What influences self-perception of health in the elderly? The role of objective health condition, subjective well-being and sense of coherence
Introduction
Self-perception of poor health has been identified as an independent predictor of health-related outcomes, including mortality among clinical populations (Idler et al., 1999, Lee, 2000, Nybo et al., 2003). The subjective evaluation of health influences the frequency of medical consultations and health care utilization more than objective health variables (Dening et al., 1998, Hessel et al., 2000). Self-perception of poor health is even associated with a significantly increased risk of suicidal ideation among general medical patients (18–70 years) (Goodwin and Olfson, 2002). On the other hand self-rated health has been demonstrated to be relatively stable in the elderly, despite worsening objective health conditions (Leinonen et al., 2002).
What influences self-perceived health? Self-perceived health has been shown to be strongly associated with personality characteristics (Suominen et al., 2001, Goodwin and Engstrom, 2002) and mental health (Hansen et al., 2001).
Sense of coherence (SOC) was defined (Antonovsky, 1993) as a global orientation that expresses the extent to which a person has a pervasive, enduring feeling of confidence that (1) the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable (comprehensibility), (2) resources are available to meet the demands posed by these stimuli (manageability), and (3) these demands are challenges, worthy of investment and engagement (meaningfulness). Thus, SOC should be a personality orientation that facilitates coping with the health problems and disabilities of old age, influencing subjective health perception.
Although there are studies on the association between objective health conditions and self-rated health (Leinonen et al., 2002, Lee and Shinkai, 2003), no study examined in what way psychic health and SOC interfere to explain self-perception of health in the elderly. The goal of the present study is to determine the relation between self-perceived health, objective medical status, SOC and measures of subjective well-being and depression. We hypothesized that self-perceived health is influenced more by measures of psychic health and personality factors than by objective health-related variables.
Section snippets
The sample
The 261 patients aged 60 and older of an internistic-geriatric hospital, who had been examined between 1994 to 1997, were contacted five years later. Of the original sample, 135 patients had died, six could not be located, 21 had to be excluded because of dementia and two because of a severe physical illness. Of the remaining 97 with no exclusion criteria, 74 agreed to an extensive follow-up investigation. The 23 patients who refused to participate (study drop-outs in a strict sense of the
Results
On the visual analog scale for the subjective evaluation of one’s own health, the participants scored a mean of 5.7 (S.D.: 2.3; range 0.7–10). No significant differences could be found between men and women, although women were significantly more functionally impaired in the IADL-scale.
In a correlation matrix of the instruments employed in the second investigation (Table 1) with regard to the subjective health assessment, no significant correlation between age and the OGB could be demonstrated;
Limitations of the study
One methodological problem of all longitudinal studies is the selective decline of the sample from the first to the second investigation, which is all the more evident in investigations with the elderly (Herzog and Rodgers, 1988, Nuthmann and Wahl, 1996, Lindenberger et al., 2002). As expected, especially the older and sicker patients dropped out of second investigation. In view of the original negative selection (inpatients of a general hospital), thereafter positive selection for both
Acknowledgements
The German Research Association (Deutsche Forschungs-gemeinschaft, DFG) (He 1898/2-1; He 1898/2-2; SCHN 657/1-1).
References (50)
The structure and properties of the Sense of Coherence scale
Social Sci. Med
(1993)- et al.
Congestive heart failure and depression in older adults: clinical course and health services use 6 months after hospitalization
Psychosomatics
(2003) - et al.
Mental disorders in medical inpatients and the association to severity of illness, self-rated physical disability, and health-perception
Psychosomatics
(2001) - et al.
A comparison of correlates of self-rated health and functional disability of older persons in the Far East: Japan and Korea
Arch. Gerontol. Geriat
(2003) - et al.
Changes in health, functional performance and activity predict changes in self-rated health: a 10-year follow-up study in older people
Arch. Gerontol. Geriat
(2002) - et al.
Subjective body complaints as an indicator of somatization in elderly patients
Psychosomatics
(2003) - et al.
Sense of coherence as a predictor of subjective state of health. Results of 4 years of follow-up of adults
J. Psychosom. Res
(2001) - et al.
Somatoform disorders in consultation-liaison psychiatry: a comparison with other mental disorders
Gen. Hosp. Psychiatry
(2003) - Borchelt, M., Gilberg, R., Horgas, A., Geiselmann, B., 1996. Zur Bedeutung von Krankheit und Behinderung im Alter. In:...
- Bortz, J., 1993. Multikollinearität und Suppressionseffekte. In: Bortz, J., Statistik für Sozialwissenschaftler....
Changes in self-rated health, disability and contact with services in a very elderly cohort: A 6-year follow-up study
Age Ageing
Inter-rater-reliability of assessments administered by individuals with and without a background in health care
Occup. Ther. Res
A decade of spontaneous long-term cause of psychogenic impairment in a community population sample
Soc. Psychiat. Psych. Epidemiol
Psychometric evaluation of Antonovsky’s Sense of Coherence Scale
Psychol. Assessment
A standardized psychiatric interview for use in community surveys
Brit. J. Prev. Soc. Med
Personality and the perception of health in the general population
Psychol. Med
Self-perception of poor health and suicidal ideation in medical patients
Psychol. Med
Functional decline in Alzheimer’s disease: a longitudinal study
J. Am. Geriatr. Soc
Age and response rates to interview sample surveys
J. Gerontol. B
Inanspruchnahme medizinischer Leistungen und Medikamenteneinnahme bei über 60Jährigen in Deutschland—gesundheitliche, sozialstrukturelle, sozio-demographische und subjektive Faktoren
Z. Gerontol. Geriat
Inter-rater reliability of the Physical Self-Maintenance Scale and the Instrumental Activities of Daily Living Scale in a variety of health professional representatives
Aging Mental Health
The meanings of self-ratings of health: a qualitative and quantitative approach
Res. Aging
Cited by (102)
Physical and sexual assault, and negative perceptions of health: Does age of onset matter?
2022, Journal of Criminal JusticeCitation Excerpt :Despite the abundance of evidence for physical and sexual assault leading to negative health outcomes, very few studies have been conducted to measure the health autonomy or the perception of health in assault victims (Afifi et al., 2016; Anda et al., 2006; Norman et al., 2012). In fact, the literature on either topic seems to focus heavily on personality influences and elderly/clinically ill populations (Cloninger & Zohar, 2011; Henderson, Holzleitner, Talamas, & Perrett, 2016; Schneider et al., 2004). However, given the numerous adverse effects of being assaulted, physically or sexually, it seems pertinent to discover whether these victimizations - especially those that occur during childhood – shape an individual's perception of health or their sense of health autonomy.
Questionnaires for assessing self-perceived physical fitness: A systematic review
2021, Experimental GerontologyCitation Excerpt :For instance, the lack of a strict definition or frame of reference to the questions, as well as the absence of a clear objective reference for self-comparison and interpretation, are factors that limit the utility of self-reported measures (Balachandran et al., 2016). In addition, self-perceived health might be influenced by personal characteristics (i.e. sense of coherence) (Schneider et al., 2004) and other factors (i.e. level of education, employment, income) (Kaleta et al., 2009). Thus, there is a need to keep up investigating the accuracy, effectiveness and experience of self-assessment among older adults.
Primary dysmenorrhea and postural control: Is it a problem only during menstruation?
2021, Gait and PostureAge-specific differences in patient reported outcomes among adults with atherosclerotic cardiovascular disease: Medical expenditure panel survey 2006–2015
2020, American Journal of Preventive Cardiology