Self-perceived health in functionally independent older people: associated factors

Impact of Polypharmacy on Self-Rated Health in Community-Dwelling Older Adults: A 3-Year SONIC Study

OBJECTIVES

Previous studies have reported that polypharmacy (PP) is associated with objective health indicators, such as falls or a decline in physical function. However, few studies have examined the relationship between PP and subjective health indicators, such as self-rated health (SRH). Therefore, this study examined the association between PP and SRH in older adults.

DESIGN

Prospective study.

SETTING AND PARTICIPANTS

Participants from the longitudinal cohort study of the SONIC were included in this study.

METHODS

Among the participants who completed the baseline and 3-year follow-up surveys, 1103 with complete items were included in the analysis. Multiple medication use was categorized into 4 categories: 0, 1-4, 5-9 (PP), and ≥10 (hyper-PP). SRH was categorized into 2 groups according to the responses: good (excellent/good) and poor (not good/poor). Multivariable logistic regression analysis was performed to assess the prospective relationship between PP at baseline and SRH 3 years later after adjusting for age, sex, economic status, instrumental activities of daily living, depressive mood, and the number of chronic conditions.

RESULTS

The multivariable logistic regression analysis showed that PP [adjusted odds ratio (aOR), 3.159; 95% confidence interval (CI), 1.479-6.747] and hyper-PP (aOR, 5.000; 95% CI, 1.884-13.27) were significantly associated with poor SRH.

CONCLUSIONS AND IMPLICATIONS

An increase in the number of medications was strongly associated with poor SRH. Older people with PP need to be regularly observed and reviewed not only for the disease being treated but also for various aspects of their health, including SRH and the adverse effects of their medication.

Gender Differences in Predictors of Physical Functioning Limitations Among the Elderly Population in Serbia: A Population-Based Modeling Study

Background and Objective: Active aging is influenced by various factors, including chronic diseases, multimorbidity, functional limitations, and disabilities. The presence of these factors might lead to greater dependence on caregivers and could present potential barriers to community engagement. Physical functioning might be considered as one of the vital components for healthier aging experience promotion and support in elderly people. This study aimed to assess self-perceived general health and related health characteristics among the elderly population in Serbia, with a focus on varying degrees of functional limitations, as well as to analyze the predictors of physical functioning limitations in relation to gender. Materials and Methods: This population-based modeling study included a representative sample of 3540 elderly individuals aged above 65 years from Serbia. We employed a dual approach to model the four distinct difficulty levels related to the two groups of limitations of physical functioning (PF1 and PF2) for both genders. The PF1 focused on walking half a kilometer on level ground without the assistance of any mobility aids, and the PF2 navigated a set of 12 steps of ascent and descent: Model 1: inability to execute PF1, Model 2: some/a lot of difficulty in PF1, Model 3: inability to execute PF2, and Model 4: some/a lot of difficulty in PF2. Further variables were evaluated: self-perceived general health, long-lasting health problems, and chronic diseases/chronic conditions. Logistic regression analysis was performed to assess predictors of physical functioning. The models' performance was presented. Results: Significant predictors were as follows: self-perceived general health (Model 1 (male OR: 8.639; female OR: 3.569); Model 2 (male OR: 2.759; female OR: 2.277); Model 3 (male OR: 24.290; female OR: 5.090); Model 4 (male OR: 3.256; female OR: 2.152)); long-lasting general health (Model 1 (female OR: 2.867); Model 3 (female OR: 3.602)); pulmonary diseases (Model 2 (male OR: 2.036); Model 4 (male OR: 1.976; female OR: 1.756)); musculoskeletal diseases (Model 1 (female OR: 1.537); Model 2 (male OR: 1.397; female OR: 1.410); Model 3 (male OR: 1.954; female OR: 1.739); Model 4 (male OR: 1.531; female OR: 1.483)); and other chronic diseases (Model 3 (male OR: 2.215)). Conclusions: Bad self-perceived general health and pulmonary and musculoskeletal diseases were predictors of functional disability in both genders of elderly individuals, while long-lasting health problems were predictors of functional disability in females and other chronic diseases were predictors in elderly males.

Factors contributing to self-rated health in community-dwelling independent 75-year-old Finns: a population-based cross-sectional cohort study

BACKGROUND

Self-rated health (SRH) reflects biological, social, and functional aspects of an individual, incorporating personal and cultural beliefs as well as health behaviours. A deeper understanding of the structure of SRH can help health professionals focus on patients' personal health and functional goals and guide preventive health policies. This study aimed to examine the associations between SRH and independent factors by gender.

METHODS

The population-based, cross-sectional cohort study included 2,539 community-dwelling 75-year-old Finns who participated in the Turku Senior Health Clinic study. Data were collected through clinical examinations, questionnaires, and interviews, which included assessments of SRH, sociodemographic factors (living arrangements, education, self-rated financial status), psychosocial factors (sense of life meaningfulness, satisfaction with relationships, loneliness), health-related behaviours (smoking, alcohol use, physical activity), physical functioning (use of a mobility device, self-rated ability to walk 400 m, history of falls), and health conditions (pain, depressive symptoms, central obesity, vision, sleep quality, and number of self-reported diseases). A backward logistic regression analysis with an inclusion criterion of p < 0.001 was used to identify independent variables associated with SRH.

RESULTS

Fifty percent of both men and women reported having a poor SRH. There were no significant interactions between gender and independent variables regarding SRH. Independent variables associated with poor SRH were experiencing difficulties in walking 400 m (odds ratio 7.45, 95% confidence interval 4.91-11.30), being multimorbid (≥ 6 diseases 6.00, 4.11-8.75; 2-5 diseases 2.97, 2.18-4.06), poor self-rated financial status (3.46, 2.82-4.24), lower levels of life meaningfulness (2.53, 2.07-3.11), having poor (2.34, 1.70-3.21) or moderate (1.58, 1.26-1.98) sleep quality, experiencing depressive symptoms (2.08, 1.57-2.77), reporting at least moderate (2.01, 1.59-2.54) or mild (1.31, 1.01-1.70) pain, and vision impairment (1.50, 1.21-1.86). The area under the curve of this model was 0.842.

CONCLUSIONS

Our findings support early and proven prevention strategies for the most disabling chronic diseases, as well as promoting self-care management, physical activity, and muscle strength. Additionally, a balanced treatment approach that addresses vision impairments and manages symptoms such as pain, poor sleep, and depression is important for older adults' health.

TRAIL REGISTRATION

The study is registered in ClinicalTrials.gov (Identifier: NCT05634239). Retrospectively registered.

The impact of health information seeking and social influence on functional food purchase intention

The COVID-19 pandemic has given rise to unprecedented transformation of consumer behaviors. Despite the abundance of research on this subject, less is known about why and how consumers processed health information and subsequently decided to purchase food during the pandemic. This study employed a survey questionnaire to collect the data. The sample size consisted of 590 consumers in China. The data were analyzed via SPSS and SmartPLS version 3.2.9 to explore the relationships among variables. The results showed that health information-seeking behavior has a significant impact on healthy food product purchasing intention. Similarly, health-related internet use also has a positive impact on health information seeking. Moreover, the impact of motivation for healthy eating on health information seeking is significant. The results indicate a significant moderating role of social influence (i.e., interaction between health information seeking and healthy food product purchasing intention). Multigroup analysis revealed differences between income and age in terms of health-related internet use and purchasing intention. This study assessed healthy food product purchasing intention in a timely manner by incorporating health communication. variables and social influence into consumer behavior research in the context of COVID-19. It thus expands the extant literature and provides insights into the knowledge and practices concerned.

Self-rated health status and associated factors in Ilam, west of Iran: results of a population-based cross-sectional study

Background

Self-rated health (SRH) is a single-item subjective indicator that asks individuals to assess their overall health and acts as a good indicator to reveal general health status. This study aimed to determine the SRH status and determining factors.

Methods

This was a population-based cross sectional study conducted in Ilam city (West of Iran) in 2023. A total of 1,370 people were invited to participate in the study using multi-stage stratified cluster random sampling method. Demographic and SRH status data were collected by face-to-face interview. SRH was indicated by a single question in five scales of very good, good, fair, poor and very poor. Multiple ordinal logistic regression was used for data analysis.

