Association of physical performance and self-rated health with multimorbidity among older adults: Results from a nationwide survey in Japan

ObjectivesTo examine the association of physical performance measures and self-rated health with multimorbidity among older Japanese adults aged ≥60 years using cross-sectional data from a nationwide longitudinal survey.MethodsUsing respondents’ self-reported data from the 2012 National Survey of the Japanese Elderly, we analyzed multimorbidity involving nine major chronic diseases (heart disease, arthralgia, hypertension, diabetes, stroke, cataract, cancer, respiratory disease, and low back pain). Respondents who reported having two or more of these diseases were identified as having multimorbidity. Multivariate logistic regression analysis was used to examine if physical performance (grip strength and walking speed) and self-rated health were independently associated with multimorbidity after adjusting for potential confounders (e.g., demographic, physiological, and lifestyle-related variables).ResultsThe responses of 2525 participants who responded to the survey by themselves (i.e., without proxies) were analyzed (response rate: 57.9%). Among the chronic diseases examined, hypertension had the highest prevalence (44.1%), followed by low back pain (25.7%) and cataract (24.7%). Approximately 44.4% of the respondents had multimorbidity. The regression analysis revealed that multimorbidity was significantly associated with both poor grip strength (P = 0.006) and self-rated health (P < 0.001), but not with walking speed (P = 0.479).ConclusionsMultimorbidity is prevalent in older Japanese adults, and poor grip strength and self-rated health were independently and significantly associated with multimorbidity. Health assessments that include these indicators may provide insight into the health status patterns of older adults with multimorbidity and inform the development of health management strategies.     

Association of unmet need with self-rated health in a community dwelling cohort of disabled seniors 75 years of age and over

Self-rated health (SRH) is a measure of perceived health that has been shown to predict use of community services, functional decline, pain, and mortality. Many factors associated with SRH have been identified, but unmet need for physical assistance with activities of daily living (ADL) has not yet been examined. The objective of this paper is to examine the association between unmet need and SRH while accounting for the effects of other, previously identified, correlates of SRH. We conducted a secondary analysis of a population-based study of 839 residents of Montréal, Québec who were 75 years of age or older, not cognitively impaired, and living in the community. Multivariable logistic regression was used to evaluate the association between met and unmet personal ADL (PADL) and instrumental ADL (IADL) need for physical assistance with SRH. Among 508 disabled community-dwelling elderly, for each additional unmet IADL need, subjects were 1.70 (95% CI: 1.11–2.61) times more likely to report poorer SRH. For each additional unmet PADL need, subjects were 2.26 (95% CI: 1.31–3.91) times more likely to report poorer SRH. Subjects at increased risk of malnutrition, with greater comorbidity and whose income was insufficient to meet their needs were also more likely to report poorer SRH. After adjustment for important correlates, unmet PADL and IADL needs retain a statistically significant association with poorer SRH, with nutritional status, comorbid conditions, and income satisfaction being important confounders of the relationship.     

The neighborhood effect of cognitive function on self-rated health: A population-based observational study

This study investigates the interaction between the neighborhood effect of cognitive function on self-rated health among middle aged and older adults. Data from the Korean Longitudinal Study on Aging (KLoSA) were analyzed. A total of 9,998 participants were selected for biennial follow-ups from 2006 to 2018 to estimate the probability of change in cognitive function according to individual, regional and dependent variables. A generalized estimating equation (GEE) model and chi-square test were used. The odds ratio (OR) of underestimation, when an individual's cognitive function is lower than his/her regional average of cognitive function, was 1.173 times higher (95 % Confidence Interval [CI]: 1.108–1.241, p-value: <.0001) compared to accurate, when an individual's cognitive function is equal to his/her regional average of cognitive function. The OR of individuals with low cognitive function in regions with low cognitive function levels had the highest probability of poor SRH (self-rated health) (OR: 3.525; 95 % CI: 3.182–3.905, p-value: <.0001) compared to individuals with high cognitive function in regions with high cognitive function levels. Findings speak of the importance of the neighborhood effect of cognitive function on self-rated health among Korean middle aged and older adults. Further research is needed to investigate the potential mediation of pleasurable mechanisms in the rapidly aging population of Korea.     

