Übereinstimmungen und Unterschiede in der selbst- und fremdeingeschätzten Gesundheit bei extrem Hochaltrigen

Especially in old age, the global well-being of persons is strongly influenced by their health situation. Due to functional limitations, research on the development of persons in extreme old age often uses proxy ratings of health instead of self-ratings common in younger age groups. However, it is not known whether self- and proxy-ratings provide comparable information about the health status of extremely old persons. The current study with 53 centenarians and 53 proxies examines similarities and differences between self and proxy-ratings of health. The results indicate a high degree of similarity in some health ratings, an overestimation of ADL capacities by the centenarians, and that self-ratings to a large degree reflect the current mood levels of individuals. Findings are discussed with respect to the differences in the kind of information used for general health ratings.     

Preliminary evaluation of a visual analog function scale for use in rheumatoid arthritis

OBJECTIVE: Key outcomes in rheumatoid arthritis (RA) are evaluated with multi-item ratings scales such as the Health Assessment Questionnaire (HAQ) and visual analog scales (VAS) such as pain and patient and physician global. As VAS scales are easy to use and particularly effective in research and patient care, we studied the characteristics, association, and psychometric properties of a VAS function scale (VAS-F) to determine if it could be used in RA studies and clinical practice. METHODS: A total of 394 patients with RA completed the HAQ, the HAQ-II, and a VAS functional scale. In addition, they completed standard assessments of pain, global, fatigue, sleep problems, joint count, and the Medical Outcome Study Short-Form 36 (SF-36) physical component summary score (PCS) and vitality and total pain scores. RESULTS: The HAQ-II was correlated with VAS-F at 0.76, but distributional characteristics of the HAQ and VAS-F differed, as the VAS-F scale results contained more higher scores as well as more lower scores compared with the HAQ-II and HAQ. Kendall's tau concordance analyses indicated that VAS scales were more concordant with other VAS than with non-VAS scales. Concordance of VAS-F was greatest with VAS global and was similar overall with VAS pain, sleep disturbance, fatigue, and quality of life. By contrast, the PCS, a multi-item scale, was more concordant with HAQ-II and HAQ. There was little to no difference between the VAS-F and the 2 HAQ with regard to concordance with the multi-item joint count, SF-36 vitality, and SF-36 total pain. CONCLUSION: The distribution differences between HAQ and HAQ-II and the VAS-F suggest that patients do not see minor limitations as problematic, but rate major limitations as being particularly limiting and worthy of high ratings. A VAS functional scale represents a patient-weighted functional assessment in which additional interpretation is given to the meaning of the limitations by the patient. VAS-F scales may be suitable for use in the clinic and in research. However, studies to assess sensitivity to change are required to determine the appropriate role of this scale.     

Functional ability and oral health among older people: a longitudinal study from age 75 to 80

OBJECTIVE: To examine whether functional ability at age 75 and age 80 is associated with oral health and use of dental services cross-sectionally and whether changes in functional ability from age 75 to age 80 are associated with oral health and regular use of dental services at age 80. DESIGN: The study included a random sample of 75-year-olds at baseline and a follow-up study 5 years later. The data are treated as two cross-sectional studies at age 75 and 80, respectively, and as a longitudinal study from age 75 to 80. SETTING: The western part of Copenhagen County. PARTICIPANTS: The two cross-sectional studies of 75- and 80-year-old people included 411 and 321 persons, respectively. The longitudinal study from age 75 to 80 included the 326 persons who participated in both surveys. MEASUREMENTS: Oral health status was measured roughly by number of teeth and chewing ability. Use of dental services was measured by frequency of visits to a dentist or denturist. Functional ability was measured by two scales on mobility in relation to tiredness and need of help. Changes in mobility from age 75 to 80 is described as (1) improved or sustained good, (2) decreased, and (3) sustained poor. Gender, chronic diseases, self-rated health, socio-demographic factors, living alone, and social relations were included as possible confounders. RESULTS: The odds ratio of having no or few teeth was 1.7 (1.1-2.6) in 75-year-old individuals who felt tired in mobility, 1.7 (1.0-2.9) in 80-year-old persons who needed help with mobility, and 2.7 (0.94-7.5) in persons with sustained need of help with mobility from age 75 to 80. The odds ratio of chewing difficulties was 1.7 (1.1-2.8) in 80-year-old people in need of help, and 1.8 (1.1-3.0) in persons age 75 to 80 needing sustained help. Dentate 80-year-old persons who felt tired in mobility had an odds ratio of 2.0 (0.94-4.2) of not using dental services. CONCLUSIONS: The results indicate that oral impairment (e.g., having no or few teeth), oral functional limitations (e.g., chewing problems), and general functional limitations (e.g., mobility problems) are interrelated and that prevention of disabilities should be aimed at both functional limitations and oral health problems if the intention is to promote a good life in old age. In addition, the results point to the importance of taking problems in mobility seriously in delivering preventive services to old people because people who are tired or dependent on help seem to be at a higher risk of not using dental services regularly.     