Results

The 59.38% (95% CI: 56.76 to 62) participants reported a good SRH status. By ordinal multiple logistic regression, odds ratio (OR) and 95% confidence interval (CI) was calculated and based on that, female gender [OR: 1.68 (1.29 to 2.20)], not having insurance coverage [OR: 1.35; (1.01 to 1.80)], history of job loss [OR: 1.72; (1.28 to 2.31)], hopelessness for the future [OR: 5.07; (3.96 to 6.49)], and having underlying diseases [OR: 2.95; (2.25 to 3.88)], were positively associated with poor SRH status. The Kurd race [OR: 0.45; (0.25 to 0.78)], higher economic status [OR: 0.72; (0.54 to 0.96)] and use of health care service [OR: 0.68; (0.53 to 0.88)] were negatively associated with poor SRH status. The most effective variables for poor SRH status were hopelessness about the future and suffering from underlying diseases.

Conclusion

It is important to devise corrective measures and effective public health policies to address causes and factors associated with poor SRH. It is also necessary for local health officials to allocate financial resources and introduce other kinds of supportive initiatives to provide targeted support for those who are struggling with poverty and suffering chronic diseases.

Relationship Between Frequency of Physical Activity, Functional Mobility, and Self-Perceived Health in People with Different Levels of Pain: A Cross-Sectional Study

Background: Habits including regular physical activity are necessary for maintaining good health. Functional mobility, including walking and going up and down stairs, is essential for personal autonomy and well-being. Pain is a condition related to biological and psychosocial aspects that influence people's lives. Objective: The main objectives of this study were (1) to analyse the associations between physical activity frequency (PAF) and self-perceived health (SPH) and functional mobility (walking and going up and down stairs) in middle-aged and older people living in Spain with different pain levels; and (2) to analyse the risk factors for having a negative SPH and functional mobility difficulties by calculating the probabilistic risks adjusted by different variables (sex, body mass index, social class, civil status, smoking status, pain level, and PAF). Methods: A cross-sectional study based on the European Health Survey data in Spain (EHSS 2014-2020) and The Spanish National Health Survey (SNHS 2017) was carried out, with a final sample of 21,152 participants with ages between 40 and 79 years. Results: Associations between high pain levels and worse SPH and difficulties in walking and climbing stairs were found. Lower PAF levels were associated with higher-probability risks of having a negative SPH and difficulties in walking and climbing stairs. Conclusions: Physical inactivity emerged as an important risk factor for worse SPH and functional mobility. These associations underline the importance that PA programmes can play in the improvement of health and functional mobility, as well as in other aspects, in people with pain.

Evaluation of the association of physical activity levels with self-perceived health, depression, and anxiety in Spanish individuals with high cholesterol levels: a retrospective cross-sectional study

Background

Hypercholesterolemia is the most common form of dyslipidaemia in the world leading to negative health effects, both physical and mental. Physical activity (PA) can reduce total cholesterol and has positive effects on mental health. This retrospective cross-sectional study analyses the relationships between physical activity level (PAL), self-perceived health (SPH) and mental health.

Methods

This study was based on data from the Spanish National Health Survey 2017 (SNHS 2017), with 3,176 Spanish adults with high cholesterol as participants. Non-parametric tests were used as the data did not follow normality.

Results

Dependent relationships were found between PAL and SPH, depression and anxiety. Women had higher depression and anxiety prevalences than men, while men were more likely to report being very active, although the proportion of walkers was higher in women. The physically inactive population presented higher negative SPH, depression and anxiety proportions and psychological distress than physically active people.

Conclusion

The physically inactive people had a higher risk of negative SPH, depression and anxiety. Regular PA may improve SPH and mental health in people with high cholesterol, but more studies are needed to establish causal relationships, mechanisms, and optimal doses.

Correlation between socio-demographic characteristics, metabolic control factors and personality traits with self-perceived health status in patients with diabetes: A cross-sectional study

Purpose

This study aimed to assess the relationship between metabolic control factors, socio-demographic characteristics, personality traits, and self-perceived health status in diabetes.

Methods

This cross-sectional study included 318 patients with type 1 and 2 diabetes (DM). Participants completed a questionnaire-based survey, which included the NEO Personality Inventory-Revised to measure five personality dimensions and the SF-12 survey to assess self-perceived health status. Binary logistic regression was performed to analyze the data, with socio-demographic characteristics, clinical data, and nutrition status as independent variables, and self-perceived health status (categorized as poor or good condition) as the dependent variable. Unadjusted and adjusted binary logistic regression analyses were used to examine the association between personality traits (high vs. low) and metabolic control factors (good control vs. bad control) with health status scores.

Results

60.7% of the participants with diabetes in the study described their health as "good." The results indicated that female gender (OR: 0.314, 95%CI: 0.105-0.938, P = 0.038), age > 60 years (OR: 0.263, 95%CI: 0.117-0.592, P = 0.001), comorbidities (OR: 0.314, 95%CI: 0.178-0.556, P = 0.001), DM complications (OR: 0.531, 95%CI: 0.337-0.838, P = 0.007), diabetic neuropathy (OR: 0.562, 95%CI: 0.356-0.886, P = 0.013), and diabetic ulcer (OR: 0.130, 95%CI: 0.023-0.747, P = 0.022) were independent variables associated with a "poor" health status. However, regular physical activity (OR: 3.144, 95%CI: 1.209-8.175, P = 0.019) and a healthy nutritional diet (OR: 2.456, 95%CI: 1.421-4.245, P < 0.001) were associated with a higher likelihood of a "good" self-perceived health status.

Conclusion

Preventive programs and interventions aimed at improving self-perceived health among patients with diabetes should focus on increasing regular physical activity and promoting a healthy nutritional status. These actions should be particularly targeted towards female and older patients with higher neuroticism traits.

Evaluation of effectiveness of an art-based museum intervention in reducing loneliness among older adults (ArtGran): a quasi-experimental study

OBJECTIVES

Loneliness is a public health issue among older adults. We designed an intervention offering 10 sessions with diverse artistic methods (ArtGran). This study assessed the effectiveness of ArtGran in reducing loneliness and its negative effects on health in community-dwelling older adults in 2022 in Barcelona.

STUDY DESIGN

Quasi-experimental study, with an intervention group (IG) and a comparison group (CG).

METHODS

The sample included residents aged ≥70 years from 6 selected neighbourhoods of Barcelona. In each neighbourhood, an IG and a CG was formed with participants who reported loneliness and without special mobility needs. The participants were referred from primary care centres, social services, and community health centres. We included 138 participants (IG = 63, CG = 75). We collected data on loneliness, quality of life (QoL-5D), mood, and self-perceived health before and after the intervention through validated questionnaires. To assess the effect of the intervention, we built Poisson models with robust variance and linear regression models.

RESULTS

At the end of the intervention, participants in the IG were more likely than those in the CG to be able to perform their usual activities without problems (adjusted prevalence ratio [aPR] = 1.22; 95% confidence interval [CI]: 1.02-1.45). Compared with the CG, participants in the IG attending more than half of the sessions had lower levels of loneliness (aPR = 1.36; 95%CI: 1.07-1.73), a better ability to perform their usual activities (aPR [95%CI] = 1.24 [1.05-1.48]), and higher happiness scores (β = 0.73; P = 0.01).

CONCLUSIONS

The effectiveness of the intervention was more pronounced when participants had high attendance. Our results suggest that high attendance of the ArtGran program was helpful in shielding older individuals from loneliness, fostering positive moods, and preserving their functional status.

Risk and Preventive Factors for Depressive Symptoms Among Older Chilean Adults During the SARS-CoV-2 Outbreak: A Longitudinal Study

OBJECTIVE

To specifically examine the multiple factors related to the increase in depressive symptoms during the COVID-19 outbreak in older adults in Chile.

METHOD

A longitudinal study was conducted using a dataset from a nationally representative survey cohort of Chilean older adults followed at three time points during the COVID-19 outbreak. The main outcome was depressive symptoms (Patient Health Questionnaire scale). The independent variables included: age, sex, educational level, geographic area, living alone, self-perceived health, self-reported resilience, loneliness, and social isolation.