The health advantage of volunteering is larger for older and less healthy volunteers in Europe: a mega-analysis

There is a vast literature on the health benefits associated with volunteering for volunteers. Such health advantages are likely to vary across groups of volunteers with different characteristics. The current paper aims to examine the health advantages of volunteering for European volunteers and explore heterogeneity in the association between volunteering and health. We carry out a mega-analysis on microdata from six panel surveys, covering 952,026 observations from 267,212 respondents in 22 European countries. We provide open access to the code we developed for data harmonization. We use ordinary least squares, fixed effects, first difference, and fixed effect quantile regressions to estimate how volunteering activities and changes therein are related to self-rated health for different groups. Our results indicate a small but consistently positive association between changes in volunteering and changes in health within individuals. This association is stronger for older adults. For respondents 60 years and older, within-person changes in volunteering are significantly related to changes in self-rated health. Additionally, the health advantage of volunteering is larger for respondents in worse health. The advantage is largest at the lowest decile and gradually declines along the health distribution. The magnitude of the association at the first decile is about twice the magnitude of the association at the ninth decile. These results suggest that volunteering may be more beneficial for the health of specific groups in society. With small health advantages from year to year, volunteering may protect older and less healthy adults from health decline in the long run.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00691-5.     

The effect of trust and change in trust on self-rated health: A longitudinal study among aging people

This study examined whether trust predicted subsequent self-rated health over time at 3 years follow-up among aging people, and whether changes in trust were associated with self-rated health. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926–1930, 1936–1940, and 1946–1950) living in the Province of Päijät-Häme, southern Finland. The response rate at the baseline in 2002 was 66% (n = 2815). The follow-up was carried out in 2005, with 79% of eligible individuals participating (n = 2216). Logistic regression analyses were used to derive the results. High trust was a strong predictor for good self-rated health at the follow-up. Adjusting for background variables, however, attenuated the association. In addition, good self-rated health was most common among men with sustained high trust, among women the association was somewhat weaker. Among men improvement in trust was associated with good self-rated health, but this correlation weakened after multiple adjustments. Thus, longitudinally trust is an important contributor to self-rated health among aging people. Moreover, improvement of trust but also the stability of high trust especially among men indicate better self-rated health. Trust has a positive effect on health and should therefore be seen as a significant element in health promotion.     

Views on aging: older adults’ self-perceptions of age and of health

Perceptions of age and perceptions of health have each been found to predict future health and well-being, yet surprisingly, studies typically focused on one or the other. Studies on perceived age suggested that its effects on longevity may be mediated by perceived health. Within each of these lines of research, the constructs have not been consistently operationalized, making it difficult to generalize across studies. We aimed to investigate the associations of different measures of perceptions of age and of health with one another and with longevity. Data collected at baseline from the 851 participants of the Rutgers Aging and Health longitudinal study (mean age 73) included perceptions of age and health, each assessed with four different single-item measures, sociodemographic, and health measures. Mortality was followed-up for 10 years. All four health perceptions and two of the age perceptions (Age-group identity and nearness-to-death) were associated with survival time. Age and health perceptions had similar independent effects in models that included measures of both types, controlling for demographics and chronic conditions, though not after controlling for age. In contrast with our hypothesis, health perceptions did not mediate the association between age perceptions and mortality. Findings regarding health perceptions were generally consistent across measures, whereas age perception measures differed in their associations with various outcomes, indicating that they assess different subjective age constructs. The findings correspond with proposed explanations for the predictive effect of age and health perceptions and support the significant though weaker independent effects of age perceptions compared with health perceptions.     

Age and gender patterns in associations between lifestyle factors and physical performance in older Korean adults

Purpose

To investigate age and gender patterns in associations between lifestyle factors and physical performance in community-dwelling older Korean adults.

