Changes In Self-rated Health Research Articles

Vision and Self-Rated Health: Longitudinal Findings from an Older Australian Population

Purpose: To assess temporal associations between vision and self-rated health. Methods: We examined 3654 Australian residents (82.4% response) aged 49+ years in the Blue Mountains Eye Study, during 1992 to 1994, and re-examined 2334 in 1997 to 1999. Change in vision was defined if baseline and 5-year visual acuity (VA) changed by ≥10 letters (2 lines). Change in self-rated health was defined if overall health ranking (excellent, good, fair, poor) changed by ≥1 step. Results: Of 2285 participants with data from both examinations, 59.8%, 23.9%, and 16.3% reported unchanged, declined, and improved self-rated health, respectively. Among persons whose self-rated health declined, the proportions with a decline in presenting VA, no change, or improvement were similar (25.2%, 23.8% and 22.5%, respectively, p for trend = 0.5). Among participants with decline, no change, or improvement in self-rated health, a similar magnitude in the age-sex adjusted mean VA decline (−1.0 to −2.7 letters) was observed. After adjusting for age, sex, hospitalizations, and incident chronic conditions, declining VA was not associated with increased decline in 5-year self-rated health (multivariate-adjusted odds ratio 0.99, 95% CI 0.75–1.30). Conclusion: There were no parallel 5-year changes in self-rated health and vision in this population.

Predictors of declining self-rated health during the transition to menopause

Objective: To determine factors associated with declining self-rated health as measured annually for 8 years in a prospective population-based cohort of middle-aged Australian-born women. In particular, to investigate the potential role of the menopausal transition in changing self-rated health. Methods: A total of 262 women from the Melbourne Women's Midlife Health Project were asked to rate their present health compared with other women about the same age as worse than, the same as or better than most. Results: Women reporting their health to be “better than most” decreased from 51.2% at Year 1 to 41.3% at Year 8. In the year prior to the late menopausal transition, women reporting their health to be ‘better than most’ declined by 5%. Comparing women who experienced the menopausal transition with women whose menopausal status did not change, there was no significant difference in changes in self-rated health. Change in body mass index (OR=1.53; 95% CI=1.13 to 2.06) and change in feelings for partner (OR=0.38; 95% CI=0.17 to 0.86) predicted a change in self-rated health from a baseline status of ‘better than most.’ Having an operation or procedure in the last year (OR=8.63; 95% CI=1.84 to 40.4) and an increase in the number of symptoms (OR=1.32; 95% CI=1.01 to 1.72) predicted a decline in self-rated health from baseline status of ‘same as others.’ Conclusion: This prospective study found a small decline in self-rated health with age but no significant effect of the menopausal transition. Different factors relate to differing self-rated health groupings. Further studies involving other ethnic groups and larger sample sizes are needed.

Depressive symptoms and self-rated health in community-dwelling older adults: a longitudinal study.

To test whether baseline depressive symptoms in older adults increase the risk of subsequent decline in self-rated health and decrease the likelihood of subsequent improvement in self-rated health. A 2-year prospective cohort study. Six thousand seven hundred fourteen community-dwelling older persons who completed the first and second wave of the Asset and Health Dynamics among the Oldest-Old Survey in the United States. Community-dwelling older people in the United States. Baseline depressive symptoms were measured using a short-form of the Center for Epidemiological Studies Depression Scale. Self-rated health was measured using a single item of global health rating. After adjustment for covariates, a high burden of depressive symptoms at baseline was predictive of greater decline in self-rated health (odds ratio (OR) for decline in those with high burden of depressive symptoms vs those without = 1.47, 95% confidence interval (CI) = 1.26-1.70). Likewise, high burden of depressive symptoms at baseline predicted less improvement in self-rated health (OR for improvement in those with high burden of depressive symptoms vs those without = 0.57, 95% CI = 0.50-0.65). Depressive symptomatology is an independent risk factor for subsequent changes in self-rated health in older adults. Thus, early prevention and intervention of depressive symptoms in community-dwelling older adults might be critical to promote and maintain their self-rated health.

