Health asymmetry as a predictor of depressive symptomatology over time among older European adults: A growth curve analysis

OBJECTIVE

Subjective (SH) and objective health (OH) measures are associated with depressive symptomatology in older adults. We explored whether the discrepancy between SH and OH (operationalised as 'health asymmetry' with four categories: 'health optimistic', 'health pessimistic' and 'good health realistic' and 'poor health realistic') may also relate to depressive symptomatology 1) cross-sectionally, and 2) longitudinally, among older European adults.

METHODS

Adults (n = 26,520), aged 50+, from 11 European countries, were assessed over six waves of data collection (2006-2020) in the SHARE study. A hierarchical multi-level growth curve model explored whether health asymmetry was associated with depressive symptomology at baseline, and with depressive symptom trajectories across time, accounting for country of origin.

RESULTS

At baseline, 11.8% of older adults were classified as health pessimistic, with 15.5% being health optimistic, 42.9% being poor health realistic and 29.8% being good health realistic. A positive linear trend in depressive symptomatology was noted across 14 years of SHARE data (β = 0.11, p < .001). Health pessimists displayed higher levels of depressive symptoms than both health realistic groups and health optimists. However, health pessimists experienced a less steep increase in depressive symptoms across time (β = -0.10, p < .001), relative to good health realists.

CONCLUSION

Health pessimists experience elevated levels of depressive symptoms, but show less growth in depressive symptomatology than expected. Further research is required to understand the underlying causes of the varying depressive symptom trajectories among these groups.

Child Lead Screening Behaviors and Health Outcomes Following the Flint Water Crisis

BACKGROUND

There is little research on lead (Pb) screening behaviors and outcomes and possible health sequelae of children in Flint, Michigan in the years following the city's 2014 water crisis, which included widespread tap water contamination with elevated levels of heavy metals and other environmental contaminants.

METHODS

Between June and November 2019, we collected and analyzed cross-sectional data on Flint children's demographics and self-report of screenings of blood lead levels (BLLs) and results and various potential water contamination-related health symptoms and outcomes. We calculated descriptive statistics to summarize the prevalence of health outcomes and screenings in children, and fit multivariable models using generalized estimating equations to characterize the association between baseline traits and health symptoms and outcomes in children.

RESULTS

A total of 244 children (mean age 8.6 ± 4.8) were included in the analysis. Overall, 76.6% of the children were reported to have been screened for elevated BLLs after the water source switch. In total, after the water source switch, 25.0% of children were reported as having clinician-diagnosed elevated BLLs. Overall, 43.9% of children experienced hyperactivity, 39.3% had emotional agitation, 29.1% had comprehension issues/learning delays, while 38.9% of children had skin rashes and 10.7% experienced hair loss. A child having elevated BLLs also significantly increased the odds of experiencing adverse cognitive/behavioral outcomes (comprehension issues/learning delays OR = 4.0, hyperactivity OR = 6.6, emotional agitation OR = 3.5).

CONCLUSION

Child BLL screening following the crisis initiation was moderate, and BLLs and potential water contamination-related morbidity outcomes appeared heightened. Further research is needed to contextualize epidemiologic factors contributing to BLL screening patterns and results and the potential water contamination-associated sequelae observed here.

Sick of social status: A Bourdieusian perspective on morbidity and health inequalities

Self-reported health (SRH) is one of the most frequently used measures for examining socioeconomic inequalities in health. Studies find that when faced with 'identical objective health', individuals in lower socioeconomic groups consistently report worse SRH than those in higher socioeconomic groups. Such findings are often dismissed as being the result of reporting bias, and existing literature dominated by the biomedical conception of SRH has not investigated the underlying social mechanisms at work. To address this limitation, drawing on the work of Bourdieu we employ a relational thinking between health and social position. By way of multiple correspondence analysis, we construct social space of health determinants for three European countries from different welfare states and map the trajectories of educational groups experiencing similar levels of morbidity and their relation to SRH. Differences in SRH observed among social groups for the same level of morbidity are understood in relation to the position and the relative power of individuals in different educational groups to maintain or improve their social conditions, especially with increasing levels of health loss. Our analysis indicates that reporting differences in SRH among educational groups emerges from objectively healthy individuals and follows differences in accumulation of social advantages and disadvantages.

Weight, Weight Perceptions, and Health and Well-Being Among Canadian Adolescents: Evidence From the 2017-2018 Canadian Community Health Survey

PURPOSE

The present study examines the extent to which (mis)matched weight and weight perceptions predict adolescents' self-rated health, mental health, and life satisfaction.

DESIGN

Quantitative, cross-sectional study.

SETTING

Data from the 2017-2018 Canadian Community Health Survey (CCHS)-a nationally representative sample collected by Statistics Canada.

PARTICIPANTS

Canadian adolescents aged between 12 and 17 (n = 8,081).

MEASURES

The dependent variables are self-rated health, mental health, and life satisfaction. The independent variable is (mis)matched weight and weight perceptions.

ANALYSIS

We perform a series of ordinary least squares (OLS) regression models.

