomarkers, according to "normal" or "ideal" criteria. However, the proportion healthy according to all measures is extremely small. Relatively few U.S. adults are completely healthy according to clinical criteria (meta-ideal), and even fewer are completely healthy according to population norms (meta-normal). Results are interpreted through sociological writing on medicalization.

Beyond the treatment: The role of race, sex, and education in health trajectories between cancer survivors and noncancer older adults

INTRODUCTION

The number of older, long-term cancer survivors is increasing. However, little is known about how cancer and aging affect the health trajectories of older adults differently. In addition, the impact of race, sex, and education on the processes of aging and the cancer experience needs further investigation. The current study aims to address this knowledge gap by combining two National Cancer Institute (NIC)-funded longitudinal studies conducted in Cleveland from 1998 to 2010.

MATERIALS AND METHODS

The unique cross-sequential design facilitates a comparison between the health changes in long-term (five years +) older cancer survivors (breast, prostate, and colorectal cancer) and demographically matched older adults without a history of cancer in the same geographic area within the same period. The study also captured comprehensive information on how socioeconomic status interacts with cancer and aging over time. General linear models were employed in the data analysis.

RESULTS

The findings showed that early cancer experience did not affect long-term cancer survivors' health status in later life. Conversely, comorbidities, being an African American, being female, and having education less than a college degree significantly decreased the health trajectory in later life for all older adults. Moreover, compared to other groups, older African American cancer survivors reported a dramatic decrease in self-reported health after controlling for other conditions.

DISCUSSION

Study findings can inform public policy and social services to offer comprehensive treatment plans and help individuals overcome their diseases and lead longer and healthier lives.

How do individual, social, environmental, and resilience factors shape self-reported health among community-dwelling older adults: a qualitative case study

BACKGROUND

While older adults are living longer, they often face health challenges, including living with multiple chronic conditions. How older adults respond and adapt to the challenges of multimorbidity to maintain health and wellness is of increasing research interest. Self-reported health, emerging as an important measure of health status, has broad clinical and research applications, and has been described as a predictor of future morbidity and mortality. However, there is limited understanding of how individual, social, and environmental factors, including those related to multimorbidity resilience, influence self-reported health among community-dwelling older adults (≥ 65 years).

METHODS

Informed by the Lifecourse Model of Multimorbidity Resilience, this explanatory case study research explored older adults' perceptions of how these factors influence self-reported health. Data were generated through semi-structured telephone interviews with community-dwelling older adults.

RESULTS

Fifteen older adults participated in this study. Four key themes, specific to how these older adults describe individual, social, environmental, and multimorbidity resilience factors as shaping their self-reported health, were identified: 1) health is a responsibility - "What I have to do"; 2) health is doing what you want to do despite health-related limitations - "I do what I want to do"; 3) the application and activation of personal strengths - "The way you think", and; 4) through comparison and learning from others - "Looking around at other people". These themes, while distinct, were found to be highly interconnected with recurring concepts such as independence, control, and psychological health and well-being, demonstrating the nuance and complexity of self-reported health.

CONCLUSIONS

Findings from this study advance understanding of the factors that influence assessments of health among community-dwelling older adults. Self-reported health remains a highly predictive measure of future morbidity and mortality in this population, however, there is a need for future research to contribute additional understanding in order to shape policy and practice.

Complex PTSD in Chinese Adolescents Exposed to Childhood Trauma: A Latent Profile Analysis

Although numerous studies have supported the idea that complex posttraumatic stress disorder (CPTSD) is a distinct disorder from posttraumatic stress disorder (PTSD) and demonstrated that childhood interpersonal trauma is an important risk factor for CPTSD, few studies have examined the validity of CPTSD in adolescents, especially in non-Western contexts. Moreover, the question of which form of child maltreatment plays the most important role in predicting CPTSD, and how CPTSD is associated with psychological health, physical health, and social function among adolescents, is not clear. The present study used a Chinese high school student sample with childhood trauma experiences (N = 395) to address these questions. Latent profile analysis indicated that there were four subgroups in our sample: Low symptoms (54.43%), Disturbance of self-organization (DSO, 18.99%), PTSD (15.95%), and CPTSD (10.63%). Further analysis revealed that emotional abuse was an important risk factor for CPTSD. In addition, the CPTSD class showed the highest levels of depression, anxiety, and stress, as well as the lowest levels of life satisfaction and physical health. This study revealed that CPTSD is a distinct disorder from PTSD in Chinese adolescents exposed to childhood trauma. It provides evidence that emotional abuse might be an important risk factor for CPTSD, and demonstrates that CPTSD is accompanied by serious psychological and physical consequences in adolescents. We suggest that parents and educators should focus more on adolescents' emotional needs, avoid using negative ways such as verbal violence to express love, and pay more attention to adolescents' DSO symptoms in parenting, teaching practices and clinical interventions.

The relationships between IBS and perceptions of physical and mental health-a Norwegian twin study

BACKGROUND AND AIMS

Poor quality of life is a main complaint among individuals with irritable bowel syndrome (IBS). Self-rated health (SRH) is a powerful predictor of clinical outcomes, and also reflects psychological and social aspects of life and an overall sense of well-being. This population-based twin study evaluates how IBS affects ratings of physical and mental health, and influences perceptions of hindrance of daily activity by physical or mental health. Further, we examine how IBS is related to these SRH measures.