Elevated Blood Levels of Dehydroepiandrosterone Sulphate Vary with Symptom Load in Posttraumatic Stress Disorder: Findings from a Longitudinal Study of Refugees in Sweden

Background: The present study is part of a longitudinal study of recently resettled refugees with the aim of learning which factors in their daily life influence health as measured by self-report and stress-responsive hormones. Methods: In a group of recently resettled refugees with a high incidence of posttraumatic stress disorder (PTSD), diagnosed by structured interview, self-rated symptoms of PTSD were followed three times over a period of 9 months after inclusion in the study. Eighty-six individuals were included in the study and 58 subjects (67.4%) completed it. Blood samples were drawn at each examination for assessment of hormone levels. Results: After adjustment for age, dehydroepiandrosterone sulphate (DHEA-s) was observed to be higher in non-depressed PTSD cases than in non-PTSD without depression. There was an interaction between PTSD and depression regarding DHEA-s levels. DHEA-s correlated significantly with changes in self-rated symptoms of PTSD at last follow-up; the greater the increase in PTSD symptoms, the greater the increase in plasma DHEA-s. The variation of DHEA-s levels in relation to changes in self-rated health in non-PTSD showed the opposite pattern, although not reaching significance. Conclusions: The finding of changes in DHEA-s should encourage further studies of the role of altered steroid metabolism in PTSD.

Changes Predicting Long-Term Care Use Among the Oldest-Old

The aim of this study was to identify health-related changes occurring between 1983 and 1990 that characterize and differentiate 1996 long-term care outcomes (no services, home care, nursing home) among people aged 85 years and older. Variables capturing health-related changes between 1983 and 1990 in a cohort (N = 616) of Aging in Manitoba Longitudinal Study participants aged 85 years and older were used in a series of logistic regression models to identify factors that best predicted the use of long-term care services in 1996, controlling for age and sex. Factors predicting home care use relative to no services included changes in self-rated health, income adequacy, and railings outside of the house. Factors predicting nursing home use relative to home care included age and changes in general life satisfaction. Factors predicting nursing home use relative to no services included age; previous service use; length of time in the community; and changes in income adequacy, type of housing, and state of mind. These findings challenge assumptions about the linearity of the continuum of long-term care services, because different factors were shown to predict home care use than were shown to predict nursing home use.

Self-rated health as a predictor of survival among patients with advanced cancer.

Evidence is emerging about the strong predictive relationship between self-rated health (SRH) and survival, although there is little evidence on palliative populations where an accurate prediction of survival is valuable. Thus, the relative importance of SRH in predicting the survival of ambulatory patients with advanced cancer was examined. SRH was compared to clinical assessments of performance status, as well as to quality-of-life measures. By use of a prospective cohort design, 181 patients (76% response rate) with advanced cancer were recruited into the study, resurveyed at 18 weeks, and observed to record deaths. The average age of patients was 62 years (SD = 12). The median survival time was 10 months. SRH was the strongest predictor of survival from baseline. Also, a Cox regression comparing changes in SRH over time yielded hazard ratios suggesting the relative risk (RR) of dying was greater for fair ratings at 18 weeks (approximately 3 times) compared with consistent good or better ratings; the RR was even greater (4.2 and 6.2 times) for poor ratings, especially when ratings were poor at baseline and 18 weeks (31 times). Improvement in SRH over time yielded the lowest RR. SRH is valid, reliable, and responsive to change as a predictor of survival of advanced cancer. These qualities suggest that SRH should be considered as an additional tool by oncologists to assess patients. Similarly, health managers could use SRH as an indicator of disease severity in palliative care case mix. Finally, SRH could provide a key to help us understand the human side of disease and its relationship with medicine.

Changes in health, functional performance and activity predict changes in self-rated health: a 10-year follow-up study in older people

The purpose was to examine changes in self-rated health (SRH) in older people and associations between these changes and various self-reported and objectively measured indicators of health status, functional performance and activity at three time-points 5 years apart. Further, our aim was to examine whether SRH takes the form of a continuum. The study group comprised all the baseline 75-year-old inhabitants of the City of Jyväskylä, Finland ( N=382). Four groups were formed according to change/stability in SRH: ‘good–good’, ‘good–bad’, ‘bad–good’ and ‘bad–bad’. Cross-tabulation and one-way analysis of variance (ANOVA) was used to examine the cross-sectional differences, and GLM Repeated Measures to analyze the differences in changes in the determinants of SRH over time. Stability was more common than change in SRH, although in most participants there was a decline in most of the determinants of SRH. A systematic relation was found between the SRH groups and the indicators of health status, functional performance and physical and social activity, especially over the first 5-year period. A substantial decrease in these indicators was associated with a decline in SRH. Among older people change and stability in SRH over time systematically reflect health status, functional performance, and physical and social activity. The relatively high stability found in SRH indicates that with increasing age older people adapt to their worsening health conditions. SRH seems to form a continuum when a wide range of self-reported and objectively measured indicators on physical, psychological and social components of health are taken into account.