RESULTS

A total of 424 older adults were included. Female sex (β = 0.95, 95% CI: 0.22 to 1.68) and loneliness (β = 1.21, 95% CI: 1.05 to 1.37) were the main risk factors for an increase in depressive symptoms in older adults. In contrast, living outside the metropolitan region (β=-0.70, 95% CI: -1.39 to -0.02), living in company (β=-0.34, 95% CI:-1.24 to 0.56), having better self-perceived health (β=-5.04, 95% CI:-6.33 to -3.75) and greater resilience (β=-0.30, 95% CI: -0.38 to -0.23) were preventive factors.

CONCLUSION

These results provide useful evidence to develop mental health prevention or control strategies for older adults.

CLINICAL IMPLICATIONS

The findings highlight the importance of a holistic approach to health care for older adults that integrates strategies to address loneliness, foster resilience, and promote an active social life.

Socioeconomic inequality in self-rated health and its determinants: an Oaxaca blinder decomposition in Ilam, West of Iran during 2023

AIM

To determine inequality and decompose it's in Self-Rated Health (SRH).

METHOD

This population-based cross-sectional study was undertaken on the entire population of the city of Ilam, Iran, in 2023. Multi-stage stratified cluster random sampling with proportion-to-size approach was used to select the participants. Oaxaca-Blinder decomposition technique was used to show the amount of inequity in SRH and to decompose of the gap of SRH between the poor and the rich group of participants.

RESULTS

1370 persons participated in the study. The 59.38% of participants stated good SRH status and just 8.86% of participants had poor SRH status. The results of the Oaxaca-Blinder decomposition revealed a considerable gap (15.87%) in the poor status of SRH between the rich and the poor. A large proportion (89.66%) of this difference was described by explained portion of the model. The results of decomposition showed that economic status was directly responsible for explaining 27.98% of overall inequality gap between rich and poor people. Moreover, hopelessness to future (32.64%), having an underlying disease (18.34%) and difference in the education level (10.71%) were associated with an increase in inequality disfavoring the poor.

CONCLUSION

For people suffering from underlying disease, it is suggested to devise policies to improve access to/and remove healthcare utilization barriers. To address hopelessness to future, it is recommended to carry out further studies to reveal factors which affect it in more details. This can help policy makers to formulate more realistic and evidence-informed policies on order to lessen the current socioeconomic inequity in SRH.

Increased Salivary IL-1 Beta Level Is Associated with Poor Sleep Quality in University Students

Poor sleep quality is a major public health concern for all ages. In particular, university students often face stress levels and changes in social life habits that negatively influence their quality of sleep. This could be associated with psychological well-being in terms of anxiety and depressive symptoms, stress levels, and a poor self-perceived health status. The increases in the pro-inflammatory cytokine interleukin 6 (IL-6), IL-1 beta (IL-1β), and tumor necrosis factor alpha (TNFα), in blood have been linked to poor sleep quality in many diseases, but data on salivary cytokine levels in students are missing or are seldom analyzed. In this study we determined the quality of sleep in a sample of university students and the role of psychological assessment and factors affecting sleep (alcohol intake, tobacco, consumption of stimulant drinks, exercise, and body mass index). We also aimed to shed new light on the associations between sleep quality and salivary inflammatory cytokines (IL-1β, IL-6, and TNFα). Sleep quality was measured with the Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI). Perceived stress was assessed using Cohen's Perceived Stress Scale (PSS), and the Goldberg Anxiety and Depression Scale (GADS) was used to assess the level of anxiety or depression. Perceived health status was measured with a visual analogue. Saliva samples was taken in the morning and the inflammatory cytokines was measured via enzyme-linked immunoassay. There was a direct and significant association between the salivary IL-1β concentration and AIS score (r = 0.248; p = 0.038, Pearson correlation) and Pittsburgh scale score (r = 0.274; p = 0.022, Pearson correlation). The relationship between IL-1β and AIS controlling for sex, age, and chronic disease, is still significant (r = 0.260; p = 0.033). The relationship between IL-1β and PSQI controlling for the influence of these variables is also significant (r = 0.279; p = 0.022). Salivary IL-1β concentrations were not significantly associated with any of the scores of the other psychological assessments (PSS, anxiety, depression symptoms, or self-perceived health). Salivary TNFα was significantly and inversely associated with self-perceived health (r = -0.259; p = 0.033, Pearson correlation), but the salivary IL-6 concentration was not associated with any of the sleep quality scale or psychological assessment scores. Our results provide a novel relationship between pro-inflammatory cytokine IL-1β in saliva and poor sleep quality. However, the role of inflammation in poor sleep quality requires further study to identify strategies that could lower inflammation and thus, likely improve sleep quality.

Social networks as a protective factor for worsened self-perceived health status related to self-perceived changes in loneliness and health conditions in adults aged 50+ during the COVID-19 outbreak

The coronavirus disease 2019 (COVID-19) has emerged as a global pandemic, leading millions of people to change their lifestyles, especially older individuals who are the most at-risk population. Social isolation, the main preventive action to slow the pandemic's spread, reduced and drastically limited social connections, increasing older individuals' loneliness and stress, and worsening their health. We examined the connection between self-perceived changes in loneliness, the existence and type of social contact (face-to-face/electronic), and health conditions on self-perceived changes in health status during the outbreak, analyzing 51,778 individuals aged 50 plus from the Survey of Health, Ageing and Retirement in Europe (SHARE) database Wave 8 beta (June-August 2020). We found that the odds for worsened self-perceived health status were 249% higher among individuals who reported increased loneliness compared to the non-increase group and were lower in individuals with face-to-face contact (31%) or electronic contact (54%) during the outbreak. In addition, the odds for worsened self-perceived health status were higher for individuals with hypertension (17%), cancer (19%), chronic lung disease (25%), heart problems (27%), and other illnesses (32%). Based on the results obtained, electronic contact has shown a stronger connection as a protective factor for worsened self-perceived health since the outbreak compared to face-to-face interactions. Thus, adopting a policy that encourages the usage of electronic communications could reduce the burden on the healthcare system, particularly during pandemics, while improving patient health outcomes and minimizing pandemic-related health risks. This approach is especially important for older individuals, for whom any departure from home can cause an additional risk of exposure to the virus.

Relationship between physical activity and perceptions of ageing from the perspective of healthy ageing among older people with frailty with chronic disease: a cross-sectional study

BACKGROUND

In Taiwan, the 2019 Elderly Frailty Assessment found that 11.2% of older people have frailty problems. Some researchers have found that older persons' negative perspectives on ageing aggravate the progression of frailty, thereby increasing their risk of disability. This study aimed to investigate associations of physical activity and perceptions of ageing on perspectives of healthy ageing in older people with frailty and chronic diseases and to compare the differences in their frailty status.

METHODS

This study used a descriptive cross-sectional design. Participants were recruited from community long-term care stations. The inclusion criteria were (1) no severe cognitive impairment and ability to communicate in Mandarin and Taiwanese; (2) over 65 years old; (3) at least one chronic disease; and (4) at least one debilitating item in the Study of Osteoporotic Fracture index. A total of 312 participants were recruited. The Brief Ageing Perceptions Questionnaire Chinese version, Healthy Ageing Perspectives Questionnaire, and Physical Activity Scale for the Elderly Chinese Version were used for measurement.

RESULTS

The study results found that demographic variables, perceptions of ageing, and physical activity were significantly correlated with perspectives on healthy ageing, including age, Activities of Daily Living, education, all domains of perceptions of ageing, and household- and work-related physical activity. With regard to the frailty status level, prefrailty was better than frailty from the perspective of healthy ageing in older people with chronic disease (t = 5.35, p < 0.05). Hierarchical regression analysis was used to predict the healthy ageing perspectives of older persons with chronic disease involving a chronic time-line, positive control, health-related changes, and work-related activities. Those domains could predict 21% of the variance in healthy ageing perspectives.

CONCLUSION

It is suggested that in community long-term care stations, health care providers can arrange activities to improve the perception of ageing that are acceptable for older people with frailty and chronic diseases and encourage older people to participate in service activities to achieve a sense of social participation.

Prevalence of early and late onset of chronic diseases and multimorbidity and its association with physical, mental and functional health among older Indian adults

BACKGROUND

Identifying people with early and late onset of chronic conditions might help target the subpopulations that are more vulnerable to negative mental, physical and functional health outcomes. The current study aimed to examine the association of early and late onset of chronic single and multiple morbidities with self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults.