METHODS

The sample included 5288 Norwegian twins aged 40-80, of whom 575 (10.9%) suffer from IBS. Hierarchical regressions were used to estimate the impact of IBS on perceptions of health, before and after accounting for other chronic physical and mental health conditions. Two dimensions of SRH, physical and mental, and two aspects of functional limitations, the extent to which physical or mental health interferes with daily activities, were included as outcomes in separate models. Co-twin control analyses were used to explore whether the relationships between IBS and the four measures of SRH are causal, or due to shared genetic or shared environment effects.

RESULTS

IBS was an independent predictor of poor self-rated physical health (OR = 1.82 [1.41; 2.33]), the size of this effect was comparable to that predicted by chronic somatic conditions. However, in contrast to somatic diseases, IBS was associated with the perception that poorer ratings of mental health (OR = 1.45 [1.02; 2.06]), but not physical health (OR = 1.23 [0.96; 1.58]), interfered with daily activity. The co-twin control analyses suggest that causal mechanisms best explain the relationships between IBS with self-rated physical health and with hindrance of daily activities. In contrast, the relationship between IBS and self-rated mental health was consistent with shared genetic effects.

CONCLUSION

IBS is predictive of poor self-rated physical health. The relationship between IBS and self-rated mental health is best explained by shared genetic effects which might partially explain why mental health interferes with daily activity to a larger degree among those with IBS.

The structure of health in Europe: The relationships between morbidity, functional limitation, and subjective health

The main objective of this study is to explore the relationships between the three commonly used proxies of health, morbidity, functional limitation, and subjective health, using the most recent data from 18 European countries. The existing studies on the topic are outdated, limited to the United States and to elderly population. Data on 32,679 respondents of the European Social Survey (2014) were analyzed using structural equation modeling. The results suggest that (a) morbidity and functional limitation lead to poorer self-rated health, and (b) morbidity increases the probability of reporting functional limitation(s). Moreover, functional limitation mediates the relationship between morbidity and self-rated health. The model as a whole holds across both genders and all age groups. However, specific tests (SEM multi-group analyses, t-tests) show differences in the health structure between all seven subsamples compared with each other. When both gender and age are taken into account the differences in the structure of health seem to diminish, apart from the elderly, suggesting that the health structure of the elderly differs from others. It is recommended for policy planners to acknowledge the group differences when shaping the policies and health services.

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First study to test a structure of health model on Europeans of all adult ages.

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Morbidity affects functional limitation and subjective health.

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Functional limitation has a negative effect on subjective health.

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Morbidity also affects subjective health indirectly via functional limitation.

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The model is stable across the groups despite some differences in the effect magnitudes.

Low Self-Rated Health as A Risk Factor for Depression in South Korea: A Survey of Young Males and Females

This is a cross-sectional study aimed to examine whether low self-rated health (SRH) is a risk factor for depression among young males and females. Data from the SRH, quality of life (QoL) and depression questionnaires as well as general information, were collected from 512 males and females aged 20-29 years in South Korea. Chi-square test was used to analyze the distribution of depression between the high and low SRH groups. Logistic regression was used to analyze the relationship between SRH and depression after adjusting for covariates. There were 32.6% males and 30.1% females who were at risk for depression. A significant difference in the distribution of depression between the low and high SRH groups in both males and females was found. The low SRH group had a higher prevalence of depression than the high SRH group in both males and females in the crude analysis. However, when the BMI, economic status, and mental component score were adjusted, the OR of the low SRH group was still significant in males. Low SRH may be a risk factor for depression especially in males. Further studies to improve SRH by developing preventive measures against depression status while considering gender characteristics are needed.

Smoking and Physical Activity Explain the Increased Mortality Risk Following Marital Separation and Divorce: Evidence From the English Longitudinal Study of Ageing

BACKGROUND

Marital separation and divorce are associated with an increased risk of early mortality, but the specific biobehavioral pathways that explain this association remain largely unknown.

PURPOSE

This study sought to identify the putative psychological, behavioral, and biomarker variables that can help explain the association of being separated or divorced and increased risk for early mortality.

METHODS

Using data from the English Longitudinal Study of Ageing, a representative community sample of aging adults (N = 5,786), we examined the association of marital status and life satisfaction, health behaviors measured 2 years later, biomarkers measured 4 years later, and mortality outcomes from the subsequent 4 years.

RESULTS

Consistent with prior literature, older adults who were separated/divorced evidenced greater risk of mortality relative to those in intact marriages over the study period, OR = 1.46, 95% CI [1.15, 1.86]. Marital status was associated with lower levels of life satisfaction, β = -0.22 [-0.25, -0.19] and greater likelihood of smoking 2 years later β = 0.17 [0.13, 0.21]. Lower life satisfaction predicted less frequent physical activity 2 years later, β = 0.07 [0.03, 0.10]. Smoking, but not physical activity, predicted poorer lung functioning 2 years later, β = -0.43 [-0.51, -0.35], and poorer lung function predicted increased likelihood of mortality over the following 4 years, β = -0.15 [-0.27, -0.03]. There was a significant total indirect effect of marital status on mortality through these psychological, behavioral, and biomarker variables, β = 0.03 [0.01, 0.05], which fully explained this mortality risk.

CONCLUSIONS

For separated/divorced adults, differences in life satisfaction predict health behaviors associated with poorer long-term lung function, and these intermediate variables help explain the association between marital dissolution and increased risk of earlier mortality.

