Predictors of decline in self-assessments of health among older people - a5-year longitudinal study

Within the framework of the Evergreen project we examined how changes in se veral indicators of health and functioning and physical activity predicted a decline in self-assessments of hearth evaluated over a 5-year period in o lder people by two different measurements: self-rated health (SRH) and self -assessed change in health (SACH). The study group comprised all 75-year-ol d persons born in 1914 (N = 382) and living in Jyvaskyla, a town in central Finland. At baseline in 1989, 91.6%, and at follow-up 5 years later in 199 4, 87.3% of those eligible participated in the interview and 77.2 and 71.3% , respectively, in the examinations in the study centre, focusing on differ ent domains of health and functional capacity. One-fifth of the subjects re ported a deterioration in and one-fifth an improvement in SRH over the 5 ye ars. The rest gave identical self-assessments of their health at baseline a nd at follow-up in response to the same question. Decline in SRH was associ ated with a decrease in physical activity and cognitive capacity. When aske d directly about changes in their health (SACK), however, half the subjects said their health had declined. Negative SACH over the 5-year period was r elated to an increased number of chronic conditions, deterioration in funct ional performance and physical activity, and to the number of chronic condi tions at baseline. We suggest that ageing people adapt to changes in their objective health and functional performance: the majority tend to assess th eir health as similar to or even better with increasing age despite an incr ease in chronic diseases and decline in functional performance. However, a negative SACH indicates that older people are realistic about these negativ e changes. These results support the assumption that the two subjective mea surements of change in health are based on different criteria: assessment o f current general health status tends to be based on inter-individual compa rison, whereas assessment of change in health over a given time period may be based on intra-individual comparison. Physical activity seems to be an i mportant factor when older people assess their health. (C) 2001 Elsevier Sc ience Ltd. All rights reserved.