Self ratings of health predict functional outcome and recurrence free survival after stroke

Body structure/function impairments and activity limitations of post-stroke that predict social participation: a systematic review

BACKGROUND

Stroke is the leading cause of death and disability in Brazil, and its prognostic indicators of social reintegration are not well established yet.

OBJECTIVE

To identify body structure/function impairments and activity limitations in post-stroke that predict social participation restrictions in the community.

METHODS

cohort studies were selected, involving adult post-stroke participants, which investigated body structure and function impairments or activity limitations of post-stroke individuals as predictors of social participation in the community. Studies that included individuals with subarachnoid hemorrhage, other neurological disorders and participants in long-term care facilities were excluded. The Newcastle-Ottawa quality assessment scale was applied to assess the methodological quality. The results were synthesized according to the found exposures, considering the used statistical models.

RESULTS

Eleven articles were included, with a total of 2,412 individuals, 58.4% men, 83.7% ischemic stroke. Seven exposures were assessed across studies, in which 10 studies assessed body structure and function exposures (stroke severity, cognitive, executive, emotional and motor function), and 8 studies assessed activity exposures (daily living activity and walking ability).

CONCLUSION

There is some evidence that stroke severity, mental and motor deficits, limitations in activities of daily living and the ability to walk after a stroke can predict social participation in the community. PROSPERO registration CRD42020177591.

General and comparative self-rated health in chronic stroke: an important outcome measure for health professionals

BACKGROUND

After a stroke, several aspects of health and function may influence how individuals perceive their own health. However, self-rated health (SRH), as well as its relationship with functioning, has been little explored in individuals with stroke. The aims of this study were to determine how individuals with chronic post-stroke disabilities evaluate their health, considering general, time- and age-comparative SRH questions and to investigate whether SRH measures would be influenced by the following health and functioning domains: mental/physical functions and personal factors.

METHODS

Sixty-nine individuals with chronic post-stroke disabilities answered the three types of SRH questions and were assessed regarding depressive symptoms (emotional function domain), physical activity levels (physical function domain), and engagement in physical activity practice (personal factor domain). Subjects were divided into the following groups: good/poor for the general SRH question; better, similar, and "worse" for both time- and age-comparative questions. Between-group differences in the three domains for each SRH question were investigated (α = 5%).

RESULTS

General SRH was rated as good by 73% of the participants. Time- and age-comparative SRH was rated as better by 36% and 47% and as similar by 31% and 28% of the subjects, respectively. Significant between-group differences in emotional function were found for both the general and age-comparative questions. For the time-comparative question, significant differences were only observed for physical function.

CONCLUSION

SRH evaluation differed in individuals with chronic post-stroke disabilities according to the types of questions and health/functioning domains.

What underlies the difference between self-reported health and disability after stroke? A qualitative study in the UK

Background

Levels of self-reported health do not always correlate with levels of physical disability in stroke survivors. We aimed to explore what underlies the difference between subjective self-reported health and objectively measured disability among stroke survivors.

Methods

Face to face semi-structured interviews were conducted with stroke survivors recruited from a stroke clinic or rehabilitation ward in the UK. Fifteen stroke survivors purposively sampled from the clinic who had discordant self-rated health and levels of disability i.e. reported health as ‘excellent’ or ‘good’ despite significant physical disability (eight), or as ‘fair’ or ‘poor’ despite minimal disability (seven) were compared to each other, and to a control group of 13 stroke survivors with concordant self-rated health and disability levels. Interviews were conducted 4 to 6 months after stroke and data analysed using the constant comparative method informed by Albrecht and Devlieger’s concept of ‘disability paradox’.

Results

Individuals with ‘excellent’ or ‘good’ self-rated health reported a sense of self-reliance and control over their bodies, focussed on their physical rehabilitation and lifestyle changes and reported few bodily and post-stroke symptoms regardless of level of disability. They also frequently described a positive affect and optimism towards recovery. Some, especially those with ‘good’ self-rated health and significant disability also found meaning from their stroke, reporting a spiritual outlook including practicing daily gratitude and acceptance of limitations. Individuals with minimal disability reporting ‘fair’ or ‘poor’ self-rated health on the other hand frequently referred to their post-stroke physical symptoms and comorbidities and indicated anxiety about future recovery. These differences in psychological outlook clustered with differences in perception of relational and social context including support offered by family and healthcare professionals.

