Patterns of self-rated health in older adults before and after sentinel health events

OBJECTIVES: To describe and compare patterns of change in self-rated health for older adults before death and before and after stroke, myocardial infa rction, congestive heart failure, cardiac procedure, hospital admission for cancer, and hip fracture. DESIGN: "Event cohort," measuring time in months before and after the event . SETTING: Four U.S. communities. PARTICIPANTS: 5888 participants in the Cardiovascular Health Study (CHS), s ampled from Medicare rolls and followed up to 8 years. Mean age at baseline was 73. MEASUREMENTS: Self-rated health, including a category for death, assessed a t 6-month intervals, and ascertainment of events. METHODS: We examined the percentage that was healthy each month in the 5 ye ars before death and in the 2 years before and after the other events, and compared the patterns to a "no event" group and to one another, using graph s and linear regression. RESULTS: For people who died, health status declined slowly until about 9 m onths before death, when it dropped steeply. Comparing persons equally far from death, health was unrelated to age, but men and whites were healthier than women and blacks. Health for other events declined before the event, d ropped steeply at the event, showed some recovery, and then declined furthe r after the event. About 65% to 80% of the subjects were healthy 2 years be fore their event, but only 35% to 65% were healthy two years afterwards. Pa tterns were similar although less extreme for the "no event" group. CONCLUSION: Visualizing trajectories of health helps us understand how seri ous health events changes health. Conclusions about change must be drawn wi th care because of a variety of possible biases. We have described the traj ectories in detail. Work is now needed to explain, predict, and possibly pr event such changes in health.