RESULTS

Overweight adolescents with overweight perceptions are associated with poorer self-rated health (b = -.546, p < .001 for boys; b = -.476, p < .001 for girls), mental health (b = -.278, p < .001 for boys; b = -.433, p < .001 for girls), and life satisfaction (b = -.544, p < .001 for boys; b = -.617, p < .001 for girls) compared to their counterparts with normal weight and normal weight perceptions. Similar patterns have also been observed among normal weight adolescents with overweight perceptions (e.g., normal weight adolescents with overweight perceptions are associated with poorer self-rated health (b = -.541, p < .01 for boys; b = -.447, p < .001 for girls)).

CONCLUSION

Normal weight adolescents are not immune to adverse self-rated health, mental health, and life satisfaction because their weight perceptions are also a contributing factor to health and well-being consequences.

Health congruence paradox in older adults: Contribution of cognition and relational visits

The health congruence paradox can have important implications for those working with older adults as older adults' health understanding may be vague or directed toward health concerns other than those medically identified. Objective health was measured as diagnosed conditions from medical records. Two measures of subjective health were obtained through relational visits of university students, 1) health concerns older adults reported on a visit survey, 2) health concerns students reported during casual conversation. The results showed that community dwelling older adults with lower cognitive functioning ability were more susceptible to the health congruence paradox on the subjective measure of the survey report. Qualitative analysis of health concerns from subjective measures found older adults most concerned about health conditions impacting daily functioning, such as mobility and cognition, but not diagnosed hypertension. This mixed methods study confirmed the importance of understanding older adults' subjective health with measures easily obtained through relational visits with university students.

The effects of social comparisons on subjective age and self-rated health

Older adults consistently report young subjective age and provide high ratings of their subjective health. The current research examined which social comparisons older adults make when they assess their subjective age and health, as well as the effects of experimentally manipulated social comparisons on these assessments. In Study 1, 146 participants (aged 60 and over) reported to whom they compared themselves when assessing their subjective age or health. In Study 2, 100 participants (aged 60 and over) reported their subjective age and health after receiving feedback that compared them to younger adults or to their peers. Study 1 shows that participants compared themselves primarily to their peer group. Yet, individuals who selected a younger comparison group when assessing subjective age reported a younger subjective age, better self-rated health and more positive expectations regarding ageing relative to those who selected their peers as a comparison group. No equivalent differences emerged in any of the measures when participants were divided by their selection of comparison group after providing their self-rated health ratings. In Study 2, feedback that emphasised the performance of younger people led to reports of younger subjective age relative to feedback that emphasised peer performance, with no equivalent difference for self-rated health. These findings help explain why older adults feel younger and healthier than they actually are. We suggest that older adults use social comparisons as a strategy that protects them from the negative effects of ageing on self-perception.

Views on aging: older adults' self-perceptions of age and of health

Perceptions of age and perceptions of health have each been found to predict future health and well-being, yet surprisingly, studies typically focused on one or the other. Studies on perceived age suggested that its effects on longevity may be mediated by perceived health. Within each of these lines of research, the constructs have not been consistently operationalized, making it difficult to generalize across studies. We aimed to investigate the associations of different measures of perceptions of age and of health with one another and with longevity. Data collected at baseline from the 851 participants of the Rutgers Aging and Health longitudinal study (mean age 73) included perceptions of age and health, each assessed with four different single-item measures, sociodemographic, and health measures. Mortality was followed-up for 10 years. All four health perceptions and two of the age perceptions (Age-group identity and nearness-to-death) were associated with survival time. Age and health perceptions had similar independent effects in models that included measures of both types, controlling for demographics and chronic conditions, though not after controlling for age. In contrast with our hypothesis, health perceptions did not mediate the association between age perceptions and mortality. Findings regarding health perceptions were generally consistent across measures, whereas age perception measures differed in their associations with various outcomes, indicating that they assess different subjective age constructs. The findings correspond with proposed explanations for the predictive effect of age and health perceptions and support the significant though weaker independent effects of age perceptions compared with health perceptions.

Self-reported health and the social body

Since the strong predictive power of self-reported health (SRH) for prospective health and social outcomes has been established, researchers have been in a quest to build a theoretical understanding of this widely used health measure. Current literature based predominantly in a biomedical perspective asserts a linear relationship between physical conditions and perception of health. Discrepancies from this expected relationship are considered an important weakness of SRH. Systematic discrepancies between physical conditions and reporting of SRH have been documented across different socio-economic groups. Evidence identified for educational groups shows that for the same level of health status, lower-educated groups report poorer levels of perceived health. This raised doubts whether it is useful to use SRH to measure social inequalities in health within and between countries. To date, sociologists of health have not engaged in the discussion of reporting heterogeneity in SRH. After reviewing existing evidence, we contend that the discrepancy in SRH reporting across social groups argued to be a weakness of SRH as a health measure is a strength from a sociological perspective. SRH as a social measure of health is a better predictor than objective measures of health precisely because it captures the lived experience of the embodied agent.

Psychological factors and self-rated health: An observative study on cardiological patients

This study investigated the association of illness representations, awareness of bodily states and health complaints to self-rated health in N = 150 consecutive patients with heart disease (ischaemic disease, heart failure and heart valve disease) and explored differences between ‘health optimist’ and ‘health pessimist’ patients. After controlling for medical variables, health complaints accounted for 14.2 per cent of patients’ self-rated health, and illness representations contributed for another 16.2 per cent; body awareness was not associated with self-rated health. Also, ‘optimists’ tended to see less negative consequences from their illness and perceived greater control over illness treatment compared to ‘pessimists’. Targeting symptoms and illness representations may optimize rehabilitation outcomes.