Conclusions

The disability paradox may be illuminated by patterns of individual attributes and relational dynamics observed among stroke survivors. Harnessing these wider understandings can inform new models of post-stroke care for evaluation.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12883-021-02338-x.

[Association of self-rated health with inflammatory markers among nursing home employees]

OBJECTIVES

Although self-rated health (SRH), the self-evaluation of one's own health status, has been reported to be associated with the immune status, the relationship between three different SRH measures (global, self-comparative, and age-comparative) with inflammatory markers as well as the relative strength of these associations by age are not well understood. The current study investigated the associations between SRH measures and inflammatory markers among nursing home employees.

METHODS

A sample of 120 Japanese employees at a nursing home (90 women and 30 men), aged 21-68 years (mean, 40.9 years), underwent a blood test for the measurement of inflammatory markers (interferon-γ, interleukin [IL]-4, IL-6, and tumor necrosis factor [TNF]-α, white blood cell count) and SRH during the annual health checkup. Multiple regression analysis adjusted for covariates was performed to analyze the relationship between inflammatory markers and SRH measures stratified by age, that is, aged < 40 years (younger age group) and 40 years and over (older age group).

RESULTS

Among the participants aged 40 years and over, poor global SRH was significantly associated with an increase in IL-6, while poor age-comparative SRH was significantly associated with an increase in TNF-α among participants aged < 40 years in the fully adjusted model controlling for potential confounders. Age-comparative SRH was also significantly associated with an increase in IL-6 among all participants. Self-comparative SRH was not significantly associated with inflammatory markers.

CONCLUSIONS

Our results suggest that three SRH measures are not equivalently associated with inflammatory markers, especially when the analyses were performed separately for the younger and older populations. This implies that not only differences in forms of SRH but also in age modify the relationship between SRH and inflammatory markers.

A prediction model of health-related quality of life in young adult patients with stroke

AIMS AND OBJECTIVES

This study aimed to establish and test a predictive model for explaining the health-related quality of life of young adult patients with stroke.

BACKGROUND

Individual characteristics, biological and physiological variables, social support, emotional and cognitive symptoms, physical function disability and general health perception may be interrelated and may directly or indirectly affect the health-related quality of life of young adult patients with stroke.

DESIGN

A cross-sectional study.

METHODS

237 young outpatients with stroke were recruited and surveyed. Data collection used a structured questionnaire from July-November 2018. The collected data were analysed using SPSS version 25.0^® and AMOS 23.0. This study is based on STROBE guidelines.

RESULTS

The hypothetical model's fit indices were adequate. Stroke severity, social support, fear of stroke recurrence, physical function disability and general health perceptions directly affected the health-related quality of life. Additionally, stroke severity, depression and fear of stroke recurrence also indirectly affected it. These variables explained 60.3% of the variance in this quality.

CONCLUSIONS

Variables such as severity of stroke, depression, fear of stroke recurrence, social support, physical function disability and general health perception were found to be related to the HRQoL of young adult patients with stroke.

RELEVANCE TO CLINICAL PRACTICE

A variety of physical, psychological, functional and social factors related to health-related quality of life should be systematically monitored. Furthermore, nurses need to develop and apply detailed nursing interventions that take into account all these variables.

Self-rated health over the first five years after stroke

BACKGROUND

Self-rated health (SRH) focuses on the patient's own perception, and represents an important patient-reported outcome. The aim was to investigate SRH one to 5 years after stroke, follow the development over time and search for factors associated with SRH.

METHODS

Consecutive stroke patients admitted to Stroke Units at the Skaraborg Hospital, Sweden were included 2007-2009 (n = 2190). Patient-reported outcomes were collected annually over 5 years using a postal questionnaire. SRH was assessed by the question about general health from SF-36. Factors associated with SRH were investigated by multiple logistic regression analysis.