Interrelations between subjective health and episodic memory change in Swedish and Canadian samples of older adults

Recent research has documented associations between subjective health ratings and objective indicators of disease and death. Less is known about relations between subjective health ratings and level of cognitive performance in older adults. In this study, we explored whether subjective health ratings are related to episodic memory performance, both concurrently and across a three-year longitudinal interval. Persons aged 75-84 years, and participating in the Swedish Kungsholmen Project (n = 105) or the Canadian Victoria Longitudinal Study (n = 71), were examined. Results showed that in both samples, while the cross-sectional relationship was non-significant, longitudinal change in perceptions of subjective health were related to change in episodic memory performance. Next, the two samples were combined in additional analyses. Here, results further revealed that the associations between longitudinal change in subjective health and memory performance generalized across samples independently of demographic, changing physical health status, and subjective memory decline differences. Thus, the present findings suggest that subjective health may be added to the growing number of individual-difference variables that are predictive of episodic memory change in very old age.     

Validation of four scales for the acute stage of stroke

Abstract. Objectives. To validate whether a simplified scale for the acute stage of stroke–the Scandinavian Stroke Supervision scale–is sufficient for monitoring symptom progression of prognostic importance. Design. The capacity of the scale was compared to that of the Mathew, Toronto and Fugl-Meyer stroke scales and the Barthel ADL index. Setting. The stroke unit of Danderyd Hospital, which cares for a defined population. Subjects. Fifty noncomatose patients with objectively recorded symptoms at entry were examined over a period of 5 days by one physician (250 ratings/scale). The last 10 patients were also investigated by another doctor in the same manner (50 ratings/scale) and by nurses (50 ratings) the Scandinavian scale only. The amount of time required by each scale was tested in another 10 patients by two nurses (100 ratings/scale). Interventions. Routine investigation and treatment. Main outcome measures. The reliability, validity, time requirement and correlation of the scales were evaluated, as was their ability to reveal progress of symptoms. Results. All scales were highly significantly correlated. The interobserver agreement was excellent between the physicians but not as good between the physician and the nurses. The prediction of the outcome at discharge and after 3 months was very satisfactory for all of the scales with regard to the whole groups of patients, but none of them could predict the outcome for an individual with certainty. The Scandinavian Stroke Supervision scale was least time consuming, and had the fewest uncertainties expressed by the testers. This scale recorded the progression of slightly fewer symptoms, but did record those with a more serious impact on patient outcome. Conclusion. The time-saving, simplified Scandinavian scale was as reliable and as valid as the other scales, and detected deterioration that was important for patient outcome as satisfactorily as the other scales.     

The hierarchy of functional loss associated with cognitive decline in older persons

OBJECTIVES: We studied a representative cohort of community-dwelling elderly persons to (i) examine the relationship between the loss of specific functional activities and cognitive status at the time of these losses, (ii) compare the cognitive status of participants who have and have not lost independence in these functional activities, and (iii) determine whether a hierarchical scale of functional loss is associated with declining cognitive status. METHODS: A cohort of 5874 community-dwelling persons aged 65 years and older from the Canadian Study of Health and Aging I and II were analyzed. At baseline and 5 years later, cognitive status with the Modified Mini-Mental State Examination (3MS) and functional status with 14 Older American Resources and Services (OARS) items were measured. For each OARS functional item, the mean 3MS scores for persons who lost independence during the 5-year period versus those who did not were compared. RESULTS: For each functional item, the 5-year decline in 3MS scores of persons who lost independence were significantly greater than those who remained independent (e.g., ability to do finances), with an 18-point decline for those who lost independence and a 2-point decline for those who retained independence. A hierarchy of functional items existed, with instrumental activities of daily living (ADLs) (e.g., shopping, banking, and cooking) being lost at higher cognitive scores than basic ADL items (e.g., eating, dressing, and walking), although there was some overlap. CONCLUSIONS: This is the first prospective study using a large representative cohort of elderly persons to demonstrate that progressive cognitive decline is associated with a specific pattern of loss of functional tasks. Clear cognitive thresholds at which development of dependency in OARS functional items occurred. By providing estimates of the cognitive status of persons at the time at which they developed dependency in specific functional items, a natural hierarchy of functional loss associated with cognitive decline emerged. For caregivers, clinicians, and health policy makers, this information can help anticipate the pattern of functional decline and the subsequent care needs of persons with declining cognition, potentially improving the quality of life of these persons and their caregivers and playing an important part in health care planning.     