Factors associated with formal volunteering among retirees

The present study developed and tested a comprehensive multivariate model designed to assess the relative importance of various factors found or proposed in previous research to be associated with engagement in volunteering among 799 fully retired Australian older adults (62% female; mean age = 71.92 years (SD = 6.69)). Engagement in volunteering in the 12 months preceding the study and a range of sociodemographic, psychological, physical, social, and attitudinal variables were measured. Respondents' perceived personal responsibility to volunteer was found to be especially important in the tested model. This variable was directly associated with engagement in volunteering and acted as an important mediator between the following variables and volunteering engagement: personal growth, social connectedness, religious attendance, self-rated health, and depression. Efforts to increase volunteering engagement among older adults may therefore need to target perceptions of their responsibility to volunteer. Especially important focus areas for future strategies may include increasing social connectedness, facilitating personal growth, and improving self-rated health.

Identifying modifiable factors associated with health optimism in older adults

OBJECTIVE

Despite the documented importance of health optimism for enhancing health outcomes, very little work has been done to examine who experiences health optimism and under what conditions. The present study sought to identify modifiable factors associated with health optimism that could constitute the focus of future intervention efforts designed to promote health optimism among older people.

DESIGN

Participants were 453 (44% males) community-based Western Australians aged 60+ years (M = 70.39 years, SD = 6.06). Participants completed questionnaires to assess sociodemographic characteristics and provided information relating to physical and psychological health status.

RESULTS

Almost a quarter of participants (24%; n = 108) were classified as health optimists. Results from a multivariate regression analysis found quality of life, psychological well-being, and age to be directly and positively associated with health optimism. A subsequent path analytic model found depression (negatively) and self-efficacy (positively) to be indirectly associated with health optimism via both psychological well-being and quality of life.

CONCLUSION

These findings extend the limited evidence on health optimism in older adults by identifying various modifiable factors that may constitute potential areas of focus for future interventions designed to enhance health outcomes via the fostering of health optimism.

The Meaning and Predictive Value of Self-rated Mental Health among Persons with a Mental Health Problem

Self-rated health is a valid measure of health that predicts quality of life, morbidity, and mortality. Its predictive value reflects a conceptualization of health that goes beyond a traditional medical model. However, less is known about self-rated mental health (SRMH). Using data from the Medical Expenditure Panel Survey ( N = 2,547), we examine how rating your mental health as good-despite meeting criteria for a mental health problem-predicts outcomes. We found that 62% of people with a mental health problem rated their mental health positively. Persons who rated their mental health as good (compared to poor) had 30% lower odds of having a mental health problem at follow-up. Even without treatment, persons with a mental health problem did better if they perceived their mental health positively. SRMH might comprise information beyond the experience of symptoms. Understanding the unobserved information individuals incorporate into SRMH will help us improve screening and treatment interventions.

Depression Moderates the Frailty-Subjective Health Link among Chinese Near Centenarians and Centenarians

OBJECTIVE

Very old adults may be physically frail, but they do not necessarily experience poor subjective health. The authors hypothesized that the relationship between frailty and subjective health is moderated by depression for very old people.

METHODS

In a cross-sectional study, a survey administered was by a face-to-face interview to 129 community-dwelling older adults aged 95-108. Measurements included the five-item FRAIL scale, the Geriatric Depression Scale Short-Form (GDS), and a subjective health rating. Hierarchical multiple regressions were conducted to test the moderation effects, adjusting for age, gender, living arrangement, perceived socioeconomic status, and cognition.

RESULTS

The interaction effect between frailty and depression was significant. Inspection of the simple slopes revealed that those who were more depressed had a more negative frailty-subjective health relationship. There was no significant moderation effect for a withdrawal-apathy-vigor dimension of the GDS.

CONCLUSION

Our findings suggest a protective psychological mechanism may enable very old adults to maintain an optimistic view of their health despite their increasing physical and functional limitations.

The Meanings of Self-Ratings of Health

Self-ratings of health are central measures of health status that predict outcomes such as mortality and declines in functional ability. Qualitative and quantitative data are used to test the hypothesis that definitions of health that are narrowly biomedical are associated with underestimates of self-ratings relative to respondents’medical histories, while definitions that are broad and inclusive are related to relatively better self-ratings. A sample of 159 elderly African Americans rates their health and reports “what went through your mind.” Analysis of variance shows that respondents who overestimate their health are more likely to report ratings based on social activities and relationships, or psychological, emotional, or spiritual characteristics, rather than biomedical criteria. The authors conclude that inclusive definitions of health facilitate more positive self-ratings of health, given a fixed health status; methodologically, they conclude that this is a promising method for exploring self-ratings of health.

Factors associated with depression among elderly Koreans: the role of chronic illness, subjective health status, and cognitive impairment

OBJECTIVES

The objective of this cross-sectional study was to investigate the relationship between depression in elderly individuals and chronic illness, subjective health status, and cognitive impairment.

METHOD

This study used the dataset of the Survey of Living Conditions and Welfare Needs of Korean Older Persons, which was conducted by the Korea Institute for Health and Social Affairs in 2011. Participants (n = 10,674) were randomly selected from a pool of individuals aged 65 years and older. Elderly depression was evaluated by the short version of the Geriatric Depression Scale. Multivariate logistic regression was used to investigate factors associated with depression in terms of their sociodemographic and health-related characteristics.