RESULTS

Response-rate was > 90% at all time points. Overall, 40.2, 41.9, 40.7, 45.0 and 46.3% of the patients reported good SRH, 1 to 5 years after stroke. Performance in activities of daily living (ADL) was strongly associated with good SRH; 49.8 and 14.7% after 1 year in independent and dependent survivors respectively, p < 0.001. In independent survivors 1 year after stroke, good SRH was positively associated with female sex (OR = 2.0; p = < 0,001), physical activity (OR = 2.14; p = < 0,001), car driving (OR = 2.25; p = < 0,001), and negatively associated with age (OR = 0.99; p = < 0,001), pain (OR = 0.49; p = < 0,001), depression (OR = 0.30; p = < 0,001), and self-perceived unmet care needs (OR = 0.39; p = < 0,001). In dependent survivors, depression (OR = 0.23; p = < 0,001) and age (OR = 0.96; p = < 0,05), were negatively associated with good SRH 1 year after stroke. Similar patterns were observed throughout the follow-up.

CONCLUSION

The proportion stroke survivors reporting their health as good is slightly increasing over time. After stroke, SRH is associated with pain, depression, ability to perform activities and self-perceived unmet care needs, indicating that efforts to support stroke survivors in the chronic phase after stroke should concentrate on targeting these factors.

The relationship between gender roles and self-rated health: A perspective from an international study

OBJECTIVES

To examine the relationship between gender roles and self-rated health in older men and women from different contexts.

METHODS

2002 community-dwelling older adults from the International Mobility in Aging Study were recruited from 5 research sites. Gender role was measured with the 12-item Bem Sex Role Inventory, which categorized study participants into four gender roles: Masculine, Feminine, Androgynous, and Undifferentiated. Self-rated health was collapsed into a dichotomous variable (Very Good/Good and Fair/Poor/Very Poor). Prevalence risk ratios (PRR) of self-rated health relative to gender roles were estimated with Poisson regression models adjusted for all relevant confounders.

RESULTS

After complete adjustment, feminine (PRR 1.22 (95 % CI 1.01-1.49)) and undifferentiated (PRR 1.25 (95 % CI 1.05-1.50)) gender roles were associated with poorer relative self-rated health.

DISCUSSION

Gender roles confer independent risks and benefits for self-rated health in older adults.

Self-rated health after stroke: a systematic review of the literature

Background

Self-rated health (SRH) allows for comparison and identification of the health status of various populations. The aim of this study was to conduct a systematic review of the literature to expand the understanding of SRH after stroke.

Methods

This systematic review was registered with PROSPERO (CRD42017056194) and conducted according to PRISMA guidelines. Studies published until December 2018 that evaluated the SRH of adults with stroke were included.

Results

Of the 2132 identified studies, 51 were included. Only four studies had experimental designs (7.8%). In 60.7% of the studies, SRH was assessed by variations on direct questions (i.e., general and comparative SRH). Analog visual scales and quality of life instruments were also used to evaluate SRH, but there is no consensus regarding whether they are appropriate for this purpose. The results of cross-sectional and longitudinal studies revealed significant associations between poor SRH and stroke as well as between SRH, function, and disability. The power of SRH to predict stroke mortality is still uncertain. Two interventions (a home-based psychoeducational program concerning stroke health care and family involvement in functional rehabilitation) effectively improved SRH.

Conclusions

Direct questions are the most common method of evaluating SRH after stroke. Studies reported significant associations between the SRH of individuals with stroke and several relevant health outcomes. However, few experimental studies have evaluated SRH after stroke. Interventions involving health education and family involvement had a significant impact on SRH.

Self-Rated Health Status and Risk of Incident Stroke in 0.5 Million Chinese Adults: The China Kadoorie Biobank Study

Background and purpose

Self-rated health (SRH) is a consistent and strong predictor of all-cause and cardiovascular mortality in various populations. However, the associations between SRH measures and risk of first-ever or recurrent stroke were rarely explored. We thus aim to prospectively investigate the associations between SRH measures and risk of total and subtypes of stroke in Chinese population.

Methods

A total of 494,113 participants from the China Kadoorie Biobank without prior heart diseases or cancer (486,541 without stroke and 7,572 with stroke) were followed from baseline (2004 to 2008) until December 31, 2013. General and age-comparative SRH were obtained from baseline questionnaires. First-ever stroke or recurrent events were ascertained through linkage to disease registry system and health insurance data.