Factors Related to Frailty among the Elderly in South Korea: A 3-year Longitudinal Study

PURPOSE

To examine factors associated with frailty among the young-old elderly (YOE) and old-old elderly (OOE).

METHODS

This longitudinal study with a 3-year follow-up included 486 participants who received home care services.

FINDINGS

Precipitous weight loss and depression in the YOE and worsening of complex mobility and depression in the OOE were associated with worsened frailty over the 3-year period.

CONCLUSIONS

To prevent frailty, we suggest weight-loss prevention programs for the YOE, lower-limb exercise programs for the OOE, and depression management programs for both groups.

IMPLICATIONS FOR NURSING PRACTICE

The findings may be used by geriatric nurses in developing programs to prevent frailty in the OOE and YOE, and in administering nursing intervention programs at nursing home centers.

Self-rated health and all-cause and cause-specific mortality of older adults: Individual data meta-analysis of prospective cohort studies in the CHANCES Consortium

OBJECTIVES

To evaluate, among the elderly, the association of self-rated health (SRH) with mortality, and to identify determinants of self-rating health as "at-least-good".

STUDY DESIGN

Individual data on SRH and important covariates were obtained for 424,791 European and United States residents, ≥60 years at recruitment (1982-2008), in eight prospective studies in the Consortium on Health and Ageing: Network of Cohorts in Europe and the United States (CHANCES). In each study, adjusted mortality ratios (hazard ratios, HRs) in relation to SRH were calculated and subsequently combined with random-effect meta-analyses.

MAIN OUTCOME MEASURES

All-cause, cardiovascular and cancer mortality.

RESULTS

Within the median 12.5 years of follow-up, 93,014 (22%) deaths occurred. SRH "fair" or "poor" vs. "at-least-good" was associated with increased mortality: HRs 1.46 (95% CI 1·23-1.74) and 2.31 (1.79-2.99), respectively. These associations were evident: for cardiovascular and, to a lesser extent, cancer mortality, and within-study, within-subgroup analyses. Accounting for lifestyle, sociodemographic, somatometric factors and, subsequently, for medical history explained only a modest amount of the unadjusted associations. Factors favourably associated with SRH were: sex (males), age (younger-old), education (high), marital status (married/cohabiting), physical activity (active), body mass index (non-obese), alcohol consumption (low to moderate) and previous morbidity (absence).

CONCLUSION

SRH provides a quick and simple tool for assessing health and identifying groups of elders at risk of early mortality that may be useful also in clinical settings. Modifying determinants of favourably rating health, e.g. by increasing physical activity and/or by eliminating obesity, may be important for older adults to "feel healthy" and "be healthy".

An Investigation on Self-Rated Health of Adolescent Students and Influencing Factors From Sichuan, China

To investigate adolescent students' self-rated health status and to identify the influencing factors that affect students' health status. A stratified cluster sampling method and the Self-assessed General Health Questionnaires were used to enroll 503 adolescent students from Sichuan Province, Southwest part of China. Most adolescent students perceived their self-rated health as “Fair” (29.4%), “Good” (52.1%), or “Very Good” (16.3%). Regarding the sleep quality, most of them rated them as “Fair” (24.9%), “Good” (43.1%), or “Very Good” (19.7%), but 59.7% students reported to sleep less than 8 hours a day, even a few reported to sleep less than 6 hours (4.4%) or more than 9 hours (9.7%). A considerable number of students (41.1%) reported that they “Never” or just “Occasionally” participated in appropriate sports or exercises. As to the dietary habit, a significant number of students (15.7%) reported that they “Never” or “Occasionally” have breakfast. Students from different administrative levels of schools (municipal level, county level, and township level) rated differently (P < 0.05) in terms of their self-rated health, Health Behaviors, Sleeping, Dietary behaviors, Safety Awareness, and Drinking and Smoking behaviors. In general, Chinese teenage students perceived their own health status as fairly good. However, attention needs to be paid to health problems of some of the students, such as lack of sleep and exercise and inadequate dietary habits, etc. More concerns need to be addressed to students from different administrative levels of schools, and strategies should be put forward accordingly.

The Relationship of Personality Trait Variables to Subjective Age Identity in Older Adults

The present study examines the relationship between personality trait variables and subjective age identity with two elderly samples. Subjects were asked both the age they feel (feel age) and the age they would like to be (ideal age). In Sample 1, which consisted of 241 community-dwelling adults aged 55 to 75 years, the traits of locus of control and social desirability were examined. In Sample 2, neuroticism, extraversion, and openness to experience were examined with 355 community-dwelling adults aged 55 to 85 years. Internal locus of control and extraversion were related to the feel age measure, whereas powerful-others locus of control, neuroticism, extraversion, and openness to experience were related to the ideal age measure. Trait variables did not moderate the relationships between the feel age measure and either self-reported health or affective state variables. However, both neuroticism and openness to experience were found to alter the relationship between the ideal age measure and affective state variables.

Current and Future Family Help with Long-Term Care Needs of the Elderly

An accurate perspective of the variation in current mixes of familial/public sector support for older individuals with health-related needs requires a careful assessment of the huge diversity -in the sociodemographic composition of the older population as well as in the availability and type of family caregiving resources. This analysis of a sample of individuals 60 years of age and older from the National Survey of Families and Households attempts to provide an in-depth assessment of the sociodemographic composition of the older population and variation in primary kin support for this population by determining (a) the proportions of various age/race/gender population segments of the elderly that have one or more potential primary kin caregivers; (b) the number and proportions of these population segments who are in need of family support due to health status; and (c) who within these population segments receives familial assistance and who does not, given a consideration of both the potential family support network and health status. The analysis also includes an illustrative exercise exploring the potential future impact on the level of unmet need from changes in female labor force participation rates and norms regarding both work and parent care.