METHODS

Cross-sectional study was conducted using data from the Longitudinal Ageing Study in India (LASI) Wave 1 (2017-2018). The total sample size for the present study was 31,386 older adults age 60 years or older. Multivariable binary logistic regression analysis was used to establish the association between the outcomes (poor perceived physical/mental health, functional difficulty and physical inactivity) and explanatory variables (early [ = < 50 years of age] and late [> 50 years]) onset of chronic illnesses such as hypertension, diabetes, heart attack, heart disease, stroke, cancer, lung disease, arthritis, osteoporosis and psychiatric disease).

RESULTS

Overall, 24.21% of the sample population had poor self-perceived physical health, whereas 8.67% of participants had poor self-perceived mental health. The prevalence of difficulty in ADL, difficulty in IADL, and physical inactivity was 23.77%, 48.36%, and 68.9%, respectively. Odds of poor perceived mental health were higher for the respondents with early as well as late onset of hypertension, stroke, and arthritis; while individuals with late onset of diabetes, and heart disease had higher odds of poor perceived mental health than those without chronic disease. Individuals with early onset of single morbidity were more likely to report ADL difficulty (adjusted odds ratio [AOR]: 1.33, confidence interval [CI]: 1.06-1.67); while those with late onset of single (AOR: 1.34, CI: 1.17-1.53) and multimorbidity (AOR: 1.91, CI: 1.63-2.24) were more likely to report ADL difficulty compared with individuals without morbidity. Individuals with early as well as late-onset of multimorbidity had more than two times higher odds of reporting poor physical health, poor mental health and IADL difficulty compared with individuals without chronic disease.

CONCLUSIONS

The present study revealed that early and/or late onset of chronic single and/or multiple morbidities significantly predicted poor self-perceived physical and mental health, functional limitations and physical inactivity among older Indian adults. The findings further suggest that late onset of chronic diseases such as cancer and stroke and multi-morbidity had stronger associations with physical inactivity that may help identify high risk groups for screening and support.

Trajectories of care of community-dwelling people living with dementia: a multidimensional state sequence analysis

BACKGROUND

The type and level of healthcare services required to address the needs of persons living with dementia fluctuate over disease progression. Thus, their trajectories of care (the sequence of healthcare use over time) may vary significantly. We aimed to (1) propose a typology of trajectories of care among community-dwelling people living with dementia; (2) describe and compare their characteristics according to their respective trajectories; and (3) evaluate the association between trajectories membership, socioeconomic factors, and self-perceived health.

METHODS

This is an observational study using the data of the innovative Care Trajectories -Enriched Data (TorSaDE) cohort, a linkage between five waves of the Canadian Community Health Survey (CCHS), and health administrative data from the Quebec provincial health-insurance board. We analyzed data from 690 community-dwelling persons living with dementia who participated in at least one cycle of the CCHS (the date of the last CCHS completion is the index date). Trajectories of care were defined as sequences of healthcare use in the two years preceding the index date, using the following information: 1) Type of care units consulted (Hospitalization, Emergency department, Outpatient clinic, Primary care clinic); 2) Type of healthcare care professionals consulted (Geriatrician/psychiatrist/neurologist, Other specialists, Family physician).

RESULTS

Three distinct types of trajectories describe healthcare use in persons with dementia: 1) low healthcare use (n = 377; 54.6%); 2) high primary care use (n = 154; 22.3%); 3) high overall healthcare use (n = 159; 23.0%). Group 3 membership was associated with living in urban areas, a poorer perceived health status and higher comorbidity.

CONCLUSION

Further understanding how subgroups of patients use healthcare services over time could help highlight fragility areas in the allocation of care resources and implement best practices, especially in the context of resource shortage.

Sensory impairments and subjective well-being status in middle-aged and older Chinese population: Cross-sectional and longitudinal analyses of a nationally representative survey

Purpose

To investigate the impacts of sensory impairments (SIs) including single vision impairment (SVI), single hearing impairment (SHI) and dual sensory impairment (DSI) on subjective wellbeing measurements including life expectancy (LE), life satisfaction (LS) and self-rated health (SRH) in middle-aged and older Chinese population.

Methods

We obtained data from the China Health and Retirement Longitudinal Survey (CHARLS). In total, 9,293 Chinese middle-aged and older adults aging over 45 were included at baseline 2011 in this study, and 3,932 participants who accomplished all 4 interviews from 2011 to 2018 were adapted for longitudinal analyses. Sensory status and subjective wellbeing measurements were collected. Other covariates included socio-demographic characteristics, medical condition and lifestyle-related factors. The impacts of baseline sensory status on LE, LS and SRH were assessed using univariate and multivariate logistic regression analyses. A linear regression analysis with generalized estimating equations (GEE) was used to assess the association between time-varying sensory statuses with LE, LS and SRH over 8 years after being adjusted with multi-confounding factors.

Results

Participants with SIs had significantly lower level of LE, LS, and SRH, compared to those who were free of SI. All kinds of SIs were significantly associated with LE, LS, and SRH according to cross-sectional data. The correlations between SIs and LE or SRH over 8 years were also noticed. However, only SHI and DSI were found to be significantly associated with LS according to longitudinal data (all p values &lt; 0.05).

Conclusion

Sensory impairments had explicitly detrimental effects on subjective wellbeing status over time among middle-aged and older Chinese population.

Polypharmacy and the Change of Self-Rated Health in Community-Dwelling Older Adults

Polypharmacy is associated with poorer self-rated health (SRH). However, whether polypharmacy has an impact on the SRH progression is unknown. This study investigates the association of polypharmacy with SRH change in 1428 participants of the Berlin Initiative Study aged 70 years and older over four years. Polypharmacy was defined as the intake of ≥5 medications. Descriptive statistics of SRH-change categories stratified by polypharmacy status were reported. The association of polypharmacy with being in SRH change categories was assessed using multinomial regression analysis. At baseline, mean age was 79.1 (6.1) years, 54.0% were females, and prevalence of polypharmacy was 47.1%. Participants with polypharmacy were older and had more comorbidities compared to those without polypharmacy. Over four years, five SRH-change categories were identified. After covariate adjustment, individuals with polypharmacy had higher odds of being in the stable moderate category (OR 3.55; 95% CI [2.43-5.20]), stable low category (OR 3.32; 95% CI [1.65-6.70]), decline category (OR 1.87; 95% CI [1.34-2.62]), and improvement category (OR 2.01; [1.33-3.05]) compared to being in the stable high category independent of the number of comorbidities. Reducing polypharmacy could be an impactful strategy to foster favorable SRH progression in old age.

Self-Rated Health as a Predictor of Mortality in Older Adults: A Systematic Review

The aim of this study was to investigate the link between self-reported health (SRH) and mortality in older adults. In total, 505 studies were found in PubMed and Scopus, of which 26 were included in this review. In total, 6 of the 26 studies included did not find any evidence of an association between SRH and mortality. Of the 21 studies that included community dwellers, 16 found a significant relationship between SRH and mortality. In total, 17 studies involved patients with no specific medical conditions; among these, 12 found a significant link between SRH and mortality. Among the studies in adults with specific medical conditions, eight showed a significant association between SRH and mortality. Among the 20 studies that definitely included people younger than 80 years, 14 found a significant association between SRH and mortality. Of the twenty-six studies, four examined short-term mortality; seven, medium-term mortality; and eighteen, long-term mortality. Among these, a significant association between SRH and mortality was found in 3, 7, and 12 studies, respectively. This study supports the existence of a significant relation between SRH and mortality. A better understanding of the components of SRH might help guide preventive health policies aimed at delaying mortality in the long term.