Results

We identified 27,662 first-ever stroke and 2,909 recurrent events during an average of 7.0 years of follow-up. Compared with excellent general SRH, the hazard ratios (HRs) and 95% confidence intervals (CIs) for first-ever stroke associated with good, fair, and poor general SRH were 1.04 (1.00 to 1.08), 1.19 (1.15 to 1.23), and 1.49 (1.42 to 1.56) in the multivariate model, respectively. Compared with better age-comparative SRH, the HRs (95% CIs) of same and worse age-comparative SRH were 1.13 (1.10 to 1.17) and 1.51 (1.45 to 1.58), respectively. The relations of SRH measures with ischemic stroke, hemorrhagic stroke, and recurrent stroke were similar to that with total first-ever stroke. However, the magnitude of associations was much stronger for fatal stroke than for non-fatal stroke.

Conclusions

This large-scale prospective cohort suggests that self-perceived health status is associated with incident stroke, regardless of stroke subtype.

Perceptions of self-rated health among stroke survivors: a qualitative study in the United Kingdom

Background

Self-rated health predicts health outcomes independently of levels of disability or mood. Little is known about what influences the subjective health experience of stroke survivors. Our aim was to investigate stroke survivors’ perceptions of self-rated health, with the intention of informing the design of interventions that may improve their subjective health experience.

Methods

We conducted semi-structured interviews with a purposive sample of 28 stroke survivors recruited from a stroke unit and follow-up outpatient clinic, 4–6 months after stroke, to explore what factors are perceived to be part of self-rated health in the early stages of recovery. Qualitative data were analysed using a thematic analysis approach to identify underlying themes.

Results

Participants’ accounts show that stroke survivors’ perceptions of self-rated health are multifactorial, comprising physical, psychological and social components. Views on future recovery after stroke play a role in present health experience and are shaped by psychosocial resources that are influenced by past experiences of ill-health, dispositional outlook such as degree of optimism, a sense of control and views on ageing.

Conclusions

Severity of physical limitations alone does not influence perceptions of self-rated health among stroke survivors. Self-rated health in stroke survivors is a multidimensional construct shaped by changes in health status occurring after the stroke, individual characteristics and social context. Understanding the factors stroke survivors themselves associate with better health will inform the development of effective approaches to improve rehabilitation and recovery after stroke.

Response shift in self-rated health after serious health events in old age

OBJECTIVE

Although health generally deteriorates with advancing age, how older adults evaluate their health status (i.e., their self-rated health, SRH) remains rather positive. So far, however, little is known about how SRH in old age may change in the face of an abrupt health decline. Because change/stability in SRH may reflect not only change/stability in health but also changes in the meaning people assign to the concept of "health", response shift effects in SRH for people with and without a serious health event are investigated in the present study in the older general population.

METHOD

Longitudinal data from 1764 participants of the German Ageing Survey aged 65 + assessed at two occasions three years apart was used to investigate changes in SRH and three types of response shift: recalibration (change in standards for good health), reprioritization (change in the importance of different factors for health), and reconceptualization (omission/inclusion of new factors). The so-called "then-test" was used to examine recalibration response shift and path analyses, to examine reprioritization and reconceptualization response shift.

RESULTS

SRH declined between the two measurement occasions. As expected, people who experienced a serious health event indicated stronger declines in SRH. The study found evidence of two types of response shift. Regardless of whether they experienced a serious health event or not, individuals on average retrospectively overestimated their baseline health relative to the concurrent rating (recalibration). Furthermore, the predictive importance of depressive symptoms and optimism for SRH increased for individuals who experienced a serious health event (reprioritization).

CONCLUSION

The results indicate that older adults maintain stable SRH by using two types of response shift: recalibration and, when faced with a serious health event, reprioritization response shift.

Influence of Allergy on Immunoglobulins and Amyloid-β in the Cerebrospinal Fluid of Patients with Alzheimer's Disease

BACKGROUND

Peripheral inflammation has been suggested to influence the development of Alzheimer's disease (AD). Elevated levels of pro-inflammatory markers in the plasma of patients with AD indicate that a systemic pro-inflammatory status occurs concomitantly with inflammatory changes in the brain.

OBJECTIVE

To investigate whether allergy influences the levels of immunoglobulins (Ig) and of pro- and anti-inflammatory cytokines in the serum and cerebrospinal fluid (CSF) from patients with AD, mild cognitive impairment (MCI), and subjective cognitive impairment (SCI).