Role-Specific Control, Personal Meaning, and Health in Late Life

The purpose of this study is to develop and empirically evaluate a latent variable model that examines the relationships among role-specific control, personal meaning, and health in late life. It is hypothesized that older adults with high levels of role- specific control are likely to develop a deep sense of personal meaning. This conceptual scheme further specifies that elderly people who derive a sense of meaning will, in turn, enjoy better health than older adults who are unable to find meaning in life. Data from a nationwide survey of older people provide support for this theoretical rationale.

Education, Personal Control, Lifestyle and Health

The concept of human capital implies that education improves health because it increases effective agency. We propose that education's positive effects extend beyond jobs and earnings. Through education, individuals gain the ability to be effective agents in their own lives. Education improves physical functioning and self-reported health because it enhances a sense of personal control that encourages and enables a healthy lifestyle. We test three specific variants of the human-capital and learned-effectiveness hypothesis: (1) education enables people to coalesce health-producing behaviors into a coherent lifestyle, (2) a sense of control over outcomes in one's own life encourages a healthy lifestyle and conveys much of education's effect, and (3) educated parents inspire a healthy lifestyle in their children. Using data from a 1995 national telephone probability sample of U.S. households with 2,592 respondents, ages 18 to 95, a covariance structure model produces results consistent with the three hypotheses.

Stress, Social Support, and Negative Interaction in Later Life

The aim of this research is to examine the impact of stress on supportive social relationships in later life. Although a number of researchers propose that exposure to life stress increases the amount of assistance provided by significant others, findings from studies with older adults are equivocal. Three potential explanations for these contradictory findings are examined. The results, which are based on a nationwide survey of older people, reveal that the relationship between stress and social support is contingent upon the nature of the stressor as well as the source of support. It was further predicted that negative interaction would play an important role in this process, but consistent findings failed to emerge from the data. The theoretical implications of these findings are discussed.

Early Retirement and Functional Impairment from a Multi-Ethnic Perspective

The overall purpose of the present study was to identify differences between the early retired and the nonretired among three ethnic groups: Whites, Blacks, and Mexican Americans. Analysis focused on a community-based sample of 1,146 residents of San Diego County aged 45 to 64 years. Three categories of variables that were hypothesized to contribute to early retirement were examined: demographic characteristics, self-reported health measures, and Older American Resource and Service (OARS)based objective summary ratings of functional impairment. Results were consistent with the literature and indicated that functional impairment was higher for the early retired within each of the ethnic groups. For both retirement status groups, Mexican Americans reported the most impairment of the three ethnic groups. Discriminant analysis was used to identify the predictive value of the three categories of variables for early retirement status and yielded the following results: age, gender, and the mental health OARS objective functional-impairment score were the only significant discriminators for all groups. Mexican Americans appeared to have the greatest variety of factors contributing to early retirement status, with fewer variables involved for Blacks and fewer still for Whites.

The Role of Discrimination and Acculturative Stress in the Physical Health of Mexican-Origin Adults

The authors propose that perceived discrimination has an effect on self-reported health statuses, which are known to affect future morbidity and mortality. A sample of 3,012 Mexican-origin adults from the Mexican American Prevalence and Services Study in California is utilized to test this hypothesis. Dependent variables include a self-rating of health and a count of self-reported chronic conditions; the key independent variable is a scale of overall discrimination specific to one’s Mexican origin. Results indicate that discrimination is related to poor physical health—net of controls for acculturation stress, national heritage, sociodemographic variables, and social support. Depression is identified as a major mechanism through which discrimination may affect physical health. Notably, job market stress/discrimination has a very strong association with poorer physical health, net of depression. Individual-level effects of discrimination found in this study, as well as institutional-level conditions and contextual effects, should be treated as crucial to future studies of individual-level physical health differentials.

Incongruence between Health Perceptions and Health Problems

Subjective ratings of health are not always congruent with other health indices. The present study explored the congruence/incongruence between subjective overall health ratings and diseases/health problems as reported by elderly individuals. The goals were to consider the prevalence of health congruence/incongruence among seniors and to examine whether congruence/incongruence relates to mortality. Overall, it was found that incongruence was more likely to be in the form of more favorable, rather than less favorable, ratings (i.e., overestimates rather than underestimates). The relationship between congruence/incongruence and mortality was explored using three different follow-up periods and was examined separately among those who were well, ill, or neither well nor ill (i.e., typical elders). Although the findings differed depending on length of follow-up and health status, they generally suppported a link between overestimation of health and survival. Even among ill elders, those who overestimated their health were less likely to die than were those who did not.

Dimensions and Correlates of General Well-Being among Older Adults

This article examines dimensions and correlates of psychological well-being among older adults aged 55 and above using the General Well-Being (GWB) Scale with data ( N=2,931) collected in Kentucky in 1982. A shortened, 11-item version of the GWB is confirmed for use among older respondents and is found to comprise three correlated dimensions termed positive affect, enervation, and negative affect. Development of this scale involved exploratory and confirmatory factor analysis, comparison of alternative model specifications, and regression of its component dimensions onto known correlates of psychological well-being in older adults, including age, education, marriage, gender, race, and subjective health.

