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Determinants of change in self-rated health among older adults in Europe: a longitudinal perspective based on SHARE data.

ABSTRACT: The present study aims at detecting factors which may predict a decline or an improvement in self-rated health (SRH) of older adults (persons aged 50 or higher) among socio-demographic characteristics, physical and mental health indicators and risky health behaviours. In the analysis, multinomial logistic regression models are applied to data from waves 1 and 2 of the Survey of Health Ageing and Retirement in Europe (carried out about 3 years apart); persons who report a decline or an improvement in SRH at wave 2 are compared to those who report no change while controlling for SRH at baseline and country of residence. The analysis was carried out for the whole sample and two subgroups, persons aged 50-64 and 65 or higher. The results indicate that female sex and higher educational attainment have a strong protective effect against decline in SRH. Worse health at baseline is an important predictor of subsequent decline but changes occurring between the waves have a more pronounced effect, implying that SRH is influenced more by recent developments. The findings also indicate that improvement in SRH is a more complex concept than decline and is strongly affected by factors other than health. Among behavioural risk factors, low levels of physical activity and a decrease in the levels of activity between the waves are significantly related to decline while frequent drinking seems associated with improvement. Differentiations by age are modest and probably suggest that advancing age is related to a milder view of one's health.

SUBMITTER: Verropoulou G

PROVIDER: S-EPMC5549107 | biostudies-other | 2012 Dec

REPOSITORIES: biostudies-other

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Project description:BackgroundAlthough self-rated health (SRH) and performance-based physical function (PPF) are both strong predictors of mortality, little research has investigated the relationships between them. The objective of this study was to evaluate longitudinal, bi-directional associations between SRH and PPF.MethodsWe evaluated longitudinal associations between SRH and PPF in 3,610 adults aged 65-89 followed for an average of 4.8 (standard deviation [SD]: 4.4) years between 1994 and July 2011 in the Adult Changes in Thought study, a population-based cohort in the Seattle area. SRH was assessed with a single-item question in the ACT study. Participants were asked at each evaluation to rate their health as "excellent", "very good", "good", "fair", or "poor" in response to the question "In general, how would you rate your health at this time". PPF scores (ranging from 0-16, with higher indicating better performance) included walking speed, chair rises, grip strength, and balance.ResultsAt the baseline visit, participants averaged 74.5 (SD: 5.8) years of age and 2,115 (58.6%) were female. In multivariable linear mixed models, PPF declined with age, with more rapid decreases associated with very good, good, and fair (vs. excellent) baseline SRH. Adjusted annual change in PPF was -0.17 points (95% confidence interval [CI]: -0.19, -0.15) for individuals with excellent baseline SRH and -0.21 points (95% CI: -0.22, -0.19) for participants with fair SRH. In multivariable generalized linear mixed models, lower baseline PPF quartiles were associated with lower odds of excellent/very good/good SRH at age 75, however, differences between baseline PPF quartiles diminished with age.ConclusionsThese results suggest that less than excellent SRH predicts decline in physical functioning, however, poor physical functioning may not predict change in SRH in a reciprocal fashion. SRH provides a simple assessment tool for identifying individuals at increased risk for decline in physical function.

Project description:Despite advances in the healthcare system, cardiovascular diseases (CVDs) are still an important public health problem with disparities in the burden within and between countries. Studies among the adult population documented that socioeconomic and environmental factors play a role in the incidence and progression of CVDs. However, evidence is scarce on the socioeconomic determinants and the interplay with behavioral risks among older adults. Therefore, we identified socioeconomic and behavioral determinants of CVDs among older adults. Our sample consisted of 14,322 people aged 50 years and above from Belgium and France who responded to the waves 4, 5, 6 and/or 7 of the Survey of Health Ageing and Retirement in Europe. The effect of determinants on the occurrence of CVD was examined using a Generalized Estimating Equation (GEE) approach for binary longitudinal data. The overall rate of heart attack was 8.3%, which is 7.6% in Belgium and 9.1% in France. Whereas, 2.6% and 2.3% in Belgium and France, respectively, had experienced stroke. In the multivariable GEE model, older age [AOR: 1.057, 95%CI: 1.055-1.060], living in large cities [AOR: 1.14, 95%CI: 1.07-1.18], and retirement [AOR: 1.21, 95%CI: 1.16-1.31] were associated with higher risk of CVD. Furthermore, higher level of education [AOR: 0.82, 95%CI: 0.79-0.90], upper wealth quantile [AOR: 0.82, 95%CI: 0.76-0.86] and having social support [AOR: 0.81, 95%CI: 0.77-0.84] significantly lowers the odds of having CVD. A higher hand grip strength was also significantly associated with lower risk of CVD [AOR: 0.987, 95%CI: 0.984-0.990]. This study demonstrated that older adults who do not have social support, live in big cities, belong to the lowest wealth quantile, and have a low level of education have a higher likelihood of CVD. Therefore, community-based interventions aimed at reducing cardiovascular risks need to give more emphasis to high-risk retired older adults with lower education, no social support and those who live in large cities.

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Determinants of change in self-rated health among older adults in Europe: a longitudinal perspective based on SHARE data.

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