METHODS

IgA, IgG, and its subclasses, IgM, and cytokines were analyzed in CSF and serum from patients with SCI, MCI, and AD, with or without allergy. The relation between allergy and Mini-Mental State Examination (MMSE) scores, and between allergy and CSF biomarkers for AD (phosphorylated (p)-tau, total (t)-tau, amyloid-β 42 (Aβ₄₂), were analyzed.

RESULTS

In MCI, the CSF levels of IgG2 were lower in allergic patients, and in AD, the levels of IgA and the IgG1/total IgG ratio were lower in allergic patients, compared to patients without allergy. MCI subjects with allergy had higher serum IgM levels compared to those without allergy. CSF levels of Aβ₄₂ were lower and MMSE scores were higher in AD patients with allergy than in those without allergy.

CONCLUSIONS

The presence of allergy was associated with seemingly beneficial effects on AD as suggested by higher Aβ₄₂ levels in CSF, and higher MMSE scores. Higher IgM levels and lower other Ig classes suggest that allergy may influence senescence of the immune response.

Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population

INTRODUCTION

Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke.

METHODS

MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years.

RESULTS

11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)).

CONCLUSIONS

Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.

Relationship of self-rated health with fatal and non-fatal outcomes in cardiovascular disease: a systematic review and meta-analysis

Background

People who rate their health as poor experience higher all-cause mortality. Study of disease-specific association with self-rated health might increase understanding of why this association exists.

Objectives

To estimate the strength of association between self-rated health and fatal and non-fatal cardiovascular disease.

Methods

A comprehensive search of PubMed MEDLINE, EMBASE, CINAHL, BIOSIS, PsycINFO, DARE, Cochrane Library, and Web of Science was undertaken during June 2013. Two reviewers independently searched databases and selected studies. Inclusion criteria were prospective cohort studies or cohort analyses of randomised trials with baseline measurement of self-rated health with fatal or non-fatal cardiovascular outcomes. 20 studies were pooled quantitatively in different meta-analyses. Study quality was assessed using Newcastle-Ottawa scales.

Results

‘Poor’ relative to ‘excellent’ self-rated health (defined by most extreme categories in each study, most often’ poor’ or ‘very poor’ and ‘excellent’ or ‘good’) was associated over a follow-up of 2.3–23 years with cardiovascular mortality in studies: where varying degrees of adjustments had been made for cardiovascular disease risk (HR 1.79 (95% CI 1.50 to 2.14); 15 studies, I2 = 71.24%), and in studies reporting outcomes in people with pre-existing cardiovascular disease or ischaemic heart disease symptoms (HR 2.42 (95% CI 1.32 to 4.44); 3 studies; I2 = 71.83%). ‘Poor’ relative to ‘excellent’ self rated health was also associated with the combined outcome of fatal and non-fatal cardiovascular events (HR 1.90 (95% CI 1.26 to 2.87); 5 studies; I² = 68.61%), Self-rated health was not significantly associated with non-fatal cardiovascular disease outcomes (HR 1.66 (95% CI 0.96 to 2.87); 5 studies; I2 = 83.60%).

Conclusions

Poor self rated health is associated with cardiovascular mortality in populations with and without prior cardiovascular disease. Those with current poor self-rated health may warrant additional input from health services to identify and address reasons for their low subjective health.

What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study

BACKGROUND

Poor self-rated health has been associated with poorer objective health outcomes across a range of conditions including stroke. Identification of factors associated with poor self-rated health in stroke survivors has received little attention compared to that in other older individuals. This study identifies determinants of self-rated health in older individuals with or without a history of stroke participating in the population-representative MRC Cognitive Function and Aging Study (MRC CFAS).

METHODS

The MRC CFAS is a multicentred longitudinal survey of a population representative sample of people in their 65th year and older at baseline. Baseline interview included questions about functional disability, psychiatric history, independent living status, social interactions, and cognitive function. Multiple logistic regression was used to determine associations between demographic, physical, cognitive, psychological and social factors with poor self-rated health among those with and without stroke.

RESULTS

After excluding those with impaired cognitive function, 776 individuals out of 11,957 reported a stroke. Factors associated with self-rated health were similar between those with or without a stroke in older individuals. Poorer self-rated health in those who had suffered a stroke was associated predominantly with the presence of comorbidity with diabetes (OR 3.5; 95% CI 1.5-8.1) and not "getting out and about" (OR 2.6; 95% CI 1.7-4.1) even after adjustment for disability levels and for depression. In those without a stroke the most important determinants were disability (OR 3.9; 95% CI 3.2-4.8) and not "getting out and about" (OR 2.9; 95% CI 2.5-3.3). The presence of disability was less strongly associated with poor self-rated health in those with a history of stroke than those without due to a substantially higher reporting of poor self-rated health in the non-disabled stroke group than the non-disabled stroke-free group, while those with disabilities reported poor self-rated health irrespective of stroke status.