Value of combined assessment of physical health and functional status in community-dwelling aged: a prospective study in Florence, Italy

A survey of the health and social conditions of a representative sample of 967 persons aged 60 years and older from the city of Florence, Italy, was undertaken in 1980. In 1987, a follow-up survey of this cohort was performed. There were 391 documented deaths, 408 survivors, and 168 individuals who could not be located. Functional ability at baseline was assessed using a World Health Organization 14-item scale. Indicators of physical health status included chronic disease status, number of drugs, physician visits, and days of hospitalization. After adjustment for age and sex, both functional ability and indicators of physical health status were found to be independent, statistically significant predictors of mortality. The results of this study further support the view that biomedical and functional assessment are both necessary for a comprehensive evaluation of the older population.     

Predictors of successful rehabilitation in geriatric patients: subgroup analysis of patients with cognitive impairment

BACKGROUND AND AIMS: Understanding which patients benefit from rehabilitation programs may be useful in balancing resources and needs. The aim of this study was to evaluate whether cognitive and nutritional status are associated with functional improvement after rehabilitation in old persons. METHODS: 2650 patients (aged > or =60 years) consecutively admitted to a geriatric rehabilitation unit in Italy between August 2001 and December 2005, were included. Functional status was evaluated with the Tinetti scale, cognitive status with the Mini-Mental State Examination (MMSE), and nutritional status with the Mini-Nutritional Assessment Short Form (MNA-SF). To identify predictors of functional recovery, multiple logistic regression models were run, with improvement on the Tinetti scale score as dependent variable. RESULTS: Eighty per cent of old persons functionally improved after rehabilitation, ranges being 84% of those with MMSE> or =24 to 58% of those with MMSE<10. Persons with both good cognition and good nutritional status were most likely to improve [odds ratio (OR)=2.5; 95% confidence interval (95% CI)=1.9-3.2]. Stratifying the sample according to cognitive status, we found that in patients with MMSE> or =18 better nutritional status emerged as a factor associated with functional improvement, whereas in patients with severe cognitive impairment (MMSE<18), the only associated factor was a higher MMSE score. CONCLUSIONS: The results of the present study suggest that both good cognition and good nutritional status are associated with functional improvement in older persons. However, patients with poor cognition can also improve, depending on their degree of cognitive impairment, and they should not be routinely excluded from rehabilitation.     

The relation between measures of health status and quality of life in COPD

Because quality of life (QoL) and health status (HS) scales contain different kinds of items and are shown not to be equivalent, there is a recommendation to use both types of scales. We investigated the relationship between either type of scale but focusing on the subscales of HS measures. A sample of chronic obstructive pulmonary disease (COPD) patients completed two QoL scales and two HS scales (BPQ and SGRQ), neuroticism, six-minute walk test and FEV1. Factor analysis revealed a two-factor structure (consistent with previous research), and showed that one type of HS subscale is different from QoL but another is equivalent to QoL. If total HS scores are used then it is valuable to include a QoL measure, but if HS subscales are reported, then these cover both latent variables, with the BPQ providing a clearer separation of the latent variables than the SGRQ.     

Differences in the appraisal of health between aged and middle-aged adults

This study examines whether the aged and the middle aged differ in their self-appraisal of health. Data were obtained through interviews and medical records from a probability sample of 460 individuals aged 45 to 89 years old. The aged evaluated their health more pessimistically than the middle aged, after controlling for physical health, psychological distress, gender, and education. The aged's perception of health was significantly worse than the middle aged's for persons having diagnoses in each of the following diagnostic categories: rheumatism and musculoskeletal deformities, nervous system and sense disorders, and digestive problems. A stronger association was found between perceived poor health and depressive symptoms among the aged than the middle aged. The importance of psychological distress on the aged's health assessment and subsequent illness behaviors is discussed.     