Relationships between Physical Activity Frequency and Self-Perceived Health, Self-Reported Depression, and Depressive Symptoms in Spanish Older Adults with Diabetes: A Cross-Sectional Study

Diabetes is one of the most prevalent noncommunicable diseases in the world. This disease can affect both physical and mental health in the population. This study analyzed the prevalence of Self-Perceived Health (SPH), self-reported depression, and depressive symptoms in comparison with the Physical Activity Frequency (PAF) reported by Spanish older adults with diabetes. A cross-sectional study was carried out with data from 2799 self-reported diabetic participants, all of whom were residents of Spain, aged 50-79 years, and included in the European Health Surveys carried out in Spain (EHIS) both in 2014 and 2020. The relationships between the variables were analysed with a chi-squared test. A z-test for independent proportions was performed to analyze differences in proportions between the sexes. A multiple binary logistic regression was carried out on the prevalence of depression. Linear regressions were performed on depressive symptoms and SPH. Dependent relationships were found between the SPH, self-reported depression, and depressive symptoms with PAF. Most of the very active participants reported a higher prevalence of self-reported depression. Physical inactivity increased the risk of depression, major depressive symptoms, and negative SPH.

A machine learning approach to determine the influence of specific health conditions on self-rated health across education groups

BACKGROUND

Self-rated health, a subjective health outcome that summarizes an individual's health conditions in one indicator, is widely used in population health studies. However, despite its demonstrated ability as a predictor of mortality, we still do not full understand the relative importance of the specific health conditions that lead respondents to answer the way they do when asked to rate their overall health. Here, education, because of its ability to identify different social strata, can be an important factor in this self-rating process. The aim of this article is to explore possible differences in association pattern between self-rated health and functional health conditions (IADLs, ADLs), chronic diseases, and mental health (depression) among European women and men between the ages of 65 and 79 according to educational attainment (low, medium, and high).

METHODS

Classification trees (J48 algorithm), an established machine learning technique that has only recently started to be used in social sciences, are used to predict self-rated health outcomes. The data about the aforementioned health conditions among European women and men aged between 65 and 79 comes from the sixth wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) (n = 27,230).

RESULTS

It is confirmed the high ability to predict respondents' self-rated health by their reports related to their chronic diseases, IADLs, ADLs, and depression. However, in the case of women, these patterns are much more heterogeneous when the level of educational attainment is considered, whereas among men the pattern remains largely the same.

CONCLUSIONS

The same response to the self-rated health question may, in the case of women, represent different health profiles in terms of the health conditions that define it. As such, gendered health inequalities defined by education appear to be evident even in the process of evaluating one's own health status.

Determinants of Self-Perceived Health: The Importance of Physical Well-Being but Also of Mental Health and Cognitive Functioning

With life expectancy increasing for the general population, public health promotion activities should be a priority to aim at a reduction of the burden and costs of hospitalization, disability, and lifelong treatment. This study aimed to explore the influence of parameters pertaining to different aspects of well-being, including physical and mental health and cognitive functioning, on self-perceived health, a predictor of chronic disease prevalence and mortality. We used data from the Survey of Health, Aging and Retirement in Europe (SHARE) project gathered between 2013 and 2017, obtaining a sample of 96,902 participants (63.23 ± 6.77 years). We found a strong association between the self-perceived health rating and not only physical health aspects but also mental health and cognitive functioning. In particular, BMI, chronic diseases and medications, muscle strength, and mobility issues had a strong effect on self-perceived health, as also did the quality of life, depression, and verbal fluency, while other aspects, such as individual characteristics, limitations in daily activities, and pain, among others only had a small effect. These results show that public health and prevention interventions should prioritize the targeting of all aspects of well-being and not only of physical health, acknowledging self-perceived health rating as a simple tool that could help provide a complete overview of psycho-physical well-being and functional status.

Characterizing delayed care among US older adults by self-rated health during the COVID-19 pandemic

OBJECTIVES

Previous studies showed that older adults with fair or poor self-rated health (SRH) were more likely to experience delayed care during the COVID-19 pandemic. We aim to understand delayed care patterns by SRH during the COVID-19 pandemic among US older adults.

METHODS

Using a nationally representative sample of older adults (≥ 70 years old) from the National Health and Aging Trends Study (NHATS), we assessed the patterns of delayed care by good, fair, or poor SRH.

RESULTS

Nearly one in five of the survey-weighted population of 9,465,117 older adults who experienced delayed care during the pandemic reported fair or poor SRH. The overall distributions of the numbers of types of delayed care (p = 0.16) and the numbers of reasons for delayed care (p = 0.12) did not differ significantly by SRH status. Older adults with good, fair, or poor SRH shared the four most common types of delayed care and three most common reasons for delayed care but differed in ranking. Older adults with poor SRH mostly delayed seeing a specialist (good vs. fair vs. poor SRH: 40.1%, 46.7%, 73%, p = 0.01).

CONCLUSIONS

The results suggest that utilizing SRH as a simple indicator may help researchers and clinicians understand similarities and differences in care needs for older adults during the pandemic. Targeted interventions that address differences in healthcare needs among older adults by SRH during the evolving pandemic may mitigate the negative impacts of delayed care.

Self-health assessments in Saudi Arabia: Directions for an integrated primary healthcare

Background

Public health data for dissemination and discussion in Saudi Arabia, for the purposes of primary healthcare, are limited but the new initiatives of General Authority of Statistics creates many national surveys. One of the most recent one, the Family/Household Health Survey - 2017 aims to fill the gaps, at the same time, aids in discussions on primary healthcare.

Objectives

Analyses done in this research are aimed at appraising the self-assessed health and to examine age-sex and geographic differentials and their probable interconnections with chronic diseases, injuries, and periodic examinations.

Data and Methods

This survey conducted in October-December, 2017 covered both native and foreigner households from all the 13 administrative areas through a random sample procedure involving primary sampling units and secondary sampling units. A portion of the published data on self-assessment of health, chronic diseases, injuries, and periodic medical examinations were analyzed.

Results

More than half of the persons in the Kingdom, reportedly, are in good health; more so among females than males: proportions decreased with increasing age up to 40 years, thereafter increased sharply. Moreover, the major regions have lesser proportion of people with good health. Prevalence of chronic diseases increases with age, in both total and native population, but with variations across specific diseases - hypertension, diabetes, cancer, and cardiovascular diseases (CVDs) and with geographic differentials. On the other hand, there are injuries (from traffic accidents and others) occurred at house, work/school, public place, and other places; pertinent with geographic variations. Moreover, age, sex, and regional differences in periodic health examinations have a contributing effect on health assessments. Moreover, the median age shows a pattern resembling adults assessing good health; chronic diseases after 50s; injuries before 40s; periodic medical examinations in 50s; with females at a lower age, in both groups of population.

Conclusions

The national health system played an important role not only in health status and health assessments but also in building confidence and trust and thereby enhancing optimism, realism, recognition, self-awareness, and acceptance of physical condition. Thus, age, sex, and regional variations in health assessment are born out of chronic diseases, injuries, and periodic medical examinations and also of expectations and experiences. Generation of such information, effective dissemination, and regular discussions at various levels followed by in-depth analyses raise the primary healthcare and thus the population health.

Uses and perceptions of medications among French older adults: results from the 2020 French Health Barometer survey

BACKGROUND

There are few studies reporting on self-medication, perceptions or difficulties older adults have with their medications. This study aimed to describe the uses and the perceptions of medications among older adults in France and to identify patient groups based on that information.

METHODS

We used data from the 2020 'French Health Barometer' - a nationally-representative cross-sectional survey. We assessed polypharmacy (five or more medications), self-medication, and patient perceptions of medications. Robust Poisson regression was used to investigate socio-demographic and health-related factors associated with the outcomes. Latent class analysis was used to identify patient groups classified by the use and the perceptions of medications. Factors associated with group assignment were investigated by multinomial logistic regression. All analyses were weighted.

RESULTS

The study sample comprised 1,623 respondents aged 70-85 years. Polypharmacy and self-medication were reported in 23.5 and 48.7% of the older population, respectively. Polypharmacy was associated with increasing age, low education, and impaired health status. Self-medication was associated with female sex and high education. Among individuals taking at least 1 medication, 8.2% reported not to understand all their medications, and 9.7% having difficulty taking medications as prescribed. Among individuals taking at least 2 medications, 23.2% thought that they took too many medications. Three patient groups were identified: 'Non-polypharmacy, positive perceptions' (62.5%), 'Polypharmacy, positive perceptions' (28.0%), and 'Negative perceptions' (9.5%).