Sampling and generalisability in developmental research: Comparison of random and convenience samples of older adults

Research in the developmental sciences is based largely on samples of convenience rather than samples drawn at random from the population. The important question of whether results observed in samples of convenience generalise to the larger population has not been studied directly. Because of demographic growth in the proportion of older adults in the population and increases in diversity across the lifespan, it is especially important to address this issue in aging adults. We compared the performance of older adults (65–100 years) on demographic and psychological measures for a random sample of community dwelling adults and two samples of convenience. Significant differences were observed on less than half the variables. When differences were present, participants in the convenience samples were advantaged compared to participants from the random sample. Differences were larger in some domains than others but remained small to moderate in magnitude. There were minimal differences in between-person variability and patterns of correlations among variables between the convenience and random samples. Results indicate the need for additional studies contrasting random and convenience samples to explore the parameters of external validity in psychological aging research.

The Importance of the Self-Concept and Coping Responses in Explaining Physical Health Status and Depression among Older Women

This study examined a model specifying the links among the physical, functional, and subjective components of physical health status and depression among older women, and assessed the effects of the self-concept (i.e., health confidence and self-esteem) and coping responses (i.e., direct action, positive cognitive, and passive cognitive coping) at each point in the model. Based on cross-sectional interview data with 274 older women, a series of regression analyses indicated that the self-concept and coping responses were significantly involved at each step of the health process but that the specific effects of the self-concept were different earlier than later in the model. Earlier in the model, self-esteem and physical health status indirectly influenced subsequent health status through their effects on health confidence and the cognitive coping responses. At the final point in the model, physical health status continued to operate indirectly through health confidence and the cognitive coping responses, however, health confidence and positive cognitive coping responses then directly affected self-esteem which, together with health confidence, subsequently had direct negative effects on depression. These results were interpreted within a social psychological framework that incorporated self-concept theory with cognitive theories of depression.

Access to Health Care and Self-Rated Health Among Community-Dwelling Older Adults

Objective: This study examined the relationship between access to health care and self-rated health among community-dwelling persons aged 65 years and older. Data Source: The analyses were based on a sample of 2,982 participants from the Duke Established Populations for Epidemiologic Studies of the Elderly. Study Design: This study was a secondary data analysis using longitudinal data collected in 1987 and again in 1990. Logistic regression was used to determine change to poor self-rated health from excellent, good, or fair self-rated health. Principal Finding: In a multivariate model, one of the seven access to health care indicators was found to be significantly related to reporting poor self-rated health. Controlling for demographics and other potential confounders, the odds of reporting poor self-rated health were approximately 87% higher among those without private health coverage.

Associations among Health Perceptions and Health Status within Three Age Groups

Using data from the 1984 Supplement on Aging to the National Health Interview Survey, the associations among five health perceptions and two indices of functional health status were investigated within each of three age groups (55-64, 65-79, 80+). Greater functional impairment was associated with less favorable health perceptions in all three age groups. However, the strength of association was not consistent for the five indices, leaving room for conflicting assessments of one's health. Efficacy at taking care of health and perceived control over health showed lower strengths of association with functional impairment, raising the possibility that the resilience of some perceptions may be studied in greater detail. Results for persons aged 80 and older were similar in some ways to those for persons aged 55-64; however, there was some evidence of stronger negative association with increasing functional limitation among persons aged 55-64, suggesting a possibly stronger impact of health problems in this group. Future research might usefully examine intraindividual consistency of health perceptions and behavior, in addition to looking for normative interindividual trends.

A Smart-Home System to Unobtrusively and Continuously Assess Loneliness in Older Adults

Loneliness is a common condition in older adults and is associated with increased morbidity and mortality, decreased sleep quality, and increased risk of cognitive decline. Assessing loneliness in older adults is challenging due to the negative desirability biases associated with being lonely. Thus, it is necessary to develop more objective techniques to assess loneliness in older adults. In this paper, we describe a system to measure loneliness by assessing in-home behavior using wireless motion and contact sensors, phone monitors, and computer software as well as algorithms developed to assess key behaviors of interest. We then present results showing the accuracy of the system in detecting loneliness in a longitudinal study of 16 older adults who agreed to have the sensor platform installed in their own homes for up to 8 months. We show that loneliness is significantly associated with both time out-of-home (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$ {\beta } = -0.88$ \end{document} and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$p<0.01$ \end{document}) and number of computer sessions (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$ {\beta } = 0.78$ \end{document} and \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$p<0.05$ \end{document}). \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{upgreek} \usepackage{mathrsfs} \setlength{\oddsidemargin}{-69pt} \begin{document} }{}$R^{2}$ \end{document} for the model was 0.35. We also show the model’s ability to predict out-of-sample loneliness, demonstrating that the correlation between true loneliness and predicted out-of-sample loneliness is 0.48. When compared with the University of California at Los Angeles loneliness score, the normalized mean absolute error of the predicted loneliness scores was 0.81 and the normalized root mean squared error was 0.91. These results represent first steps toward an unobtrusive, objective method for the prediction of loneliness among older adults, and mark the first time multiple objective behavioral measures that have been related to this key health outcome.