Sensory and affective aspects of dyspnea contribute differentially to the Borg scale's measurement of dyspnea

BACKGROUND: Recent research has shown that distinct dimensions in the perception of dyspnea can be differentiated; however, most studies to date have only used a global rating scale for the measurement of this sensation. OBJECTIVES: This study examined the different influence of sensory and affective aspects of perceived dyspnea on the commonly used Borg scale, which measures the global perception of dyspnea. METHODS: Dyspnea was induced in 16 healthy volunteers (mean age 26.2 +/- 6.3 years) by breathing through an inspiratory resistive load (3.57 kPa/l/s) in two experimental conditions (attention and distraction). After each of the two conditions the experienced intensity (i.e., sensory dimension) and unpleasantness (i.e., affective dimension) of dyspnea were rated on separate visual analog scales (VAS), followed by a global rating of dyspnea on the Borg scale. Hierarchical multiple linear regression models were calculated to analyze the predictive validity of VAS ratings of intensity and unpleasantness on the Borg scale ratings. RESULTS: When subjects attended to their breathing, only VAS intensity scores showed a significant influence on Borg scale ratings (p < 0.05). In contrast, only the VAS unpleasantness scores showed a significant influence on Borg scale ratings (p < 0.05) when subjects were distracted. CONCLUSIONS: These findings show that sensory and affective aspects of perceived dyspnea differentially influence the global measure of dyspnea as determined by the Borg scale. A differentiation between these aspects in future studies through the use of separate rating scales could yield more detailed information on the perception and report of dyspnea.     

Correlates of Self-Reported Depressive Symptoms: A Study of Older Persons of Punjab, Pakistan

This paper examines the prevalence and correlates of depressive symptoms among older persons of Punjab, the largest Province of Pakistan. Data were gathered from 4191 older persons aged 60+ using Probability Proportional to Size (PPS) of population. A version of the CES-D Scale adapted for low-literate populations was used to measure self reported depressive symptoms. Various independent factors, including socioeconomic factors, self-reported health conditions, and functional impairments were examined to see their net effect on depressive symptoms among older persons. Results of logistic regression analysis showed that region, area, living index, independent source of income, self-reported health conditions, and functional impairment were significant factors affecting self-reported depressive symptoms among older persons in Punjab. An important cross-cultural difference was a lower risk of depressive symptoms among older women, which may reflect the buffering effects of family co-residence and the position of seniors in extended families.     

Functional status and satisfaction with community participation in persons with stroke following medical rehabilitation

BACKGROUND AND AIMS: Researchers and policy-makers have recognized that quality of life assessments are essential to better understand the benefits of rehabilitation intervention. The purpose of the study was to examine associations between functional status and satisfaction with community participation for persons with stroke at 80-180 days after discharge from medical rehabilitation. METHODS: The study was retrospective, using data from the Information Technology (IT) Health-Track database for patients discharged from medical rehabilitation facilities in 2001/2002. The study population included 1870 persons with stroke aged 40 or older who had complete information at admission and follow-up (mean age at admission 68.3 yr, SD 14.5). The sample was 49.3% female and 72.6% were non-Hispanic white. RESULTS: Results showed a significant positive association between change in functional status (admission to follow-up) and satisfaction with community participation. Positive change ratings in functional status were associated with increased satisfaction with community participation (b = 0.02, SE = 0.001, p = 0.0001), after adjustment for age, gender, marital status, race/ethnicity, insurance source and functional status score at admission. Similarly, positive associations were observed for changes in motor and cognitive subscale ratings and satisfaction with community participation. The strongest association among six functional status domains and satisfaction with community participation was for communication (beta = 0.60) and social cognition (beta = 0.58). CONCLUSIONS: This study showed a statistically significant association between a modifiable factor (functional status) and a quality of life indicator (satisfaction with community participation). Results add to emerging literature on patient-centered outcomes and extend measures of recovery beyond functional status to include consumer satisfaction with a community outcome.     

Toward a Simplified Measure of Asthma Severity for Applied Research

There is no universally accepted and validated measure of asthma severity. For community research, clinical tests are too costly, and epidemiological assessments provide inadequate data on severity. Symptom measures may offer a practical alternative. This study assessed psychometric properties of symptom ratings of 91 asthmatic children. Reliability and validity of scales created from these items were examined. A sum scale of symptom ratings was internally consistent, reliable across time, and associated with concurrent health indices. This scale may be a practical measure of severity for use in community-based research.     