RESULTS

Our results revealed that chronic illness, subjective health status, and cognitive impairment were significant factors associated with depression. In particular, subjective health status showed the highest odds ratio (OR) (OR for bad subjective health status = 4.290, P < 0.001), followed by chronic illness (OR for three or more chronic illnesses = 1.403, P < 0.01) and cognitive impairment (OR = 1.347, P < 0.001) in the final model. Interestingly, the significant association between chronic illness and depression was attenuated (OR for three or more chronic illnesses = 1.403, P = 0.01) or even disappeared (OR for two chronic illnesses = 1.138, P = 0.274; OR for one chronic illnesses = 0.999, P = 0.996) after adjustment for subjective health status in the final model; this may be attributable to the close relationship among the variables studied: chronic illness, subjective health status, and depression.

CONCLUSIONS

Development and implementation of prevention strategies, including management of chronic illness, individual's perception of health status, and cognitive impairment, could possibly reduce the impact of depression.

Perceived weight, not obesity, increases risk for major depression among adolescents

This study examined the association between major depression, obesity and body image among adolescents.

METHODS

Participants were 4175 youths 11-17 years of age sampled from the community who were interviewed using the Diagnostic Interview Schedule for Children and Adolescents, Version IV, completed a self-report questionnaire, and had their weight and height measured. There were 2 measures of body image: perceived weight and body satisfaction. Obesity was associated with increased risk of depression, with no controls for covariates. However, when the association was examined in models which included weight, major depression, and body image measures and covariates, there was no association between major depression and body weight, nor between body satisfaction and major depression. Perceived overweight was strongly and independently associated with body weight (O.R. = 2.62). We found no independent association between major depression and body weight. If there is an etiologic link between major depression and body weight among adolescents, it most likely operates through processes involving components of body image. Future research should focus on the role of depression and body image in the etiology of obesity.

Factors associated with perceived health in older adult Irish population

OBJECTIVES

Perceived health status or self-reported health declines with age and is associated with increased morbidity, mortality, poor mental health and functional outcomes and health care utilisation. The aim of this study was to investigate the relationship between a range of biopsychosocial measures and self-reported health in a sample of community-dwelling older people living in Dublin.

METHOD

A total of 492 participants with a mean age of 72.5 (SD = 7.34) were assessed at the Technology Research for Independent Living (TRIL) clinic, a comprehensive geriatric assessment facility in St James's Hospital, Dublin, using standardised measures of medical morbidity, personality, functional status, depression, anxiety, perceived stress, cognition, loneliness and social support. The relationship between self-rated health and health measures was analysed using bivariate correlations and backward multiple regression. Indirect pathways of effects on perceived health were evaluated using bootstrapping mediation analysis.

RESULTS

Self-rated health was best predicted by instrumental activities of daily living (IADL), Charlson Co-morbidity Index (CCI), extraversion and perceived stress. The effects of cognition and social support from friends on self-rated health were found to be mediated by elements of these identified factors.

CONCLUSION

Self-rated health is not simply the absence of physical illness but is also strongly influenced by the degree of functional impairment, personality factors and the level of stress experienced by the older person.

Later life health optimism, pessimism and realism: psychosocial contributors and health correlates

Prior research has established positive outcomes of health optimism (appraising one's health as good despite poor objective health (OH)) and negative outcomes of health pessimism (appraising health as poor despite good OH), yet little is known about their contributors. We examined the role of psychosocial factors (life event stress, depression, dispositional optimism, perceived social support) in health realism (appraising health in accordance with OH), optimism and pessimism among 489 older men and women. We then accounted for the psychosocial factors when examining multiple health correlates of health realism, optimism and pessimism. Controlling for age, gender and income, regression results indicate that depression and social support were associated with less health optimism, while dispositional optimism was associated with greater health optimism among those in poor OH. Dispositional optimism was associated with less health pessimism and life event stress was associated with greater pessimism among those in good OH. Beyond the effects of the psychosocial factors, structural equation model results indicate that health optimism was positively associated with healthy behaviours and perceived control over one's health; health pessimism was associated with poorer perceived health care management. Health optimism and pessimism have different psychosocial contributors and health correlates, validating the health congruence approach to later life well-being, health and survival.

Characterizing self-rated health during a period of changing health status

Self-rated health (SRH) is among the most frequently assessed health perceptions. The purpose of this study was to assess the tenability of the recently proposed distinctions of SRH, as a spontaneous assessment of overall health, or as an enduring self-concept. Individuals (n = 449) undergoing total joint replacement for hip or knee osteoarthritis in Toronto, Canada were followed over 6 months of recovery. Health questionnaires, completed pre-surgery, and at 3 and 6 months post-surgery, included measures of pain, physical function, sports/recreation, fatigue, anxiety, depression, social participation, passive/active recreation, and community access. Structural equation modeling was used for the analyses. SRH was found to be responsive to current and changing mental well-being throughout the six months of recovery. Current SRH strongly predicted future SRH. In this clinical sample undergoing significant changes in health status, SRH displayed both enduring and spontaneous features; evidence is provided that both operate simultaneously. SRH may prove to be a simple yet critical health measure for identifying individuals who would benefit most from targeted interventions for improving overall health.