CONCLUSIONS

Self-rated health is determined by a range of psychological and social factors in addition to disability in older patients with stroke. Addressing social integration and mobility out of the home is an important element of rehabilitation for older people with stroke as well as those without.

Modifiable factors associated with sleep dysfunction in adults with heart failure

BACKGROUND

Sleep dysfunction contributes to poor quality of life in adults with heart failure (HF). The purpose of this study was to identify factors associated with sleep dysfunction that may be modifiable.

METHODS

Data were collected from 266 subjects enrolled from three sites in the U.S. Sleep dysfunction was measured over the past month with the Pittsburgh sleep quality index, using a score > 10 to indicate sleep dysfunction. Potentially modifiable clinical, behavioral, and psychological factors thought to be associated with sleep dysfunction were analyzed with hierarchical logistic regression analysis.

RESULTS

When covariates of age, gender, race, data collection site, and New York Heart Association (NYHA) functional class were entered on the first step, only NYHA was a significant correlate of sleep dysfunction. When the clinical, behavioral, and psychological factors were entered, correlates of sleep dysfunction were the number of drugs known to cause daytime somnolence (OR = 2.08), depression (OR = 1.83), worse overall perceived health (OR = 1.64), and better sleep hygiene (OR = 1.40). Although most (54%) subjects had sleep disordered breathing (SDB), SDB was not a significant predictor of sleep dysfunction.

DISCUSSION

Factors associated with sleep dysfunction in HF include medications with sleepiness as a side-effect, depression, poorer health perceptions, and better sleep hygiene. Sleep dysfunction may motivate HF patients to address sleep hygiene. Eliminating medications with sleepiness as a side-effect, treating depression and perceptions of poor health may improve sleep quality in HF patients.

Determinants of changes in self-rated health among Finnish war veterans: results from the Veteran Project 1992 and 2004 surveys

Self-rated health is a strong predictor of mortality, morbidity, future functional capacity and the quality of life. Measures of self-rated health have been collected fairly regularly since the 1980s, but few of them focus on self-rated health among the elderly war veterans. The aim of this study was to examine changes in self-rated health among Finnish war veterans from 1992 to 2004 and to analyze the independent determinants associated with changes in veterans' self-rated health. The study population was 4999 veterans living in Finland, who participated in data collection of both the Veteran Project 1992 and 2004. Logistic regression models were used to identify independent predictors for changes in self-rated health. Analyses were conducted separately for men with and without disability and for women. During the follow-up, self-rated health improved or remained unchanged among 88.8% of the men without disability, 90.5% of the men with disability and 87.9% of the women. Determinants for declined self-rated health were a new cardiovascular disease (CVD) among all veteran groups, increased walking difficulties among men without disability and women, a new neurological disease and institutionalization among men without disability, and a new musculoskeletal disease among men with disability. In conclusion, the majority of veterans rated their health improved or unchanged during the follow-up. The importance of mobility impairments and cardiovascular, musculoskeletal and neurological diseases as the predictors of declined self-rated health were confirmed.

The improvement of cognitive functions in patients with bronchial asthma after therapy

BACKGROUND

The severity of asthma in older people is frequently underestimated because of underdiagnosis and undertreatment. There are a number of reasons for this. In elderly patients, chronic diseases can be related to declining cognitive function. This situation could influence diagnosis and treatment. The objective of this study was to evaluate the influence of appropriate asthma therapy on cognitive function.

METHODS

A total of 359 participants diagnosed with bronchial asthma, 219 women and 140 men with a mean age of 69 ± 4.03 years, were included in this study. Cognitive function was assessed with the Mini-Mental State Examination (MMSE) at the beginning of this study and after 1 year. Patients were divided into three subgroups based on their initial MMSE scores dementia, mild cognitive impairment (MCI), and good cognition.

