CHANGES IN SELF-RATED HEALTH, DISABILITY AND CONTACT WITH SERVICES INA VERY ELDERLY COHORT - A 6-YEAR FOLLOW-UP-STUDY

Objectives: to study the relationships between global self-rated healt h, reported physical symptoms and depressive symptoms and the receipt of community services by very elderly people, and to examine changes i n these variables over time. Design: three-wave study with follow-up a t 2.4 and 6 years after first interview. Structured interview incorpor ating cognitive examination (Mini-Mental State Examination) and enquir ing specifically about overall self-rated health, physical symptoms an d depressive symptoms. Setting: community setting in city of Cambridge , UK. Participants: 2609 were initially recruited: all patients aged 7 5 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. Measurements: general health self-rate d in comparison to others of similar age and individual physical and d epressive symptoms self-rated as present or absent. Symptoms were adde d to produce physical health and depressive symptom scores. Data prese nted from cross-sectional analysis of 6-year sample; also examined lon gitudinal data from all three waves of study for ageing and cohort eff ects. Finally the effect of health variables on the receipt of service s was examined. Statistics used included chi(2) and non-parametric sta tistics for continuous data, also odds ratios for likelihood of receiv ing services. Results: at 6 years, 70% rated their overall health as g ood or very good. Overall self-rated health showed both ageing and coh ort effects, improving with increasing age and especially with more re cent cohort. Reported physical symptoms increased with ageing. Depress ion scores also increased with ageing but the relationship between dep ressive symptoms and ageing was less clear-cut. Receipt of services wa s associated with poor self-rated health and reported physical symptom s as well as with ageing. Higher depression scores at 2.4 years were a ssociated 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. Conclusions: although very elderly people have a high prevalence of reported physical symptoms, they oft en rate their overall health as good. There was a stronger relationshi p 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 res ponse. Cohort effects on service receipt may reflect changes in public service policy.