Costs of Ambulatory Medical Care Over the Long Term in the Quebec Medicare System

This paper examines the question of whether the costs of ambulatory medical care (AMCC) in a universal health care system, such as that in Quebec, are related to household income. Questionnaires completed by 32,000 respondents for the Enquête Santé-Québec, 1987 (ESQ87) were matched with records in the Quebec Medicare system (La Régie d'Assurance-maladie du Québec, RAMQ). Approximately 90 per cent of the individuals were matched. Respondents living in remote regions were excluded from the study since a major portion of medical care in these regions is not reimbursed through fee for service; visits to physicians not on fee for service are not recorded in RAMQ files. At the individual level, the costs of ambulatory medical care over a two-year period decreased slightly with income, but at the household level, costs increased for those with higher incomes since the number of individuals in the households increased with income. These associations disappeared when the age of the respondents was taken into account. State of health is directly related to costs of care. Among health risks, availability of social support decreases costs of AMCC for both children and adults, while unemployment increases costs for adults only. Education of parents is linked with higher levels of costs for children, but AMCC decreases with increased education of adults. Finally, costs are lower for children in larger families compared with those in smaller families. To conclude, income does not affect costs of AMCC in Quebec, although variables associated with income, such as education, unemployment and family size, do have definite effects on costs. The absence of a link between psychological distress and costs for the elderly is a matter of concern since it confirms the difficulty the elderly experience in accessing psychiatric care.

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.

Health and Happiness for Elderly Institutionalized Canadians

Cette étude explore les facteurs déterminants de l'autoévaluation de la santé et du bonheur chez les aîné(e)s vivant en établissement d'après l'Enquête nationale sur la santé de la population de 1994/95. On a établi des modèles distincts de régression de logistique ordinale pour l'autoévaluation de la santé et du bonheur dans un sous-échantillonnage de 780 aîné(e)s vivant en établissement. Les résultats indiquent que les aîné(e)s canadien(ne)s vivant en établissement évaluent leur santé et leur bonheur à divers degrés et que l'on peut prédire les variations en fonction des caractéristiques démographiques, des facteurs de maladie, de l'invalidité et de l'intégration sociale. Une évaluation positive de la santé et du bonheur est toujours associée à un plus grand âge, à un degré réduit de maladie chronique, à un faible degré perçu de difficultés de mémoire et à moins de douleur. Alors que la bonne santé se joint à un plus grand degré d'instruction et de liberté de déplacement, le bonheur se relie à un meilleur réflexe d'agrippement, à une plus forte fréquentation des activités communes de l'établissement et de la communauté et à un horaire plus flexible. Ces résultats entraînent des conséquences importantes puisque plusieurs des facteurs relevés peuvent être modifiés par des programmes de rééducation ou des interventions infirmières.

Method and Description of the Aging in Manitoba Project: A 20-Year Longitudinal Study

The Aging in Manitoba (AIM) project includes nearly 9,000 seniors who have been interviewed. Three independent cross-sectional samples (i.e. 1971, 1976, 1983) were subsequently followed (1983–1984, 1990), producing cross-sectional and longitudinal data. A major goal of this paper was to examine non-response over time and representativeness of the panel of AIM survivors. This involved analysis of non-response, calculations of completion/response rates, and comparisons of demographic variables across the AIM sample and the broader Manitoba and Canadian populations. Non-response was very low (4.6% in 1983–1984, 5.0% in 1990) and did not appear to be dependent on such factors as location, gender, education level, or nationality descent. The 95.0 per cent completion rate compares favourably with other longitudinal studies, demonstrating the value of employing rigorous tracking procedures. These findings suggest that attempts to minimize bias and selective attrition in the AIM study have been successful.

A Prospective Analysis of the Relation Between Self-Rated Health and Health Care Use Among Elderly Canadians

La recherche indique que l'auto-évaluation de la santé est associée sur une variété de séquelles sanitaires, notamment la mortalité et l'invalidité fonctionnelle, même dans les cas où Ton contrôle ces mesures de santé «objectives». L'étude poursuit la recherche déjà amorcée dans ce domaine et tente d'établir la relation éventuelle entre la santé auto-évaluée et l'utilisation des soins de santé dans un échantillonnage représentatif d'aîné(e)s canadien(ne)s (N= 1,181) interrogé(e)s en 1991/92. Les résultats du sondage ont été compares à des dossiers administratifs d'utilisation de soins de santé. La santé auto-évaluée était nettement reliée au nombre de visites chez le médecin durant les 12 mois qui ont suivi l'enquête ainsi qu'au nombre de tests subis (tests de laboratoire, rayons-X etc.), même en contrôlant les variables démographiques, l'invalidité fonctionnelle, la morbidité et l'utilisation antérieure des soins de santé. Les aîné(e)s qui avaient évalué leur santé comme «mauvaise» ou «acceptable» étaient également plus susceptibles d'être hospitalisés que ceux qui la jugeaient «excellente». Les résultats soulignent l'importance de la prise en compte de mesures globales de santé dans le cadre d'un examen de l'utilisation des soins de santé.