Job loss and health in the U.S. labor market

While U.S. unemployment rates remain low, rates of job loss are high and rising. Job loss is also becoming increasingly common in more advantaged, white-collar occupations. This article is concerned with how these patterns impact the health of U.S. workers. Drawing on recent data from the U.S. Panel Study of Income Dynamics, I find that job loss harms health, beyond sicker people being more likely to lose their jobs. Respondents who lost jobs but were reemployed at the survey faced an increased risk of developing new health conditions; they were not, however, more likely to describe their health in negative terms. This suggests that recent job "churning" within the United States (i.e., high rates of job loss but low unemployment) may impact certain health outcomes but not others. I find no evidence that the health consequences of job loss differ across white- and blue-collar occupations, although health-related selection out of jobs appears stronger within the blue-collar category.

A prospective study of parentally bereaved youth, caregiver depression, and body mass index

OBJECTIVE

To examine the relationship between body mass index (BMI) in bereaved youth and nonbereaved controls 5 years after a parent's death. The study was conducted from August 9, 2002, through December 31, 2013.

DESIGN

A prospective, longitudinal, controlled study of the effects of sudden parental death on youth.

SETTING

Bereaved families were recruited through coroner records and by advertisement. Nonbereaved families were recruited using random-digit dialing and by advertisement.

PARTICIPANTS

123 parentally bereaved offspring were compared with 122 nonbereaved control offspring, all of whom were aged 11-25 years at the 5-year assessment.

MAIN EXPOSURE

Bereavement status, type of parental death (accident, suicide, or sudden natural death), and history of depression in caregivers prior to parental death.

OUTCOME MEASURES

BMI categories (normal, overweight, and obese), according to International Obesity Task Force guidelines for adults and Centers for Disease Control and Prevention guidelines for children, and DSM-IV psychiatric disorder in offspring and caregivers before and after time of parental death.

RESULTS

Bereaved offspring were more likely to have a BMI in the obese range compared to nonbereaved controls (χ2(2) = 7.13, P < .01). There were no differences in BMI category by death type among bereaved offspring. Caregiver history of depression was a significant correlate of offspring obesity in nonbereaved youth but had a protective effect on the BMI of bereaved youth.

CONCLUSIONS

Bereaved youth were more likely to be obese than nonbereaved youth 5 years after parental death, and caregiver history of depression was associated with increased risk for obesity in nonbereaved youth only. Future studies are necessary to identify mechanisms that increase risk for obesity in parentally bereaved youth.

Socioeconomic Correlates of Gender Differential in Poor Health Status Among Older Adults in India

Assessment of the health status of the older adults can go a long way in controlling the disease burden and monitoring the path to healthy aging in India. In the absence of a population-based clinical survey to collect data on morbidities and other health conditions through biomarkers, self-rated health by nationally representative older population is used for understanding factors contributing to the gender differential in health status. Socioeconomic status is the most important factor explaining 59% of the gender gap in self-assessed health among older adults. The vulnerability of older women in terms of educational attainment, occupational status, and economic dependency is responsible for the higher level of poor self-assessed health. The gender gap in self-assessed poor health among older Indian adults, which perpetuates over the life course resulting in severe health disadvantages at old age can be reduced considerably through social empowerment and gender sensitive public policies.

The Relationship between Physical Health and Psychological Well-Being among Oldest-Old Adults

The purpose of this study was to evaluate the relationship between physical health and psychological well-being among oldest-old adults. Structural equation modeling was performed to examine health influences on psychological well-being among 306 octogenarians and centenarians from the Georgia Centenarian Study. Latent variables were created to reflect subjective health, as measured by self-ratings of health and objective health, as measured by physical health impairment (i.e., health problems, past and present diseases, hospitalization) and biomarkers (i.e., hemoglobin and albumin). Psychological well-being was measured by positive and negative affect. There were significant direct effects of subjective health on affect and significant indirect effects of objective health through subjective health on positive affect and negative affect. Subjective health took the role of a mediator between objective health and psychological well-being. These results highlight the status and perceptions of health as a critical indicator for well-being in extreme old age.

What do people include when they self-rate their health? Differential associations according to health status in community-dwelling older adults

AIMS

Self-rated health (SRH) is widely regarded a valid and reliable indicator of health status. The validity of self-rated health has been demonstrated in many studies, for example by predicting mortality over and above medical and epidemiological data. However, the meaning of SRH can differ between individuals, especially in elderly individuals with considerable individual differences in their physical health states. It is thus important to determine whether predictors of self-rated health vary according to physical health status in order to interpret self-rated health data.

METHODS

In a representative survey study, 1174 individuals over 65 years of age rated their health and filled in questionnaires on subjective well-being, control beliefs, depressive symptoms, and functional health. Structural equation modeling with latent moderated structural equations was used to determine whether health status (number of illnesses) moderated the association of self-rated health with these predictors.

RESULTS

Self-rated health was predicted by positive affect, depressive symptoms, control beliefs, and physical functioning. Moderated effects were found for positive affect and physical functioning, suggesting that there are stronger associations with positive affect in healthier individuals and stronger associations with physical functioning in less healthy individuals.

CONCLUSIONS

This implies that SRH has differential associations depending on health status, which should be taken into account in interpreting any research with SRH as predictor or criterion.

Socio-economic Status and Self-Rated Health Among Older Canadians

Although previous research has examined the various correlates of self-rated health, little attention has been paid to how position in the social structure influences this important measure of health. Drawing upon the social structure and personality perspective, I examine whether the relationship between socio-economic status (income adequacy and education) and self-rated health is mediated by financial stress, self-esteem, mastery, social support, smoking, alcohol consumption and physical activity, using data from the 1994 National Population Health Survey. Results show that almost one-third of the relationship can be explained by the mediating effect of these variables. Income adequacy and education, however, remain significantly related to self-rated health net of these variables. Further research with a broader array of variables related to social position is required to specify the mechanisms connecting socio-economic status and perceived health.

