Abstract
BackgroundObjective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Also, self-reported assessment of health by simple self-rated health (SRH) has been shown to predict mortality and institutionalization. The aim of this study was to assess the association of objective and subjective health with mortality and institutionalization in Finnish community-dwelling older adults.MethodsIn this prospective study with 10- and 18-year follow-ups, objective health was measured by registered illnesses and subjective health was evaluated by simple SRH, self-reported walking ability (400 m) and self-reported satisfaction in life. The participants were categorized into four groups according to their objective and subjective health: 1. subjectively and objectively healthy, 2. subjectively healthy and objectively unhealthy, 3. subjectively unhealthy and objectively healthy and 4. subjectively and objectively unhealthy. Cox regression model was used in the analyses. Death was used as a competing factor in the institutionalization analyses.ResultsThe mean age of the participants (n = 1259) was 73.5 years (range 64.0–100.0). During the 10- and 18-year follow-ups, 466 (37%) and 877 (70%) died, respectively. In the institutionalization analyses (n = 1106), 162 (15%) and 328 (30%) participants were institutionalized during the 10- and 18-year follow-ups, respectively. In both follow-ups, being subjectively and objectively unhealthy, compared to being subjectively and objectively healthy, was significantly associated with a higher risk of institutionalization in unadjusted models and with death both in unadjusted and adjusted models.ConclusionsThe categorization of objective and subjective health into four health groups was good at predicting the risk of death during 10- and 18-year follow-ups, and seemed to also predict the risk of institutionalization in the unadjusted models during both follow-ups. Poor subjective health had an additive effect on poor objective health in predicting mortality and could therefore be used as part of an older individual’s health evaluation when screening for future adverse outcomes.
Highlights
Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults
Poor subjective health had an additive effect on poor objective health in predicting mortality and could be used as part of an older individual’s health evaluation when screening for future adverse outcomes
In this study, we found the categorization of subjective and objective health into four health groups to be good at predicting the risk of mortality during 10- and 18-year follow-ups
Summary
Objective health measures, such as registered illnesses or frailty, predict mortality and institutionalization in older adults. Self-rated health (SRH) is an individual’s own perception of their health It is a subjective assessment, but still has been shown to predict mortality in older adults [1, 2]. Disease counts have in some studies been found almost as effective at predicting mortality [12], and a new simpler comorbidity index for use in the primary care setting has been suggested on the basis of disease count [14]. In both the CCI and the simpler index, the illnesses have been assigned a weight according to severity. Of the illnesses chosen, each alone predicted a higher risk of mortality suggesting that even one moderate to severe illness could predict an increased risk of mortality [13, 14]
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