The image in the mirror and the number on the scale: weight, weight perceptions, and adolescent depressive symptoms

Double jeopardy and health congruency theories suggest that adolescents' joint experience of their weight and weight perceptions are associated with depressive symptoms, but each theory offers a different prediction about which adolescents are at greatest risk. This study investigates the proposed associations and the applicability of both theoretical perspectives using data from 6,557 male and 6,126 female National Longitudinal Study ofAdolescent Health (Add Health) Wave II participants. Empirically, results indicate that focusing on the intersection of weight and weight perceptions better shows which adolescents are at risk of depressive symptoms than an approach that treats both predictors as independent, unrelated constructs. Weight pessimists are at greatest risk of depressive symptoms. Thus, results support the health congruency framework, its extension to subpopulations outside of older adults, and its extension to optimism and pessimism about specific health conditions.

Self-rated health during adolescence: stability and predictors of change (Young-HUNT study, Norway)

Background: Self-rated health (SRH) is an important single-item variable used in many health surveys. It is a predictor for later mortality, morbidity and health service attendance. Therefore, it is important to study how SRH is influenced during adolescence. The present study examined the stability of SRH over a 4-year period in adolescence, and the factors predicting change in it.

Methods: Analyses were based on 4-year longitudinal data from the Young-HUNT studies in Norway among adolescents aged 13–19 years. A total of 2800 students (81%) participated in the follow-up study, and 2399 of these were eligible for data analysis. Cross-tables for SRH at the start of the study (between 1995 and 1997) and 4 years later were used to estimate the stability over the period. Proportional odds logistic regression analyses of SRH during 2000–01 were carried out, controlling for initial SRH, independent variables at the start of the study and changes in the same independent variables over 4 years as covariates.

Results: In 59% of the respondents, SRH remained unchanged through the 4-year observation period during adolescence. Fewer than 4% changed their ratings of SRH by two steps or more on a four-level scale. The self-assessed general well-being, health behaviour variables, being disabled in any way, and body dissatisfaction at the start of the study and the change of these predictors influenced SRH significantly during the 4-year observation. Being diagnosed with a medical condition, or specific mental or somatic health symptoms was of less importance for later SRH. Adolescents with more health service contacts at the start of the study, or who increase their attendance rate during the 4 years, report deterioration of SRH.

Conclusion: SRH is a relatively stable construct during adolescence, and deteriorates consistently with a lack of general well-being, disability, healthcare attendance and health-compromising behaviour.

Native American Elders' Health Congruence

Addressing the need to explore how Native American (NA) elders' subjective health (SH) compares to their objective health (OH; chronic disease conditions), we examined whether: congruence between 8191 NA elders' SH and OH parallels that of non-NA elders; health optimism (SH > OH) is protective and health pessimism (SH < OH), is detrimental; and whether gender moderates links between health congruence and health-related outcomes. Results comparing health optimists and pessimists to realists in functioning, hospitalizations, and social engagement showed optimists experienced better outcomes; pessimists had poorer outcomes; the role of health congruence differed by gender. Findings suggest implications for improving health-related outcomes among NA elders.

Serious health events and their impact on changes in subjective health and life satisfaction: the role of age and a positive view on ageing

Various studies have pointed to the great importance of subjective health as an indicator for mortality in older age, while less is known about factors that contribute to changes of subjective (self-rated) health over time. Based on a nationwide longitudinal survey (German Ageing Survey, N = 1,286; initial age 40-85), two major findings emerged: first, the incidence of a serious health event caused greater changes in subjective health and life satisfaction in middle compared to older age. This was as expected because serious health events are less common in middle age and are correspondingly experienced more often as an "off-time event". Secondly, the study extended previous findings on the impact of a positive view of ageing on health by showing that this optimistic view positively affects subjective health and life satisfaction even in the face of a serious health event. Overall, the study indicates that a positive view on ageing is an important psychological resource in the case of a serious health event, both when it occurs on-time or off-time from a developmental perspective.

Self-rated health among U.S. adolescents

PURPOSE

This article investigates the meaning of subjective health assessments for younger respondents by examining the temporal stability of self-rated health (SRH) among adolescents. Two competing understandings of SRH are tested: SRH as a spontaneous health assessment or as an enduring self-concept.

METHODS

Using data from two waves of the National Longitudinal Study of Adolescent Health (n = 13,511), an intra-class correlation coefficient and a weighted Kappa estimate are calculated to assess the test-retest reliability for SRH. Self-rated health (T2) is then modeled as a function of SRH (T1), physical health (T1), and mental health (T1), and changes in physical and mental health (T2-T1).

RESULTS

SRH is found to be moderately stable over repeated observations (K = .40; rho = .55) among adolescents. Findings from multivariate analyses suggest that SRH (T2) is largely determined by SRH (T1) and less so by changes in physical or psychological health status (T2-T1).

CONCLUSIONS

SRH among adolescents is in part a spontaneous health assessment but it is best understood as an enduring self-concept.

Subjective and objective evaluations of health among middle-aged and older veterans with hypertension

OBJECTIVE

The congruence between self-rated health and objective health was examined for associations with health factors related to hypertension (health behaviors, medication barriers, and perceived blood-pressure control).

METHODS

The Charlson Comorbidity Index was cross classified with self-rated health, producing four health-congruence groups: good health realists, poor health realists, health optimists, and health pessimists. Data for this study were obtained from 588 hypertensive veterans (mean age = 63) at baseline of a clinical trial to improve blood-pressure control before randomization to an intervention.

RESULTS

Optimists had higher perceived control of their hypertension when compared to pessimists. Additionally, optimists had higher levels of exercise and fewer medication barriers when compared to poor health realists.