The Validation of Longitudinal Studies: The Case of the Ontario Longitudinal Study of Aging (LSA)

Longitudinal studies are examined with special reference to the Ontario Longitudinal Study of Aging (LSA). The specific aspects discussed are the representativeness of the sample, attrition rates, end-points, and associations, particularly the associations with age. It is concluded that, in comparison with other longitudinal studies, both in Canada and the U.S., the LSA represents a good source of longitudinal data and therefore lends itself to analyses which may be used to investigate factors expected to be important in understanding various aspects of the aging process.

Socioeconomic status and health in the second half of life: findings from the German Ageing Survey

This study examined social inequalities in health in the second half of life. Data for empirical analyses came from the second wave of the German Ageing Survey (DEAS), an ongoing population-based, representative study of community dwelling persons living in Germany, aged 40–85 years (N = 2,787). Three different indicators for socioeconomic status (SES; education, income, financial assets as an indicator for wealth) and health (physical, functional and subjective health) were employed. It could be shown that SES was related to health in the second half of life: Less advantaged persons between 40 and 85 years of age had worse health than more advantaged persons. Age gradients varied between status indicators and health dimensions, but in general social inequalities in health were rather stable or increasing over age. The latter was observed for wealth-related absolute inequalities in physical and functional health. Only income-related differences in subjective health decreased at higher ages. The amount of social inequality in health as well as its development over age did not vary by gender and place of residence (East or West Germany). These results suggest that, in Germany, the influence of SES on health remains important throughout the second half of life.

Gender differences in health among the Japanese elderly

Evidence has emerged recently to challenge the widely held notion that women experience more physical health problems than men. The purpose of this study is to re-evaluate this issue with a broad range of health measures gathered in a culturally diverse population--older adults in Japan. Taken as a whole, the findings suggest that there are gender differences in health. However, patterns of female excess in morbidity depend upon the type of health status measure that is examined. In particular, the data reveal that elderly women experience more functional disability and rate their overall health less favorably than older men. In contrast, a consistent pattern of gender differences in health fail to emerge when specific acute and chronic health problems are evaluated.

Evolving self-rated health in middle and old age: how does it differ across Black, Hispanic, and White Americans?

OBJECTIVE

This research focuses on ethnic variations in the intraindividual changes in self-rated health.

METHOD

Data came from the Health and Retirement Study involving up to 6 repeated observations between 1995 and 2006 of a national sample of 18,486 Americans above 50 years of age. Hierarchical linear models were employed in depicting variations in self-rated health across White, Black, and Hispanic Americans.

RESULTS

Subjective health worsened over time albeit moderately. Relative to younger persons, older individuals rated their health poorer with a greater rate of deteriorating health. With reference to ethnic variations in the intercept and slope of perceived health, White Americans rated their health most positively, followed by Black Americans, with Hispanics rating their health least positively. This pattern held even when socioeconomic status, social networks, and prior health were adjusted.

DISCUSSION

Significant ethnic differences exist in the evolvement of self-rated health in middle and late life. Further inquiries may include analyzing ethnic heterogeneities from a person-centered perspective, health disparities across subgroups of Hispanics, effects of neighborhood attributes, and implications of left truncation.

The Doubting Process: A Longitudinal Study of the Precipitants and Consequences of Religious Doubt

Religious doubt arises from a process in which there is a precipitant, the experience of doubt, a coping response, and a health-related outcome. We explore this process by assessing whether social factors precipitate doubt and the coping responses that are invoked to deal with it. Moreover, we evaluate whether these coping responses are, in turn, associated with health. The data reveal that, over time, people who encounter more negative interaction with fellow congregants have more doubts about religion, whereas more spiritual support and greater involvement in prayer groups are associated with less religious doubt. The findings further indicate that people who encounter more negative interaction are more likely to suppress religious doubts, but people who attend Bible study groups are more likely to seek spiritual growth when faced with doubt. Finally, the results suggest that suppressing religious doubt is associated with less favorable health, whereas seeking spiritual growth does not have a significant effect.

Self-rated health and depressive symptoms in patients with end-stage renal disease and their spouses: a longitudinal dyadic analysis of late-life marriages

Limited research has examined the ways in which changes in self-rated health experienced by aging spouses affect depressive symptoms of both members of the dyad. Longitudinal data from 315 older couples in which one partner had end-stage renal disease were analyzed using multilevel modeling. Results indicate that for both patients and spouses, own mean self-rated health was associated with own depressive symptoms, and change in self-rated health had a significant negative association with change in own depressive symptoms. Both mean self-rated health of the patient and change in patient's self-rated health had negative relationships with spouse depressive symptoms, with changes in patient's self-rated health having a stronger impact on spouse depressive symptoms than changes in spouse's own self-rated health. Results suggest the importance of understanding physical and mental health in the context of the marital dyad.

A randomized controlled trial of a health-promotion programme and its effect on ADL dependence and self-reported health problems for the elderly visually impaired

BACKGROUND

Ageing with visual impairment is associated with a high degree of disability whereby age-related macular degeneration in particular causes dependence in activities of daily living (ADL) even at an early stage.