Two views of self-rated general health status

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

The Impact of Age, Gender, and Race on the Relationship Between Depression and Self-Rated Health in Community-Dwelling Older Adults: A Longitudinal Study

ABSTRACT Objective: To examine whether the prediction of baseline depression for subsequent changes in self-rated health is consistent across different age cohorts, gender, and racial groups. Data Sources and Study Setting: A total of 6,714 participants who were 65 years old or older and took part in both the first and the second wave of Assets and Health Dynamics among the Oldest-Old (AHEAD) national survey of community-dwelling older adults were examined. Study Design: A two-year prospective cohort study. Principle Findings: Baseline depression was an independent risk factor, which not only decreased the odds of having substantial improvement in self-rated health but also increased the possibility of having substantial decline in self-rated health in older men and women, and in Blacks and Whites of all age groups. Conclusions: Early prevention and treatment of depression among community-dwelling older adults may not only reduce their health decline but also promote their health.

Social class and self-rated health: can the gradient be explained by differences in life style or work environment?

The purpose of the present paper is to describe differences in work environment and life style factors between social classes in Denmark and to investigate to what extent these factors can explain social class differences with regard to changes in self-rated health (SRH) over a 5 year period. We used data from a prospective study of a random sample of 5001 Danish employees, 18–59 years of age, interviewed at baseline in 1990 and again in 1995. At baseline we found higher prevalence in the lower classes of repetitive work, low skill discretion, low influence at work, high job insecurity, and ergonomic, physical, chemical, and climatic exposures. High psychological demands and conflicts at work were more prevalent in the higher classes. With regard to life style factors, we found more obese people and more smokers among the lower classes. The proportion with poor SRH increased with decreasing social class at baseline. The follow-up analyses showed a clear association between social class and worsening of SRH: The lower the social class, the higher the proportion with deterioration of SRH. There was no social gradient with regard to improved SRH over time. Approximately two thirds of the social gradient with regard to worsening of SRH could be explained by the work environment and life style factors. The largest contribution came from the work environment factors.

Work environment and changes in self-rated health: a five year follow-up study

A representative sample of 5001 Danish employees was followed for five years. The respondents were interviewed by telephone in 1990 and again in 1995. Social class, diseases, self-rated health (SRH), and a number of psychosocial and other work environment factors were assessed in 1990, and SRH was measured again in 1995. We analyzed predictors of changes in SRH from 1990 to 1995. After control for age, gender, and disease, the following factors predicted worsening of SRH among respondents with good SRH in 1990: repetitive work, high psychological demands, low social support, high job insecurity, and high ergonomic exposures. After further control for social class, the ORs for some of these factors were reduced, but they all remained significant. Only one of the work environment factors, ergonomic exposures, predicted improvements in SRH among those respondents who had poor SRH in 1990. Many studies have shown that SRH is a powerful independent predictor for total mortality. This is the first study showing that a number of work environment factors predict worsening of SRH over time. Copyright © 2000 John Wiley & Sons, Ltd.

Changes in self-rated health, disability and contact with services in a very elderly cohort: a 6-year follow-up study.

To study the relationships between global self-rated health, reported physical symptoms and depressive symptoms and the receipt of community services by very elderly people, and to examine changes in these variables over time. Three-wave study with follow-up at 2.4 and 6 years after first interview. Structured interview, incorporating cognitive examination (Mini-Mental State Examination) and enquiring specifically about overall self-rated health, physical symptoms and depressive symptoms. Community setting in city of Cambridge, UK. 2609 were initially recruited: all patients aged 75 years and over from lists of six general practices (and one in three from a seventh practice). At 2.4 years, 1173 individuals re-examined and at 6 years 628 individuals. General health self-rated in comparison to others of similar age and individual physical and depressive symptoms self-rated as present or absent. Symptoms were added to produce physical health and depressive symptom scores. Data presented from cross-sectional analysis of 6-year sample; also examined longitudinal data from all three waves of study for ageing and cohort effects. Finally the effect of health variables on the receipt of services was examined. Statistics used included chi(2) and non-parametric statistics for continuous data, also odds ratios for likelihood of receiving services. At 6 years, 70% rated their overall health as good or very good. Overall self-rated health showed both ageing and cohort effects, improving with increasing age and especially with more recent cohort. Reported physical symptoms increased with ageing. Depression scores also increased with ageing but the relationship between depressive symptoms and ageing was less clear-cut. Receipt of services was associated with poor self-rated health and reported physical symptoms as well as with ageing. Higher depression scores at 2.4 years were associated with increased service receipt at 6 years, indicating a lag between the symptoms and the service response. Individuals in the more recent cohort were less likely to receive services, but those who did so received more frequent contact. Although very elderly people have a high prevalence of reported physical symptoms, they often rate their overall health as good. There was a stronger relationship between ageing and physical symptoms than with depressive symptoms. Symptoms of both kinds influenced the likelihood of receiving services, although there was a lag between depressive symptoms and service response. Cohort effects on service receipt may reflect changes in public service policy.