Design and methods

A cross-sectional study was conducted in a population-based sample of an urban area. Randomly sampled older Korean adults (n = 664; mean age, 74.6 years) participated. Data on current physical activity level and doing exercise, social participation and hobbies, smoking status, drinking status, sleep quality, and physical performance were obtained. Binary logistic regression analyses were used to identify the age and gender patterns in associations between various lifestyle factors and physical performance.

Results

In younger (age <85 years) men, significant predictors of poor physical performance by logistic regression analysis after adjusting for covariates were current physical activity time, doing exercise, and engagement in social activities. In younger women, current physical activity time and sleep quality were related to poor physical performance. In older (age ≥85 years) men, family gatherings were a significant factor. In older women, no lifestyle factor assessed showed a significant relationship with poor physical performance.

Conclusion

Interventions implemented to modify lifestyle factors need to focus on age and gender subgroups in the elderly population. Lifestyle modification should be emphasised as a targeted treatment program for Korean adults aged <85 years.     

Diet and self-rated health among oldest-old Chinese

IntroductionDietary behavior is a central modifiable risk factor for human health. This study examined the longitudinal relationship between dietary habits and self-rated health among the oldest-old Chinese.MethodsParticipants aged 80 years and above (N = 7273) were first interviewed in 1998 and followed in subsequent waves 2–3 years apart till 2011–2012 in the Chinese Longitudinal Healthy Longevity Survey. Cox proportional hazards regressions were performed to estimate the effects of dietary habits on poor self-rated health, adjusting for various individual characteristics.ResultsCompared to those who rarely/never consumed fruit, vegetable, meat, egg, and soybean-derived product, participants consuming such products almost every day were 28%, 20%, 32%, 16%, and 16% less likely to report poor self-rated health during follow-up, respectively. Compared to those who rarely/never consumed fruit, meat, fish, soybean-derived product, and tea, participants consuming such products occasionally were 12%, 24%, 11%, 15%, and 14% less likely to report poor self-rated health during follow-up, respectively. Compared to those who rarely/never consumed sugar, participants consuming sugar almost every day were 14% more likely to report poor self-rated health during follow-up. The effects of dietary habits on self-rated health to some extent differed by sex.ConclusionsOldest-old Chinese could gain health benefit from regular consumption of fruit, vegetable, meat, fish, egg, soybean-derived product, and tea; whereas their sugar consumption may need to be reduced. Future research is warranted to establish the recommended daily nutrient allowances for the oldest-old adults and better address the nutritional needs of this vulnerable population.     

Self-rated health and mortality risk in relation to gender and education: a time-dependent covariate analysis

This study examines the relations between self-rated health (SRH) at baseline, SRH as a time-dependent covariate (TDC), and mortality by gender and education in a community-dwelling older population in Spain. The data used are from the longitudinal study “Aging in Leganes”, launched in 1993, carried out in a community-dwelling representative sample (n = 1,560) of the older population of Leganes (Spain). Mortality was assessed in 2008. Proportional regression models were fitted to examine the association between mortality and baseline SRH, and SRH as a TDC among subjects aged 65–85 at baseline. The multivariate analyses were stratified by gender and education and adjusted for sociodemographic factors, smoking and physical activity, physical and mental morbidity, and ADL disability. SRH and SRH as a TDC were significant predictors of mortality in men and in people with some education, but not in women or in illiterate persons. SRH and declines in SRH were associated with increased mortality risk in older men and in those who can read and write in this Mediterranean population. Given current improvements in education and decreasing gender inequality, health professionals in Spain should pay attention to both current SRH and declines in SRH in their patients regardless of gender and literacy.     

Understanding causal associations between self-rated health and personal relationships in older adults: A review of evidence from longitudinal studies

Background

As we age we experience many life changes in our health, personal relationships, work, or home life which can impact on other aspects of our life. There is compelling evidence that how we feel about our health influences, or is influenced by, the personal relationships we experience with friends and relatives. Currently the direction this association takes is unclear.