DISCUSSION

Health congruence classification could be a useful tool to alert practitioners of patients who may be having difficulties managing their hypertension.

Individual differences in the effects of disease and disability on depressive symptoms: the role of age and subjective health

Each person is affected by disease and disability differently. This study examined the role of age and subjective perception of health in determining the links of depressive symptoms with disease and disability among older adults of different ages. The hypothesized effects of age and subjective health were tested using 252 older adults divided into three age groups (i.e., 60s, 80s, and 100s). Two major findings emerged. First, individuals with advanced old age had higher levels of health problems, as expected. However, their perceptions of health and depressive symptoms were less affected by disability when compared to the younger old. Second, regardless of age, the effects of disease and disability on depressive symptoms were mediated through subjective health. Findings suggest age differences in the consequences of health problems, and the importance of subjective perception to bridge physical and mental health. Issues such as age differences within older populations, the resilience of centenarians, and the intervening roles of subjective health are further discussed.

The Role of Health Congruence in Functional Status and Depression

Few studies have attempted to examine the meaning of health congruence, particularly in the oldest old. Participants were drawn from a longitudinal study of the oldest old (N = 151; M = 90 years). Dichotomized objective health was cross classified with dichotomized subjective health, producing four health congruence groups: good health realists, poor health realists, optimists, and pessimists. Both good health realists and pessimists had good objective health, yet pessimists had the highest depression, lowest functional status, and frequent reports of hospitalization. By contrast, the poor health realists and optimist groups had poor objective health, but the optimists had better outcomes on depression. This suggests that discrepancies between objective and subjective health may have significant implications for health outcomes.

Are gender differences in the relationship between self-rated health and mortality enduring? Results from three birth cohorts in Melton Mowbray, United Kingdom

PURPOSE

The purpose of this study was to assess whether there is an enduring gender difference in the ability of self-rated health to predict mortality and investigate whether self-reported physical health problems account for this difference.

DESIGN AND METHODS

Cox models for 4-year survival were fitted to data from successive cohorts aged 75-81 years registered with a primary care practice in the U.K. Midlands surveyed in 1981, 1988, and 1993-1995.

RESULTS

Self-rated health was consistently a stronger predictor in men (hazard ratio [HR] = 2.7; 95% confidence interval [CI] = 2.1-3.5) than it was in women (HR = 1.9; 95% CI = 1.5-2.4). Women surveyed in 1993-1995 were more likely than men to report problems that were disabling but not life-threatening, whereas men were more likely to report potentially life-threatening problems. However, these differences did not explain the association of self-rated health with mortality. More than half of those who reported a potentially life-threatening problem said that their health was good.

IMPLICATIONS

Self-rated health is more strongly associated with mortality in men, but this is unlikely to be explained by differences in the nature of their physical health problems.

Two views of self-rated general health status

Global self-evaluations of health have proven to be sensitive predictors of morbidity and mortality. Yet researchers have only a limited understanding of how these self-evaluations are reached. This research compares two interpretations of self-rated health, as reflecting either a spontaneous assessment of one's health status and related practices, or an aspect of one's enduring self-concept. Using longitudinal data from successive waves of the National Population Health Survey in Canada (Statistics Canada, 1994-95, 1996-97, NPHS public use microdata documentation. Ottawa, Ontario: Statistics Canada; n = 7505), our analysis tests a model of change in self-rated health as predicted by respondents' baseline physical and mental health symptoms, social support, leisure physical activity, smoking, body mass index, and 2-yr changes in these characteristics. As in past research, self-rated health was sensitive to improvement or decline in these predictors. Much of the explained variance, however, was unique to respondents' self-rated health 2 yr earlier. Moreover, the effect of several predictors on respondents' self-rated health varied according to whether respondents intended to improve specific health-related behaviours in the future. These findings suggest that self-rated health is not only a spontaneous assessment of one's health status and related practices; like a self-concept, self-rated health may be regulated by efforts to achieve one's relatively important health-related goals.

Effects of the quality of dyadic relationships on the psychological well-being of elderly care-recipients

The purpose of this study was to examine the association of the quality of caregiver relationships with the psychological well-being of elderly care-recipients. Sociodemographic variables and characteristics of the care-recipient situation (e.g., self-rated physical health, amount of instrumental support needed) were explored as potential predictors of the psychological well-being of elderly individuals. A secondary analysis of data collected during in-home interviews with 37 community-dwelling older adults revealed no significant correlations between the quality of the primary intimate relationship and any dimension of psychological well-being. However, better self-rated health was associated with fewer depressive symptoms, higher morale, greater life satisfaction, and better quality of life. The more instrumental support needed by an individual, the greater their depressive symptoms and the lower their morale. The findings also revealed that the older the individual was, the greater the depressive symptoms were and the lower life satisfaction became. Self-rated physical health predicted each dimension of psychological well-being. The findings suggest that age, the amount of instrumental support needed, and perceptions of physical health are important indicators of the psychological well-being of elderly care-recipients.

Primary and secondary control-enhancing strategies: implications for health in later life

OBJECTIVES

The major goal of this article was to assess the link between control-enhancing strategies and health in an older population. In particular, the use of primary-control strategies, which involve modifying the environment (e.g., actively persisting) and compensatory secondary-control strategies, which involve modifying the self (e.g., expecting less of oneself) was studied.