Personality pattern in peptic ulcer disease: a cohort study

Abstract. Objectives. To investigate the direction of a possible relationship between peptic ulcer disease and personality disorders. Design. A cohort study of 50-year old patients, observed for 2 decades. Setting. Glostrup County, Denmark (population 100000). Subjects. A representative sample of 50-year old people born in 1914 (n = 673) were followed for 20 years. All 673 filled in the Minnesota Multiphasic Personality Inventory (MMPI) in 1964 and 513 were retested with MMPI in 1974. Main outcome measures. Prevalence of peptic ulcer disease 1964, incidence of peptic ulcer disease 1964-84, MMPI scores. Results. The prevalence of peptic ulcer disease in 1964 was 7% and the average annual incidence in the period 1964-84 was 2.1 per 1000 persons. Those with incidental peptic ulcer in 1964-84 had normal MMPI scores in 1964, whilst those with peptic ulcer in 1964 had a slight but statistically significant increase in one neuroticism scale (HS) only. The group with prevalent ulcer disease in 1974 exhibited statistically significant increases in the three neuroticism scales (HS, D, HY) and in scale Pd and scale Pt at MMPI retesting. In addition they had statistically significantly higher scores in the three neuroticism scales compared with the other persons who still had normal scores in all scales. Conclusions. Personality disorders in patients with peptic ulcer are consequences of the disease and not causal factors.     

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.     

Acute mood but not cognitive improvements following administration of a single multivitamin and mineral supplement in healthy women aged 50 and above: a randomised controlled trial

A number of randomised controlled trials have indicated that multivitamin/mineral supplementation for a period of 4 weeks or greater can enhance mood and cognition. To date, no studies have investigated whether a single multivitamin dose can benefit mental function in older adults. This study investigated the acute effects of a single multivitamin and mineral and herbal (MVMH) supplement versus placebo on self ratings of mood and the performance of an effortful computerised cognitive battery in a sample of 76 healthy women aged 50–75 years. Mood was assessed using the depression anxiety stress scale (DASS), state trait anxiety inventory–state anxiety scale and visual analogue scales (VAS). Mood was rated at 1 h post supplementation and again after the competition of the cognitive assessments at 2 h post supplementation. It was demonstrated that the MVMH supplement improved overall DASS mood ratings; however, the most prominent effects appeared to be a reduction in ratings of perceived mental stress. These findings were confirmed using visual analogue scales, with these measures also demonstrating MVMH-related increased ratings of calmness. There were no benefits of the MVMH to mood ratings of depression and performance was not enhanced on the cognitive battery. Supplementation with a single multivitamin, mineral and herbal supplement reduces stress several hours after intake in healthy older people.     

Health,frailty and disability after ninety: Results of an observational study in France

BackgroundIn spite of their increasing demographic weight, health characteristics of the oldest old remain poorly described in epidemiological studies.ObjectiveTo describe the health of people aged 70 years and over included in the SIPAF study, and to compare the prevalence of health indicators including successful aging, frailty, and disability between three age groups including the oldest old.MethodsThe study population is composed of 2350 retired people recruited between 2008 and 2010, of whom 512 are aged 90 and over (21.8%). A comprehensive geriatric assessment was performed at home by trained nurses. The prevalence of health and functional indicators, as well as the distribution of people among successful ageing, frailty, and disability, were described by age group (70–79, 80–89, 90+) and sex.ResultsCompared to their younger counterparts, people aged 90 years and over were more likely to experience functional limitations, sensory impairment, cognitive impairment, poor mood, and frailty. One third of the nonagenarians needed help in at least one basic activity of daily living and 25% met the frailty criteria. In contrast, the prevalence of most chronic diseases did not increase after ninety. Successful ageing concerned 9% of the oldest old. Women were less likely to experience successful ageing and more likely to be frail or dependent.ConclusionThis study shows the diversity of health states in very old age and points out that one quarter of the people aged 90 and over said frail are likely to take advantage of preventive actions of disability.     

Impact of overweight and obesity on health-related quality of life--a Swedish population study

OBJECTIVE: To investigate the impact of overweight and obesity on health-related quality-of-life (HRQL) in the general population in western Sweden. DESIGN: Cross-sectional survey. SUBJECTS: A total of 5633 men and women aged 16-64 y born in Sweden. MAIN OUTCOME MEASURES: Scale and summary component scores of the SF-36 Health Survey. RESULTS: Obese men aged 16-34 y rated their HRQL lower than normal-weight men did on all four physical health scales of the SF-36 and on two of the four mental health scales. Obese women in the same age group rated their health worse than normal-weight women on three of the physical health scales. Thus, in younger men and women the analysis indicated a clearer negative association between obesity and physical health than between obesity and mental health. Obese women aged 35-64 y rated their health worse on all scales than normal-weight women did, while obese men in this age group rated their health worse on only two SF-36 subscales-physical functioning and general health perception. The massively obese men and women suffered from a poor level of HRQL. CONCLUSION: Not only does the level of obesity affect HRQL, the impact of overweight and obesity also differs by age and sex. The importance of aspects of both physical and mental health should be fully recognised.