Aim

To assess the level of published evidence available on causal links between self-rated health and personal relationships in older adults.

Methods

MEDLINE, CINAHL, and PsycINFO searches from inception to June 2012 and hand searches of publication lists, reference lists and citations were used to identify primary studies utilizing longitudinal data to investigate self-rated health and personal relationships in older adults.

Results

Thirty-one articles were identified. Only three articles employed methods suitable to explore causal associations between changes in self-rated health and changes in personal relationships. Two of these articles suggested that widowhood leads to a reduction in self-rated health in the short term, while the remaining article suggested a causal relationship between self-rated health and negative emotional support from family or friends, but this was complex and mediated by self-esteem and sense of control.

Conclusion

While there is an abundance of longitudinal aging cohorts available which can be used to investigate self-rated health and personal relationships over time the potential for these databases to be used to investigate causal associations is currently not being recognized.     

The educational,racial and gender crossovers in life satisfaction: Findings from the longitudinal Health and Retirement Study

ObjectiveTo examine variations in life satisfaction by education, gender, and race/ethnicity over a period of eight years among middle-aged and older Americans.MethodsMixed-effects models were used to analyze five waves (2006, 2008, 2010, 2012 and 2014) of longitudinal data from 16,163 participants born 1890–1953 in the U.S. Health and Retirement Study.ResultsLife satisfaction was higher in older adults, and the Great Recession had great impact on life satisfaction. Crossover interactions were found by gender, education, and race/ethnicity. Higher education was associated with higher life satisfaction for both genders, with stronger effects for females. Hispanics had the higher level of life satisfaction than non-Hispanic Whites and African Americans.DiscussionLongitudinal evidence revealed disparities in life satisfaction. The racial/ethnic differences in the impact of education suggest that the economic and health returns of education vary by social group. Researchers should continue to examine reasons for these disparities.     

Providing emotional support to others,self-esteem,and self-rated health

The purpose of this study is to assess the effects of helping others on self-rated health in middle and late life. Data are from a nationwide sample of middle-aged and older adults (N = 1154). The findings indicate that women and Blacks are more likely than men or Whites to help others. Moreover, the results suggest that people who attend church more often are especially likely to help others. The data further reveal that people who help others are more likely to have a greater sense of self-worth and people with more self-esteem, in turn, tend to rate their health in a more favorable way. The findings help clarify issues in the assessment of helping others in middle and late life.     

基于竞争风险模型的北京市老年人健康自评与卒中发生关系的队列研究

目的探讨北京市年龄≥55岁老年人健康自评与卒中发生的风险。方法研究对象来源于1992年1月至2012年12月首都医科大学宣武医院收集的北京市老龄化多维纵向研究数据共2 101名,年龄≥55岁。排除基线患有卒中121名、信息不完整92名,最终1 888名基线无脑血管病的老年人纳入分析。健康自评的判定是调查对象根据自身的实际情况,从"良好、一般、差"中选择符合自身当前状态的项目。调查截止日期为2012年12月31日。采用竞争风险模型评价健康自评状态与卒中发生的风险,将非卒中死亡,包括癌症、车祸等作为竞争事件处理。结果纳入的1 888名研究对象中,健康自评良好者946名(50.1%)、一般者616名(32.6%)、差者326名(17.3%);发生卒中438名(23.2%),非卒中死亡751名(37.8%),右删失数据699名(37.0%)。采用竞争风险模型,调整年龄、性别、居住地区、婚姻状况、教育水平、吸烟、饮酒、体育锻炼、高血压、糖尿病、冠心病和体质量指数,健康自评差者发生卒中是良好者的1.44倍(95%CI:1.11~1.87,P0.01)。结论北京市年龄≥55岁老年人健康自评中,考虑竞争风险后,健康自评差者增加了卒中发生的风险。     

Association between hilliness and walking speed in community-dwelling older Japanese adults: A cross-sectional study