RESULTS

At the beginning of this study, 31.2% of patients presented uncontrolled asthma, 46.2% exhibited partly controlled asthma, and 25.1% had well-controlled asthma. A significant improvement in control over the patients' asthma was observed over the course of this study. After 1 year of treatment, the mean MMSE score significantly increased in initially demented patients, from 18.2 ± 3.1 (mean ± SD) to 21.9 ± 2.1 (p < .01); in subjects with MCI, from 25.4 ± 0.9 to 27.2 ± 1.2; and in patients with good cognition, from 27.4 ± 0.7 to 29.7 ± 0.4 (chi-square test, p < .01).

CONCLUSION

Proper control of asthma in patients with cognitive impairments can improve some cognitive functions.

Self-rated health status transition and long-term care need, of the oldest Chinese

OBJECTIVES

The objectives of this paper are: (1) to estimate the transition probabilities among self-rated health status for the oldest Chinese aged 80 and above; (2) to project the future need of long-term care due to changes in demography and health status among the oldest Chinese.

METHODS

Self-rated health data collected in Chinese Longitudinal Healthy Longevity Survey conducted in 1998, 2000 and 2002 were used to estimate the self-rated health status transition probabilities, and to project future long-term care need by calculating the number of unhealthy person-years.

RESULTS

The majority of the oldest Chinese's health status remains unchanged or worsens within 2 years. The number of unhealthy person-years rises regardless of gender, and the absolute number and increase rate of females are higher than those of males. Under the assumption that average care expenditure is 15 US dollars per hour in 2010, the long-term care expenditure will increase from 8352 million dollars in 2010 to 42,530 million dollars in 2050, a growth of more than 400% over the next 40 years.

CONCLUSIONS

Long-term care need for the oldest Chinese will rise rapidly in the next decades, which should stimulate increased governmental and public awareness of their need.

Determinants of perceived health in older adults with hypertension

OBJECTIVE

To describe perceived health and assess the factors that contribute to perceived health in community-dwelling older adults diagnosed with hypertension.

METHODS

The study was a secondary analysis of data from a cross-sectional study that examined community-dwelling adults' health status, use of health services, and access to care. Hierarchical regression identified factors that contributed to perceived health in 1485 adults aged 60 years and older who were diagnosed with hypertension.

RESULTS

A model of nonmodifiable factors, support resources, and lifestyle factors explained a significant proportion of the variance in perceived health, most of which was captured by nonmodifiable factors.

CONCLUSION

Attention to nonmodifiable factors is needed in both clinical practice and research to identify a subset of older adults diagnosed with hypertension who are at risk for poor perceived health.

Self-rated health, activities of daily living, and mobility limitations among black and white stroke survivors

Objective. To explore racial differences in self-rated health (SRH) and its relationship to activities of daily living (ADLs) and mobility limitations among stroke survivors. Method. Data from 580 Black and White participants of the North Carolina Established Populations for Epidemiologic Studies of the Elderly (EPESE) were used to assess relationships between SRH, ADLs, and mobility variables. Fisher's exact tests, t tests, and logistic regression with backward selection (p < .20) were used. Results. No racial difference in SRH was found. SRH was significant in predicting ADL status among Whites only (OR = 0.23; CI = 0.08-0.69; p < .01). Participants older than 75 years had a greater likelihood of being in the lowest functioning ADL categories (OR = 2.31; CI = 1.48-3.60; p < .01). Discussion. Though no racial differences in SRH were found, the relationship between SRH, ADLs, and mobility status was moderated by race. SRH was predictive of limitations in Whites only. Observed differences suggest SRH construct may differ by race.

Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity

OBJECTIVE

To examine the impact of changes in comorbidity--as measured by the Charlson comorbidity index--on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories.

STUDY DESIGN AND SETTING

Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions.

RESULTS

Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia.

CONCLUSION

Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.

Factors predicting perceived improved health after emergency room visits

AIM

This study examines the key factors contributing to perceived improved health after emergency room (ER) visits.

BACKGROUND

Perceived health is a subjective measure of health status. It is an important and useful concept in nursing and assessment of health services because it reflects the clients' own assessment of his/her health, which may have led to their subsequent health-seeking behaviour.

METHODS

Secondary analysis of a main study which aimed at examining the effects of nurse follow-up on ER revisits using randomized-controlled trial. In this study, binary logistic regressions were conducted to identify factors associated with the dependent variable, perceived improved health 30 days after the index ER visit. Data were collected from 795 subjects and the sources of data were from medical records and telephone interviews.