AIMS

To compare an activity-based, health-promotion programme with an individual programme, targeting the elderly with age-related macular degeneration concerning the effect on the development of dependence in ADL, general health, and self-reported health problems.

METHODS

A randomized controlled study with a 28-month follow-up. A total of 229 persons were randomized to the study and 131 (57%) were followed up (individual intervention n=69, health-promotion programme n=62) at 28-month.

RESULTS

The health-promotion group maintained their ADL level despite a significant decrease in visual acuity, while the individual intervention group increased its dependence in ADL. General health systematically dropped to a lower level in both groups, but participants from the health-promotion group reported fewer health problems. There were significantly fewer reports of tiredness and dizziness among the health-promotion participants.

CONCLUSION

The health-promotion programme seems to have slowed down the disablement process among elderly with decreased vision by enabling them to maintain their ADL level and by reducing self-reported health problems for at least 28 months following intervention.

Factores de riesgo en el desarrollo de úlceras de presión y sus implicaciones en la calidad de vida

Resumen En la vejez la incidencia de úlceras de presión (UPs) aumenta muy debido al aumento considerable del número de factores de riesgo. Entender su etiología es esencial para su prevención. En este contexto surge este estudio, debido a la necesidad de los autores identificaren que factores están implicados y son determinantes en el desarrollo de la úlcera de presión. También se analizó el efecto de las UPs en la percepción de la calidad de vida (CV). Objetivos: Determinar la contribución específica de cada factor de la escala de Braden en la predicción del desarrollo de UPs; explorar la hipótesis de que la ausencia de úlcera de presión se asocia a una mejor percepción de la CV e identificar que factores y condiciones están presentes en los ancianos con UPs. Material y Métodos: Estudio descriptivo, con una muestra aleatoria simple, constituída por 40 ancianos (12 con y 28 sin UPs) institucionalizados, para compararse la percepción de la calidad de vida y de los factores de riesgo. Se midieron: las medidas antropométricas, composición corporal, análisis sanguíneos, percepción de la calidad de vida y escala de Braden. Para el análisis estadístico se estableció la correlación existente entre las distintas variables con un nivel de significación (intervalo de confianza [1] del 95%) p < 0,05. Resultados: Una persona enferma con alteraciones en la nutrición tiene cerca de 4.5 veces más probabilidad de tener UPs y la presencia de alteraciones en la movilidad aumenta esta probabilidad en cerca de tres veces más. De las condiciones analizadas de la salud, se destacan las alteraciones hematológicas, designadamente la glucosa y el albumen. Al nivel de la composición corporal, el estado de hidratación es lo que tiene más significado estadístico. En lo general, la CV de estos ancianos es baja, siendo mayor en las mujeres (25.6±11) y en el grupo de los ancianos sin UPs (27±10). Conclusión: Una escala simplificada de tres factores (movilidad, nutrición y actividad) se asocia más al riesgo del desarrollo de UPs que la clásica escala de Braden.

Marital status and health: exploring pre-widowhood

BACKGROUND

Health and function vary by marital status across the life-course, but little is known about older adults approaching spousal loss (pre-widowed).

OBJECTIVE

To explore health and function by marital status focusing on the pre-widowed and to examine factors associated with shorter time to spousal loss. PARTICIPANTS, DESIGN, AND MEASUREMENTS: We used 3 years of data from African American and white community-dwelling older adults in the UAB Study of Aging (N = 1000). Participants were categorized as "continuously married" (married at baseline and 3 years), "widowed" (widowed at baseline), "single" (never married/divorced); and "pre-widowed" (married at baseline and widowed within 3 years). Assessments included sociodemographic characteristics, and measures of depression, anxiety, life-space mobility, and self-reported health. chi(2) and analysis of variance (ANOVA) were used to examine baseline differences. Using Cox regression, we explored factors having independent and significant associations with shorter time to spousal loss among married older adults.

RESULTS

There were significant differences by marital status category for sociodemographic factors, health, and function. Pre-widows differed from other categories by sociodemographic characteristics as well as levels of depression, anxiety and self-reported health. Among married older adults, being female and having lower self-reported health at baseline were independent significant hazards for shorter time to widowhood; while rural residence and providing spousal care were independent significant hazards for a longer progression to widowhood.

CONCLUSIONS

Health deficits associated with spousal bereavement may be evident earlier in the marital transition than previously thought, warranting attention to the health of elderly persons whose spouses have chronic/life-limiting conditions.

Gender differences in functional status in middle and older age: are there any age variations?

OBJECTIVES

The present study examines gender differences in changes in functional status after age 50 and how such differences vary across different age groups.

METHODS

Data came from the Health and Retirement Study, involving up to six repeated observations of a national sample of Americans older than 50 years of age between 1995 and 2006. We employed hierarchical linear models with time-varying covariates in depicting temporal variations in functional status between men and women.

RESULTS

As a quadratic function, the worsening of functional status was more accelerated in terms of the intercept and rate of change among women and those in older age groups. In addition, gender differences in the level of functional impairment were more substantial in older persons than in younger individuals, although differences in the rate of change between men and women remained constant across age groups.

DISCUSSION

A life course perspective can lead to new insights regarding gender variations in health within the context of intrapersonal and interpersonal differences. Smaller gender differences in the level of functional impairment in the younger groups may reflect improvement of women's socioeconomic status, greater rate of increase in chronic diseases among men, and less debilitating effects of diseases.