Self-reported health and the well-being paradox among community-dwelling older adults: a cross-sectional study using baseline data from the Canadian Longitudinal Study on Aging (CLSA)

Carly Whitmore,Carrie Mcainey,Maureen Markle-Reid,Kathryn Fisher,Jenny Ploeg,Andrew Wister,Lauren E Griffith,Susan P Phillips

doi:10.1186/s12877-022-02807-z

Abstract

BackgroundSelf-reported health is a widely used epidemiologic measure, however, the factors that predict self-reported health among community-dwelling older adults (≥65 years), especially those with multimorbidity (≥2 chronic conditions), are poorly understood. Further, it is not known why some older adults self-report their health positively despite the presence of high levels of multimorbidity, a phenomenon known as the well-being paradox. The objectives of this study were to: 1) examine the factors that moderate or mediate the relationship between multimorbidity and self-reported health; 2) identify the factors that predict high self-reported health; and 3) determine whether these same factors predict high self-reported health among those with high levels of multimorbidity to better understand the well-being paradox.MethodsA cross-sectional analysis of baseline data from the Canadian Longitudinal Study on Aging was completed (n = 21,503). Bivariate stratified analyses were used to explore whether each factor moderated or mediated the relationship between multimorbidity and self-reported health. Logistic regression was used to determine the factors that predict high self-reported health in the general population of community-dwelling older adults and those displaying the well-being paradox.ResultsNone of the factors explored in this study moderated or mediated the relationship between multimorbidity and self-reported health, yet all were independently associated with self-reported health. The ‘top five’ factors predicting high self-reported health in the general older adult population were: lower level of multimorbidity (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.74-0.76), female sex (OR 0.62, CI 0.57-0.68), higher Life Space Index score (OR 1.01, CI 1.01-1.01), higher functional resilience (OR 1.16, CI 1.14-1.19), and higher psychological resilience (OR 1.26, CI 1.23-1.29). These same ‘top five’ factors predicted high self-reported health among the subset of this population with the well-being paradox.ConclusionsThe factors that predict high self-reported health in the general population of older adults are the same for the subset of this population with the well-being paradox. A number of these factors are potentially modifiable and can be the target of future interventions to improve the self-reported health of this population.

Highlights

Self-reported health is a widely used epidemiologic measure, the factors that predict selfreported health among community-dwelling older adults (≥65 years), especially those with multimorbidity (≥2 chronic conditions), are poorly understood
A number of these factors are potentially modifi‐ able and can be the target of future interventions to improve the self-reported health of this population
While definitions of multimorbidity vary in number (e.g., 2 or more versus 3 or more chronic conditions) and in the chronic conditions considered [1], there is consistent and strong evidence in the literature that an increasing level of multimorbidity is associated with lower self-reported health [2,3,4,5,6]

Summary

Introduction

Self-reported health is a widely used epidemiologic measure, the factors that predict selfreported health among community-dwelling older adults (≥65 years), especially those with multimorbidity (≥2 chronic conditions), are poorly understood It is not known why some older adults self-report their health positively despite the presence of high levels of multimorbidity, a phenomenon known as the well-being paradox. More recently research emphasis has shifted from objective to subjective indices of health, including those that consider the presence of positive emotions such as happiness or satisfaction in aging – despite the presence of multimorbidity [19] This is due, in part, to a subset of the older adult population, who despite having poorer health according to objective indicators, report positive levels of subjective health (e.g., selfreported health) [18]. Multimorbidity resilience is shaped by coping strategies and previous life experiences acquired throughout the lifecourse and related to health and illness at the individual, social, and environmental level [20]

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