RESULTS

Gender, income, usual practice in managing minor illness, what to do other than attending the ER, nurse follow-up, general self-rated health, triage, considered other doctors on the day of index ER visit, times of attending general outpatient clinic and times of attending general practitioner were found to be significantly associated with perceived improved health 30 days after the index ER visit.

CONCLUSION

Many of the variables identified in this study that predicted perceived improved health concurred with previous findings. What is of interest is that nurse follow-up but not multiple medical consultations helped enhance perceived improved health. We speculate that there was no continuity of care in the multiple medical consultations. Where as in the nurse follow-up, the nurse was able to follow through the care of individuals, monitor their progress and make appropriate referrals. This study shows that the nurse is an appropriate person to mediate the health needs of individuals and the healthcare system and to enhance health maintenance for individuals in the community without excessively using medical services.

RELEVANCE TO CLINICAL PRACTICE

The nurses providing care during the transitional phase should not only include the traditional clinical or hospital system variables, but should also take into account the general health perception of patients, because these are the predictors of health services utilization and morbidity.

Self-rated health, symptoms of depression and general symptoms at 3 and 12 months after a first-ever stroke: a municipality-based study in Sweden

BACKGROUND

Self-rated health is an important indicator of quality of life as well as a good predictor of future health. The purpose of the study was to follow up the self-rated health and the prevalence of symptoms of depression and general symptoms in a population of first-ever stroke patients 3 and 12 months after stroke.

METHODS

All patients surviving their first-ever stroke and residing in Nacka municipality in Stockholm County Council were included using a multiple overlapping search strategy during an 18-month period (n = 187). Our study group comprised the 145 patients who survived the first 3 months after stroke. Three and 12 months after their stroke, the patients were assessed regarding self-rated health and general symptoms using parts of the Göteborg Quality of Life Instrument (GQLI), and regarding symptoms of depression using the Montgomery Asberg Depression Scale (MADRS-S).

RESULTS

Self-rated health was rated as very good or rather good by 62% at 3 months after stroke and by 78% at 12 months after stroke. More than half of the patients suffered from symptoms of depression, with no significant improvement at 12 months. The most common general symptoms at 3 months after stroke were fatigue, sadness, pain in the legs, dizziness and irritability. Fatigue and sadness were still common at 12 months. Twelve months after stroke the prevalences of crying easily, irritability, impaired concentration, nausea and loss of weight were significantly lower.

CONCLUSION

The majority of patients rated their health as rather good or very good at 3 and 12 months after stroke. However, the majority suffered from fatigue and from symptoms of depression after both 3 and 12 months. In continued care of stroke survivors, it is important to consider the fact that many patients who rate their health as good may nevertheless have symptoms of depression, and some of them may benefit from anti-depressive treatment.

Self-rated health status as a predictor of death, functional and cognitive impairment: a longitudinal cohort study

Understanding the prognostic capacity of a simple measure of self-rated health (SRH) by older people becomes increasingly important as the population ages. SRH has been shown to predict survival, functional status and service use. The relationship with cognitive impairment has not been widely investigated. This paper investigates SRH as a predictor of death, functional impairment (inability to perform activities of daily living) and cognitive impairment (MMSE < 18) over a 10-year follow-up of participants in the MRC Cognitive Function and Ageing Study. A stratified random sample of 13,004 people aged 65 or over resident in five areas in England and Wales were interviewed. Analysis used data from interviews at baseline, 2, 6 and 10 year follow-up. Hazard ratios for risk of death, functional and cognitive impairment were estimated, unadjusted and adjusted for potential confounding baseline factors. Of the 13,004 participants recruited, 6,882 had died by 10 years and 1,252 and 481 new cases of functional and cognitive impairment respectively were recorded. SRH was associated with a higher risk of death, functional and cognitive impairment. The associations remained after adjustment for age, gender, functional ability and MMSE at baseline: comparing those who rated their health as excellent and good, hazard ratios for risk of death, functional and cognitive impairment were 0.8 (95% CI 0.8-0.9), 0.6 (95% CI 0.5-0.7) and 0.7(95% CI 0.5-0.9), respectively. In-depth qualitative study designs are needed to investigate why the meaning older people give to their health status predicts long-term outcomes.