PurposeThis cross-sectional study investigated the association between hilliness and walking speed in community-dwelling older adults, and whether it varied according to their car-driving status.MethodsData were collected from 590 participants aged 65 and older living in Okinoshima Town, Shimane prefecture, Japan, in 2018. Comfortable walking speed (m/s) was objectively assessed. Hilliness was measured by the mean land slope (degree) within a 500-m or 1000-m network buffer around each participant's home using a geographic information system. A multiple linear regression examined whether the land slope was associated with walking speed, adjusted for sex, age, body mass index, smoking habits, alcohol consumption habits, exercise habits, chronic disease, and living arrangements. A stratified analysis by car-driving status was also conducted.ResultsAfter adjusting for all confounders, the land slope within the 500-m or 1000-m network buffer was negatively associated with walking speed (B = -0.007, 95% CI [-0.011, -0.002]; B = -0.007, 95% CI [-0.011, -0.003], respectively). The stratified analysis by car-driving status showed that living in a hilly area was negatively associated with walking speed among non-drivers in the 500-m or 1000-m network buffer (B = -0.011, 95% CI [-0.017, -0.004]; B = -0.012, 95% CI [-0.019, -0.006]), though there were no associations among drivers.ConclusionsA hilly environment is positively associated with slow walking speed in community-dwelling older adults in Japan. Moreover, car-driving status potentially modifies the relationship between living in a hilly environment and slow walking speed.     

Gender,self-rated health and functional decline among community-dwelling older adults

ObjectiveThis paper examines the association between self-rated health (SRH) and functional decline (FD) in older Ghanaian cohorts and investigates whether the effect differs by gender and also modified by marital status.MethodsThe study used cross-sectional survey data (N = 1200) from an Aging, Health, Psychological Wellbeing and Health-seeking Behavior Study (AHPWHB) study conducted in between August 2016 and January 2017. A four-level gendered-stratified logit modeling estimated the SRH-FD association and the interaction terms.ResultsOverall, 23% of male respondents and 34% of women revealed significant FD (p < 0.001). The fully-adjusted model showed that SRH status was a strong predictor of FD across genders but the effect was most pronounced among men. Compared with excellent/very good SRH, fair and poor SRH (β = 0.160; p < 0.05) and (β = 1.700; p < 0.001) for women and (β = 2.202; p < 0.001) and (β= 2.356; p < 0.001) for men respectively were significantly associated with increased FD. However, good (β = − 1.760; p < 0.001), fair (β = − 2.800; p < 0.001) and poor SRH (β = −2.088; p < 0.001) decreased FD if an older woman was married compared with unmarried women with excellent/very good SRH.ConclusionThe strength of SRH-FDs association largely differed with gender and also moderated by marital status for women. Improving the SRH and marital quality could be protective of functional abilities, independence and quality of life for older people.     

The effect of loneliness and change in loneliness on self-rated health (SRH): a longitudinal study among aging people

The association between adverse health and loneliness among aging people is known, but most of the studies are cross-sectional. In addition, the associations between changes in loneliness with health are less well known, especially in the case of aging people. The present study examined whether absence of loneliness in 2005 predicted subsequent good SRH in 2008, and whether changes in loneliness were associated with SRH in 2008. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926-30, 1936-40, and 1946-50) living in southern Finland. Baseline data was collected in 2002 (n = 2815, 66%); the follow-ups were done in 2005 (n = 2476, 60%) and 2008 (n = 2064, 73%). Logistic regression analyses were used to derive the results. Never or seldom experiencing loneliness was a strong predictor for good SRH. In addition, good health was common among those who never felt lonely. Among men the group experiencing decreasing loneliness had the highest OR of good health. Thus, loneliness is a significant contributor to poor SRH among aging people. In addition, favorable SRH is indicated not only by the absence of loneliness at both measurement points, but also by decreased loneliness. Preventing loneliness is important for health promotion.     