CONCLUSIONS

Polypharmacy and self-medication are common in French older adults. One segment of people reported negative perceptions of their medications regardless of their polypharmacy status. This underlines the difference between the objective and perceived measures of polypharmacy.

Association between Domains of the Clinical-Functional Vulnerability Index and Falls History in Older Adults: A Cross-Sectional Study

Objectives: The study aimed to determine which domains, sets, and isolated or combined questions of the Clinical-Functional Vulnerability Index (CFVI-20) are associated with falls history in older adults. Methods: Instruments used were the CFVI-20 assessment and reported falls during the last year. The receiver operating characteristics (ROC) curves identified the performance of the CFVI-20 domains and questions in identifying older adults with and without falls history, while logistic regression identified relevant questions to identify fall history. Results: This study included 1725 individuals (71.9 ± 7.3 years). The area under the curve (AUC) between the CFVI-20 and fall history was 0.69. The mobility domain presented the largest AUC (0.71; p < 0.01), and most isolated domains showed low AUCs (0.51 to 0.58). Isolated questions were limited to identifying fallers. The regression analysis identified 7 questions of the CFVI-20 with falls. Conclusions: The CFVI-20 general score identified older adults with a fall history. When considered in isolation, most domains were limited to identifying falls, except for the mobility domain. Combining the CFVI-20 questions enabled identification of fallers.

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

OBJECTIVE

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

DESIGN AND SETTING

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

PARTICIPANTS

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

MEASURES

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

RESULTS

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

CONCLUSIONS

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

Influence of Social Adversity on Perceived Health Status and Depressive Symptoms among Portuguese Older People

This study aims to investigate how exposure to poverty, food insecurity, and abuse at older ages relates to health outcomes. A questionnaire collecting data on sociodemographic and economic characteristics, health status, depressive symptoms, food insecurity, and abuse was administered to a sample of 677 older adults. Logistic regression was used to quantify the association of poverty, food insecurity, and abuse with perceived health status and depressive symptoms. If the older person only reported experiences of abuse, it was more likely to report the presence of depressive symptoms, even after adjustment for covariates. If it was only reported the experience of food insecurity, it was more likely to report a worse health status. Older people exposed to at least two factors of vulnerability were significantly more likely to report (very) poor perceived health status (OR: 7.11, 95% CI: 2.77–18.25) and the presence of relevant depressive symptoms (OR: 4.34; 95% CI: 2.04–9.22). Thus, the combined effect of vulnerabilities was significantly associated with worse health among older people. Public health policies to mitigate these adverse exposures should be developed to promote health and well-being in this population.

A Cross-Sectional Study on Self-Perceived Health and Physical Activity Level in the Spanish Population

One-third of the Spanish population over 15 years of age did not achieve a reasonable amount of physical activity (PA) before the COVID-19 pandemic. We aim to analyse the associations between the PA level (PAL) and self-perceived health (SPH) in the Spanish population aged 15−69 years during the pre-pandemic period. A cross-sectional study was conducted using the Spanish National Health Survey 2017 (ENSE 2017) data, with 17,777 participants. We carried out a descriptive analysis, analysed intergroup differences with non-parametric statistical tests, and calculated the Odds Ratio (OR) and Relative Risk (RR) of having a negative SPH according to PAL. In addition, correlations between PAL and SPH were studied, finding associations between them (p < 0.001). Thus, performing moderate and intense PA was related to better SPH than just walking or inactive. Weak and moderate correlations were found between PAL and SPH (p < 0.001). We also found high ORs and RRs of negative SPH as PAL decreased. Moderate and intense PA were related to positive SPH, while the risk of negative perception in inactive people was higher.

A Cross-Sectional Study about the Associations between Physical Activity Level, Self-Perceived Health Perception and Mental Health in Informal Caregivers of Elderly or People with Chronic Conditions in Spain

Providing informal care for older people, or people with chronic conditions, is associated with poorer physical and mental health and reduced quality of life. This task, in many cases, often relies on the women in the immediate family. Physical activity (PA) is a tool to enhance caregivers' physical and mental health and their quality of life. Thus, this study aimed to analyse the associations between the physical activity level (PAL), self-perceived health (SPH) and mental health (SM) and its factors (positive coping, self-esteem, and stress) by conducting a cross-sectional study by using data from in the National Health Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic. The sample included 2225 caregivers (866 men and 1361 women). Descriptive analysis and non-parametric statistical tests, including chi-square, the Kruskal-Wallis test, the Mann-Whitney U test, and the Spearman's rho correlation coefficient, were used. Dependence relationships were found between PAL and SPH and MH and their factors. The population groups that performed moderate or vigorous PA showed better results in both SPH and MH. Women scored worse than men in all the variables analysed. Hence, intense, or moderate PA practice may improve SPH and MH in Spanish informal caregivers, requiring the implementation of policies and programs considering the differences found between men and women in PAL, SPH, and MH.

Impacts of mistreatment on the psychological and physical health of older adults living in sheltered homes

OBJECTIVES

To assess the impact of the mistreatment on psychological and physical health among older adults living in sheltered homes.

METHODS

This cross-sectional study included 446 older adults living in 43 sheltered homes. The psychological effects questions screened for suicidal ideation, depression, anxiety, and sleep problems. The physical health effects questions assessed perceived physical health status and healthcare resource utilization.

RESULTS

All subtypes of mistreatment of older adults were associated with increased prevalence rates of anxiety symptoms, depressive symptoms, and sleep problems. Perceived poor physical health is common among older mistreated adults; it was self-reported by 74% who experienced physical mistreatment and 49% who experienced other types of mistreatment. Increased healthcare utilization was higher among older adults who experienced mistreatment.

DISCUSSION

Mistreatment of older adults living in sheltered homes is associated with negative impacts on physical and psychological health, as well as increased healthcare utilization compared to those who are not mistreated.

Diet Quality and the Number of Comorbidities Are Associated with General Health Among Older Female Cancer Survivors

Objective: We aimed to investigate the associations between diet quality, general health, and comorbidities among older female cancer survivors. Methods: Participants (n = 171) completed one-time surveys to assess health-related quality of life (RAND-36), diet quality (Healthy Eating Index (HEI-2015)), and number of comorbidities. Additional demographic and clinical variables were collected. Descriptive statistics, analysis of covariance, correlations, and linear regressions were utilized. Results: A positive correlation was found between HEI-2015 and general health subscale scores (r = .26, p = .002). A negative correlation was found between the number of comorbidities and general health (r = -.21, p = .02). Being white (β = -.24, p = .02) and having fewer comorbidities (β = -.22, p = .04) were significantly associated with higher general health. Being unmarried (β = .24, p = .02) and having higher education (β = .32, p = .002) were significantly associated with higher HEI-2015 scores. Discussion: Healthcare providers should seek guidance from registered dietitian nutritionists for nutritional education to promote optimal nutritional status, thus contributing to improved general health among this growing population.

Factors Associated with Recovered Functionality After Hip Fracture in Non-Institutionalized Older Adults: A Case-Control Study Nested in a Cohort

Purpose

To identify factors associated with recovered functionality after a hip fracture in a sample of older adult patients.

Patients and Methods

Nested case-control study in a cohort. Older adults (60 years or older) with a hip fracture were recruited between May 2017 and October 2018. The Barthel scale was used to measure performance in activities of daily living (ADL). A questionnaire was applied to collect information about demographic, clinic, psychological and social variables, and anthropometric measurements were taken. A logistic regression model was built to analyze various factors related to recovered functionality.

Results

A total of 346 older adults with a hip fracture were studied (n=173 cases and n=173 controls); 69.4% (n=240) women and 30.6% (n=140) men. Mean age was 79.4 years (±8.7) overall; for cases, 77.4 (±7.9) years and for controls, 81.4 (±9.0). Mean schooling was 6.3 (± 4.3) years. Recovered functionality was associated with normal nutritional status (OR 4.81, 95% CI = 2.54–9.12), absence of heart disease (OR 4.08, 95% CI = 1.48–11.20), self-efficacy for ADL (OR 4.07, 95% CI = 2.15–7.72), absence of depressive symptoms (OR 2.99, 95% CI = 1.69–5.28), prior functionality (OR 2.83, 95% CI = 1.51–5.31), high socioeconomic level (OR 2.41, 95% CI = 1.24–4.65) and transcervical fracture (OR 2.34, 95% CI = 1.05–5.22).

