Poor self-rated health did not increase risk of permanent nursing placement or mortality in people with mild Alzheimer's disease.

Anni Brit Sternhagen Nielsen,Gunhild Waldemar,Frans Boch Waldorff,Volkert Siersma

doi:10.1186/s12877-016-0262-x

Anni Brit Sternhagen Nielsen, Gunhild Waldemar + Show 2 more

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https://doi.org/10.1186/s12877-016-0262-x

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Abstract

BackgroundSelf-rated health (SRH) has in many population-based studies predicted adverse health outcomes, e.g. morbidity, permanent nursing home (NH) placement, and mortality. However, the predictive value of SRH to NH placement and mortality among elderly people is not consistent. This may be due to cognitive impairment. Since the SRH item is widely used, it is important to know whether SRH has different predictive value among people with cognitive impairments. We aimed to examine SRH and the risk of permanent NH placement and mortality among people with mild Alzheimer’s disease (AD).MethodsData are from The Danish Alzheimer Intervention StudY (DAISY), a large randomized controlled trial of psychosocial intervention for patients with mild dementia and their caregivers with 3-years’ follow-up. Five out of 14 Danish counties participated and 321 home-living elderly (mean age: 76.2 years) with mild AD (46.4 % male) were included during 2004 and 2005. Self-rated SRH, cognitive function (MMSE), quality of life (proxy-rated QOL-AD), activities of daily living (ADCS-ADL), insight, and socio-demographics were assessed at baseline. Comorbidities and information about NH placement and mortality was obtained over 3-years’ follow-up from registries. With Cox proportional hazard regression we analysed the association between SRH (dichotomised into good vs. poor) and NH placement and mortality adjusted for potential confounders.ResultsAt baseline 66 % reported excellent or good, and 34 % fair, poor or very poor SRH. Mean MMSE was 24.0 (range: 20–30). NH placement and mortality totalled 28.1 % and 16.5 % at 3-years’ follow-up, respectively. Poor SRH at baseline was not related to increased risk of NH placement or to increased mortality neither in the univariable nor in multivariable analysis: In the fully adjusted models HR was 0.63 (95 % CI 0.38-1.05) and 1.28 (95 % CI 0.67-2.45), respectively.ConclusionsWhen poor SRH was present we found no increased risk for NH placement or death among elderly people with mild AD. SRH is a widely used parameter in clinical and epidemiological research but may not be a valid indicator of health in patients with AD due to loss of insight.

Highlights

Self-rated health (SRH) has in many population-based studies predicted adverse health outcomes, e.g. morbidity, permanent nursing home (NH) placement, and mortality
Self-rated health (SRH) measured by a single question has in many population-based studies shown to be an independent predictor of future adverse health outcomes such as nursing home (NH) placement [1] and mortality [2,3,4] even when accounting for possibly health factors like lifestyle, socio-economic status, and co-morbidities
We examined the unadjusted association between SRH and other risk factors measured at baseline, i.e. socio-demographic characteristics, the number of comorbidities, mini mental state examination (MMSE), and other disclaims as well as randomisation group and county, and NH placement and death over 3-years’ follow-up with Cox proportional hazard models

Summary

Introduction

Self-rated health (SRH) has in many population-based studies predicted adverse health outcomes, e.g. morbidity, permanent nursing home (NH) placement, and mortality. Self-rated health (SRH) measured by a single question has in many population-based studies shown to be an independent predictor of future adverse health outcomes such as nursing home (NH) placement [1] and mortality [2,3,4] even when accounting for possibly health factors like lifestyle, socio-economic status, and co-morbidities. Four community-based cohort studies including elderly aged 65 years or older adjusted the analysis for information on cognitive function [14]; re-analysis of those four studies in a metaanalysis did not show the expected relation between SRH and mortality: a higher relative risk of mortality was found among people who rated their health good as compared to excellent, but no higher risk was found among those who rated their health fair or poor [14]. An article discussing the future research into a better understanding of SRH calls for further studies on cognitive processes of health assessments [4]

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