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

OBJECTIVES: 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. DESIGN: A 2-year prospective cohort study. SETTING: 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. PARTICIPANTS: Community-dwelling older people in the United States. MEASUREMENTS: 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. RESULTS: 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). CONCLUSIONS: 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.     

Association between self-rated health and asthma: a population-based study

Introduction: Self‐rated health (SRH) is a relevant measure of health as it can predict morbidity, mortality and health‐care use. Studies have shown an association between poor SRH and elevated levels of circulating inflammatory cytokines. It is therefore interesting to learn more about the association between asthma, a chronic inflammatory disease with a recognised systemic component and SRH. Objectives: To compare SRH ratings in respondents with and without current asthma. A second aim was to compare SRH with quality‐of‐life ratings in the same groups. Methods: In 1995, we randomly selected 8200 persons ≥18 years from the population of Stockholm County, Sweden and mailed them a questionnaire. A total of 5355 persons (67.5%) responded. Respondents were divided in two groups, those with and those without current asthma. The groups were further divided by sex and age (18–44 and ≥45 years). SRH was measured with the question ‘How do you rate your general health status?’ and quality of life with the Gothenburg Quality of Life Instrument and the Ladder of Life. Results: Respondents with asthma rated their health significantly worse than did those without asthma, except women aged 18–44 years. SRH was associated at least as strong as quality of life to asthma with the advantage of being easier to apply (only one item). Conclusion: Information on SRH is easy to obtain and represents an important dimension of health status that potentially can be used as a complement to identify patients who need extra attention to manage their asthma and its consequences. Please cite this paper as: Syk J, Alving K and Undén A‐L. Association between self‐rated health and asthma: a population‐based study. Clin Respir J 2012; 6: 150–158.     

Diabetes, functional ability, and self-rated health independently predict hospital admission within one year among older adults: A population based cohort study

The aims of the present study were to determine the relationships among diabetes, functional ability and self-rated health, and whether they predict subsequent hospital admission in a representative sample of older adults. We conducted a prospective study on persons aged 65 and above (N = 2064) who participated in the National Health Interview Survey in Taiwan, 2001. A total of 1609 participants consented to data linkage and were successfully linked to 2002 National Health Insurance claims data. Functional ability was defined as the ability to perform six activities of daily living (ADL). After adjustment for potential confounders, older adults with diabetes were significantly more likely to have ADL limitation and worse self-rated health and had an increased risk of hospitalization. Diabetes, ADL limitation and worse self-rated health all independently predicted hospital admission within one year. Older adults with diabetes, ADL limitation and worse self-rated health are important target populations for interventions aimed at preventing hospitalization.     

The difference between self-perceived and chronological age in the elderly may correlate with general health,personality and the practice of good health behavior: A cross-sectional study

Background and objectiveFor the elderly, maintaining a young self-perceived age has a positive impact on physical and mental health. The purpose of this study was to investigate the impact of the discrepancy between self-perceived age and chronological age in regards to physical activity, instrumental activities of daily living, functional capacity, personality, general self-efficacy, depressive symptoms, and disease burden.MethodsParticipants were 3094 older adults from 2015 baseline data of the Keeping Active across Generations Uniting the Youth and the Aged study. The questionnaire was mailed to 8004 elderly people aged 65 years or older. Of the 3871 people who returned the questionnaire (collection rate, 48.3%), 3094 subjects were analyzed in this study (female, 52%). The questionnaire included aspects of physical activity, instrumental activity of daily living, functional capacity, personality traits, general self-efficacy, depressive symptoms, history of falls, fear of falling, communication with young people, medical history, and self-perceived age, as well as basic characteristics such as age, sex, living alone or not, and educational history.ResultsRegression analysis showed that the presence of high self-rated health, personality traits of extraversion and openness to experience, higher general self-efficacy, and the presence of fear of falling were positively associated with a younger self-perceived age.ConclusionsThe results identified personality and psychological factors related to of self-perceived age in community-dwelling elderly people. Therefore, changes in personality traits and subjective health accompanying aging affect the self-perceived age, which may also affect the extension of healthy life expectancy.