Conclusion

In older adults who have suffered a hip fracture, clinical, psychological, and demographic characteristics are associated with recovered functionality. These factors should be considered as a priority in the care of older adults who have experienced hip fractures.

Impact of state of economic dependence and employment status on the self-perceived health of Indian elderly people across expenditure quintiles of households

Self-perceived health, a subjective assessment of health status, is influenced by state of economic independence and employment status after controlling for other demographic, social and health-related factors, particularly for elderly people as they tend to face discrimination in intra-household resource allocation. Being economically independent and employed increase the likelihood of elderly people rating their health as good/excellent compared to others and employment status came out as even more impactful. This study provides new insights by observing that across the expenditure quintile groups of the households, the importance of these variables varies as the bias in intra-household resource allocation against elderly people is supposed to increase with declining economic resources of the households. Economic independence improves the likelihood of rating one's health as good/excellent in the lowest expenditure quintile much more compared to those in the uppermost expenditure quintile. For employed too, the positive influence of employment status on self-perceived health of elderly people has been strictly increasing as we move down the expenditure quintiles of households.

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

OBJECTIVE

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

DESIGN

Retrospective secondary data analysis from EHIS 2014.

SETTING

Community based.

PARTICIPANTS

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

MAIN MEASUREMENTS

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

RESULTS

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

DISCUSSION

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

Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study

Background

Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS).

Objective

The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health.

Methods

We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16.

Results

At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005).

Conclusions

This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes.

Trial Registration

ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669

Factors influencing the perceived health status of older adults living alone based on the Korean National Health and Nutrition Examination Survey (2016-2018)

PURPOSE

Older adults living alone have a lower level of health due to functional degradation and social isolation, and hence, it is important to assess their health condition and health-related factors. In this study we intended to evaluate the factors influencing the perceived health status of older adults living alone in Korea.

MATERIALS AND METHODS

Data from the 7th (2016-2018) Korean National Health and Nutrition Examination Survey (KNHANES) were used. Perceived health status and health-related and demographic characteristics of 1,074 older adults (age≥65 years) living alone were included in this study. A complex sample design analysis method was used to consider the characteristics of the raw data of the KNHANES, and a complex sample ordinal logistic regression analysis was performed to identify factors that affect perceived health status.

RESULTS

Female sex, low economic status, not consuming alcohol, perceived stress, high number of chronic diseases, underweight, and limitation of activity were risk factors of low perceived health status of older adults living alone.

CONCLUSIONS

Interventions to improve the identified health-related factors, such as stress, underweight, and activity limitation of older adults need to be devised. In addition, differences in risk factors according to sex should be considered when providing interventions. Furthermore, policies supporting the promotion of health status among older adults with low-income and living alone are warranted to improve health equity in Korea.

The Relationship between Physical Activity, Self-Perceived Health, and Cognitive Function in Older Adults

There are consistent associations between physical activity and self-perceived health. However, it is not clear whether associations between self-perceived health and participation in physical activity could be accounted for by associations with cognitive function. In the present study, we examined whether associations between physical activity and cognitive functioning could explain the variability between physical activity and self-perceived health. A sample of 204 older adults performed three cognitive tests selected from the Vienna test system battery: The Determination, Cognitrone, and Visual Memory tests. These tests measure general processing speed, attention, and visual memory, respectively. Participants also completed the 12-item Short Form Health Questionnaire SF-12 to measure perceived health, and the Physical Activity Survey for the Elderly to measure physical activity. Linear regressions and the PROCESS macro for SPSS were used to test our hypotheses. Consistent with our hypotheses, processing speed accounted for significant variance in the relationship between physical activity and self-perceived health. This suggests that cognitive processing speed might be an indirect path by which physical activity relates to enhanced health perceptions. The results demonstrate that associations between physical activity and self-perceptions of health are related to a fundamental cognitive process.

Gut microbiome pattern reflects healthy ageing and predicts survival in humans

The gut microbiome has important effects on human health, yet its importance in human ageing remains unclear. In the present study, we demonstrate that, starting in mid-to-late adulthood, gut microbiomes become increasingly unique to individuals with age. We leverage three independent cohorts comprising over 9,000 individuals and find that compositional uniqueness is strongly associated with microbially produced amino acid derivatives circulating in the bloodstream. In older age (over ~80 years), healthy individuals show continued microbial drift towards a unique compositional state, whereas this drift is absent in less healthy individuals. The identified microbiome pattern of healthy ageing is characterized by a depletion of core genera found across most humans, primarily Bacteroides. Retaining a high Bacteroides dominance into older age, or having a low gut microbiome uniqueness measure, predicts decreased survival in a 4-year follow-up. Our analysis identifies increasing compositional uniqueness of the gut microbiome as a component of healthy ageing, which is characterized by distinct microbial metabolic outputs in the blood.

Proximity to Facilities and Its Association with the Health-Related Habits of Functionally Independent Older Adults

The aim was to examine how proximity to facilities, as a component of community determinants, is associated with the health-related habits of functionally independent community-dwelling older adults. This was a cross-sectional study. Data were collected by face-to-face interviews. Participants were >65 years old, living in 15 municipalities of Gipuzkoa (Basque Country, Spain). Proximity to park-green spaces, cultural-sport centers, market-food stores, retirement associations, religious centers, primary care centers and hospitals was explored. Sociodemographic variables and health-related habits (diet, physical activity and self-perceived social life) were collected. Logistic regression models were performed. The sample comprised of 634 individuals (55% women; mean age: 74.8, SD 6.7 years). Older age (odds ratio-OR: 0.94, 95% CI: 0.91-0.97) was associated with lower physical activity, while being male (OR: 1.71, 95% CI: 1.08-2.68) and proximity to park-green spaces (OR: 1.64, 95% CI: 1.03-2.61) were related to more physical activity. Individuals with good self-perceived health (OR: 3.50, 95% CI: 1.82-6.74) and religious centers within walking distance (OR: 2.66, 95% CI: 1.40-5.04) had higher odds of a satisfactory social life. Encouraging the creation of park-green spaces and leisure centers near residential areas can assist in promoting physical activity and improving the social life of older adults.

Working conditions mediate the association between social class and physical function in older age in Sweden: a prospective cohort study

Background

Global demographics are changing as societies all over the world are aging. This puts focus on maintaining functional ability and independence into older age. Individuals from lower social classes are at greater risk of developing limitations in physical function later in life. In this study, we investigated the mediating role of working conditions in the association between occupation-based social class and physical function measured as self-reported mobility limitations and objectively measured physical impairment in older age.

Methods

Two Swedish surveys, linked at the individual level, were used (n = 676–814 depending on the outcome). Follow-up time was 20–24 years. Multiple logistic regression analyses were performed with adjustments for age, sex, level of education, mobility, and health problems at baseline. This was followed by analyses of the size of the mediating effect of working conditions.

Results

Working conditions seem to mediate 35–74% of the association between social class and physical impairment in older age. The pattern of mediation was primarily driven by passive jobs, i.e., low psychological demands and low control, among blue-collar workers. Working conditions did not mediate the association between social class and self-reported mobility limitations in older age.

Conclusions

The results of this study indicate that working conditions are important in combating the social gradient in healthy aging, contributing to the evidence regarding the magnitude of impact exerted by both the physical and psychosocial work environment separately and in conjunction.

Factors associated with self-rated health in a Norwegian population of older people participating in a preventive home visit program: a cross-sectional study

Background

Assessing self-rated health by preventive home visits of older people can provide information about the person’s well-being, quality of life and risk of developing illness. The aim of this study was to examine associations between self-rated health and factors related to demographics, lifestyle, health conditions and medical diagnoses by older people participating in a preventive home visit program.

Methods

A cross-sectional study including 233 participants (age 75–79) from three municipalities of Western Norway was conducted. Data were collected through preventive home visits performed by six nurses, using a questionnaire including self-rated health assessment and questions and tests related to demographics (e.g. education and housing), lifestyle (e.g. social activities, alcohol and smoking), health conditions (e.g. sensory impairment, pain and limited by disease) and medical diagnoses. Descriptive and inferential statistics including linear block-wise regression model were applied.