METHODS

Participants (n = 241) in a large-scale longitudinal study were interviewed to assess their use of strategies and their health.

RESULTS

Health (physical and perceived) was found to vary for those using primary- and compensatory secondary-control strategies; however, the nature of this variation depended on age.

DISCUSSION

The findings may indicate that primary-control strategies have positive health implications for the young-old but that these same strategies become detrimental to health in late life. The findings could further suggest that compensatory secondary-control strategies become increasingly more adaptive in late life.

Gender differences in health and health actions among community-dwelling elders

This secondary analysis of data from a study of elders' health examined gender differences in the psychological and physical health and the health actions made in response to specific physical complaints in a random sample of 491 community-dwelling older adults (mean age of 75.3 years). Significant gender differences in anxiety, depression, and body awareness were found, although there were no differences in self-assessed health or total number of health problems reported. There were some gender differences in the types of health problems experienced. Subjects tended to use self-care actions, particularly over-the-counter medications and home remedies, more so than professional consultation. Different patterns of care emerged for women and men, with women somewhat more inclined to use self-care and men more likely to seek professional consultation.

Validity and reliability of self-reported health of persons aged 70 and older

Four self-assessed health ratings were examined for their reliability, concurrent validity, and predictive utility in women aged 70 and older. The Perceived Well-Being (PWB) Scale and self-rated health were two subjective measures; the two objective measures were reported number of prescription medications and a medical symptom index from the Canada Fitness Survey. Four-week test-retest reliabilities ranged from .51 to .86. Significant concurrent validity was obtained among all four instruments, with the strongest association between PWB and SRH (r = .569, p < .001). The best predictor of late-life exercise was PWB, which explained 8% of the variance in involvement.

Remaining active in later life. The role of locus of control in seniors' leisure activity participation, health, and life satisfaction

Although the physical and psychological benefits of feeling in control are well-documented in the research literature, the mechanisms that account for these effects have received less attention. The present study was designed to examine the potential mediating role of exercising and participation in nonphysical leisure activities, such as attending cultural events, involvement in volunteer organizations, and so on, in the relation between perceived control and well-being in seniors. The results indicated that an internal locus of control was positively related to exercising and participation in leisure activities. Exercising and leisure activity participation, in turn, were predictive of better perceived health and greater life satisfaction. These findings point to the potential benefits of increasing seniors' sense of control as a means to promote exercising and to increase leisure activity participation and, consequently, to enhance well-being.

Sense of relatedness and interpersonal network of adult offspring caregivers: linkages with crisis, emotional arousal, and perceived health

A descriptive correlational design was used to explore factors that influence the well-being of 168 adult offspring who were caring for a dependent parent. Subjects were queried about their health, relationships within their interpersonal networks, and experiences with crisis in the previous 6 months of caregiving. The findings suggest that although relatedness and interface with an interpersonal network are interrelated with one another in both crisis and noncrisis situations, relatedness appears to be more important for adult offsprings' sense of well-being in the presence of crisis than in the absence of crisis. In contrast, adult offsprings' interface with an interpersonal environment appears to be more important for their sense of well-being in the absence of crisis than in the presence of crisis. The results have implications for ways in which nurses can help adult offspring sustain the will and strength to thrive in the role of filial caregiver.

Perceived adequacy of instrumental assistance: implications for well-being in later life

Beginning with the premise that care recipients' perceptions of inadequate help may have long-term negative consequences, this study examined whether seniors' perceptions related to patterns of well-being over a 12-year period. Patterns of change in physical health (i.e., number of chronic health conditions, self-rated health), psychological well-being (i.e., life satisfaction), and independence (i.e., functional and instrumental) were compared for older men and women who initially reported that their level of IADL assistance was either adequate or inadequate. Seniors who perceived their support as inadequate experienced more severe losses of independence. This was true for both men and women with respect to their ability to independently conduct instrumental ADLs. With respect to the ability to independently conduct functional, that is, basic ADLs, it was true only for women. These findings may imply that perceptions of support inadequacy have a more detrimental effect for women than for men.

Symptoms of psychological distress predict 7-year mortality

As part of the Health and Lifestyle Survey (HALS), 6096 adults from a representative sample of community residents completed a standardized questionnaire which elicited psychiatric symptoms--the General Health Questionnaire (GHQ-30) of Goldberg (1972). Their survival status at 7 years was determined, and 474 had died. Respondents whose GHQ score was above the conventional threshold (4/5), used when screening for psychiatric disorder, were 60% more likely to die over the 7-year interval than respondents whose GHQ score was below threshold (risk ratio 1.64 for men and 1.58 for women). The differences were statistically significant for both sexes when the effects of age, physical disorder, social class and smoking behaviour were taken into account. Personality traits (neuroticism, extraversion) were not related to mortality, neither was self-reported difficulty in sleeping. However, a low subjective rating of one's general health was associated with increased mortality. We explored a range of cut-points and found reliable effects for both sexes at all cut-points from 3/4 to 6/7. Possible differences related to natural versus unnatural causes of death were explored and found not to explain the results. The findings from this general population study confirm that is is not only psychiatric disorders, but also psychiatric symptoms, which are associated with subsequent mortality, and thereby reinforce the importance of appropriate intervention to alleviate these symptoms.