Results

The block-wise regression model showed that the variables Limited by disease and Pain were negatively associated with self-rated health and Use internet was positively associated. The model had a R² 0.432. The variable that contributed to largest change in the model was Limited by disease (R² Change; 0.297, p-value< 0.001).

Conclusions

In the present study, being limited by disease and pain were strongly associated with poor self-rated health, indicating that these are important factors to assess during a preventive home visit. Also, digital competence (Use internet) was associated with a better self-rated health, suggesting that it could be useful to ask, inform and motivate for the use of digital tools that may compensate for or improve social support, social contact and access to health -related information.

Biopsychosocial factors associated to self-percepted sleep function in Brazilian elderly people: analysis of a national survey

BACKGROUND

Sleep is a dimension of well-being and health. Non-restful sleep is related to health dysfunctions, especially in vulnerable populations, considering that related factors change contextually. Thus, the objective of the present study was to measure the magnitude of the reduction in sleep restorative function (SRF) and related biopsychosocial factors in Brazilian elderly.

METHOD

Secondary data from the 2013 National Health Survey of cross-sectional design were analyzed. The sample consisted of individuals as from 60 years old. The outcome considered was the prevalence of reduced self-perceived sleep restorative function (SRF). Health and sleep characteristics, emotional behavior, lifestyle, social support, and urbanization were all investigated. The association with outcome was measured with the prevalence ratio (PR) and estimated with Cox regression, assuming α ≤ 0.05.

RESULTS

SRF was reduced by 29.2% (95%CI 27.2 - 30.6%). It is related to depression (PR = 3.37; 95%CI 2.87 - 3.97), insomnia/sleepiness (PR = 2.45; 95%CI 2.14 - 2.79); behavioral oscillation (PR = 1.75; 95%CI 1.53 - 1.99), negative health perception (PR = 1.50; 95%CI 1.23 - 1.82), computer and internet (PR = 1.44; 95%CI 1.01 - 2.07) and functional difficulty (PR = 1.13; 95%CI 1.01 - 1.27). Living in urban areas (PR = 1.32; 95%CI 1.14 - 1.52) and having a chronic condition (PR = 1.58; 95%CI 1.11 - 2.40) were only associated to the worst situation of reduced SRF.

CONCLUSION

The reduction in SRF affects one third of the elderly in Brazil and is closely related to biopsychosocial factors, requiring intersectoral public health promotion approaches.

Investigating self-perceived health and quality of life: a longitudinal prospective study among beginner recreational exercisers in a fitness club setting

OBJECTIVES

This study investigated self-perception of overall health (SPH) and quality of life (QoL) at onset and after 3, 6 and 12 months of fitness club membership. Also, we compared SPH and QoL between those who reported regular use of the fitness club (≥2 exercise sessions/week the last month) with those who did not (one exercise session/week or no exercise the last month).

DESIGN

Longitudinal prospective study.

SETTING

25 fitness clubs in Oslo, Norway.

PARTICIPANTS

In total, 250 newly registered fitness club members (equal numbers of men and women, mean age=36.4±11.3 years, mean body mass index=25.7±4.4) were recruited. At onset (n=250), after 3 (n=224), 6 (n=213) and 12 months (n=187), the participants answered an electronic questionnaire, covering background variables, exercise involvement, perceived SPH and QoL.

OUTCOME MEASURES

SPH was measured by a single-item question, rating health status from poor to excellent on a 5-point scale. High SPH was dichotomised as excellent or good, and low SPH as moderate, fair or poor. QoL was measured on a 7-item scale, rating five statements and dichotomised according to a total max sum score of 35, with low QoL ≤25 and high QoL >25.

RESULTS

Repeated measurements did not show any changes in SPH. In QoL, we observed an improvement in QoL sum score and a significant increase in mean scores for two out of five statements at 12 months follow-up: 'In most ways, my life is close to my ideal' (p=0.036) and'If I could live my life over, I would change almost nothing' (p<0.001). Regular use of the fitness club was associated with high SPH (OR 3.532 (95% CI 1.60-7.82), p=0.002) and high QoL (OR 1.914 (95% CI 0.95-3.86), p=0.069). The results were unchanged after adjusting for confounders.

CONCLUSION

Regular attendance at a fitness club was associated with high SPH and high QoL at 12 months follow-up.

Autoavaliação negativa da saúde em pessoas idosas associada a condições socioeconômicas e de saúde: inquérito populacional em Rio Branco, Acre

Resumo Objetivo Estimar a prevalência de autoavaliação negativa da saúde e sua associação com condições socioeconômicas, sintomas depressivos, funcionalidade e morbidades autorreferidas em pessoas idosas de Rio Branco, Acre. Método Trata-se de uma pesquisa realizada com dados do Estudo das Doenças Crônicas em Idosos (EDOC-I), um inquérito domiciliar realizado com pessoas a partir de 60 anos residentes em Rio Branco, Acre, Brasil, em 2014 (n=1.016). A autoavaliação negativa da saúde foi definida pelos estratos “ruim” e “muito ruim”. Foram aplicadas as escalas de depressão geriátrica e das atividades da vida diária e instrumentais da vida diária. Como medida de associação da autoavaliação negativa da saúde com variáveis de interesse foi empregada a técnica de regressão logística múltipla. Resultados A prevalência de autoavaliação negativa da saúde foi de 15,4%, apresentando associação estatisticamente significativa com sexo feminino (OR:1,72; IC95%:1,17-2,51), baixa escolaridade (OR:2,33; IC95%:1,37-3,97), sedentarismo (OR:1,84; IC95%: 1,08-3,14) e uso de medicamentos (OR:3,01; IC95%:1,52-5,95). Também se detectou associação com sintomas depressivos (OR:2,55; IC95%:1,74-3,73), presença de multimorbidades (OR:1,73; IC95%:1,15-2,61) e dependência total nas atividades instrumentais da vida diária (OR:2,42; IC95%:1,40-4,17). As morbidades associadas à percepção negativa da saúde foram: asma/bronquite (OR:2,74; IC95%:1,61-4,67), insônia (OR:1,80; IC95%:1,25-2,58) e problemas cardíacos (OR:1,77; IC95%:1,18-2,68). Conclusão Assim, a autoavaliação negativa da saúde das pessoas idosas sofre influência das condições socioeconômicas e de saúde, sendo um indicador útil para o delineamento de estratégias em saúde que favoreçam o envelhecimento com independência e bem-estar físico e emocional.

Incidence and risk factors of depressive symptoms in 4 years of follow-up among mid-aged and elderly community-dwelling Chinese adults: findings from the China Health and Retirement Longitudinal Study

OBJECTIVES

The purpose of this study was to examine the incidence of depressive symptoms, and determine if baseline risk factors conferred a risk for incident depressive symptoms in nationally representative sample of mid-aged and elderly Chinese adults.

DESIGN

This study was a secondary analysis of a prospective cohort from a nationally representative sample.

SETTING

Community samples were recruited from the baseline survey of the China Health and Retirement Longitudinal Study. A four-stage, stratified, cluster probability sampling strategy was used, which included 10 257 households with members aged 45 years or older and their spouse.

PARTICIPANTS

A total of 11 533 participants free of depressive symptoms at baseline were identified, and 10 288 were re-examined in either the first and/or the second follow-up surveys. The current analysis was conducted among the 10 288 participants.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depressive symptoms were measured by the Center for Epidemiological Studies Depression Scale short form.

RESULTS

The findings showed that the incidence of depressive symptoms in a 4-year follow-up was as high as 22.3%. The incidence was much higher in rural areas (25.7%) and in women (27.9%). Furthermore, participants with 1 hour longer of night-time sleep had a 10% lower risk of developing depressive symptoms. Compared with individuals who perceived their health status as poor, those who perceived their health status as excellent had a 62% lower risk of developing depressive symptoms. In addition, having diabetes (OR=1.19), chronic kidney disease (OR=1.32), chronic digestive disorders (OR=1.15) and arthritis (OR=1.43) at baseline increased the risk of depressive symptoms. However, baseline body mass index was not associated with the subsequent depressive symptoms in this population.

CONCLUSIONS

This study highlights the importance of developing an appropriate screening test to identify depressive symptoms for those who are vulnerable and ensure these individuals can receive early interventions for depressive symptoms.