Davina J. French

A simple measure with complex determinants: investigation of the correlates of self-rated health in older men and women from three continents

BackgroundSelf-rated health is commonly employed in research studies that seek to assess the health status of older individuals. Perceptions of health are, however, influenced by individual and societal level factors that may differ within and between countries. This study investigates levels of self-rated health (SRH) and correlates of SRH among older adults in Australia, United States of America (USA), Japan and South Korea.MethodsCross-sectional data were drawn from large surveys of older respondents (≥ 65 years) in Australia (n = 7,355), USA (n = 10,358), Japan (n = 3,541) and South Korea (n = 3,971), collected between 2000 and 2006. Harmonized variables were developed to represent socioeconomic, lifestyle and health indicators. We then assessed whether these variables, and their potentially different impact in different countries, could account for cross-national differences in levels of SRH.ResultsSRH differed significantly between countries, with older Koreans reporting much poorer health than those in the other three nations. This was not the result of biases in response patterns (for example central versus extreme tendency). Health-related correlates of SRH were similar across countries; those with more medical conditions, functional limitations or poor mental health gave poorer ratings. After accounting for the differential impact of determinants in different national contexts, Australians reported better SRH than other nations.ConclusionsWe conclude that when examining correlates of SRH, the similarities are greater than the differences between countries. There are however differences in levels of SRH which are not fully accounted for by the health correlates. Broad generalizations about styles of responding are not helpful for understanding these differences, which appear to be country, and possibly cohort specific. When using SRH to characterize the health status of older people, it is important to consider earlier life experiences of cohorts as well as national and individual factors in later life. Further research is required to understand the complex societal influences on perceptions of health.

Correlates of subjective health across the aging lifespan: understanding self-rated health in the oldest old

Objectives: To examine the determinants of self-rated health (SRH) in different age groups of older adults, including the oldest old. Methods: Variables assessing physical health, difficulty with self-care, depressive symptoms, and cognitive impairment were pooled and harmonized from three Australian longitudinal studies of ageing (N = 5,222). The association of these with SRH was examined in older adults aged 60 to 64 years, 65 to 74 years, 75 to 84 years, and 85 years and older. Results: SRH was not associated with cognitive impairment or difficulty with self-care in the oldest old, and its association with physical health was diminished compared with younger groups. Depression showed a significant relationship in all age groups, conferring an approximately fourfold increase in the likelihood of poorer SRH. Discussion: As old age progresses, self-reports of poor health become most closely related to psychological symptoms. This explains some of the paradoxes of past literature and offers important insights for health professionals working with the oldest old.

Gender differences in alcohol consumption among middle‐aged and older adults in Australia, the United States and Korea

Objectives: To compare gender differences in alcohol use and the socioeconomic correlates of at‐risk drinking among middle‐aged and older adults in Australia, the United States (US) and South Korea.

Alcohol use and depression from middle age to the oldest old: gender is more important than age

BACKGROUND Alcohol use disorders are associated with other mental health disorders in young adults, but there are few data on alcohol use and mental health outcomes in older adults, particularly the oldest old. This study examines the relationship between alcohol consumption and depressive symptoms. METHODS Data were collected from the Dynamic Analyses to Optimise Ageing (DYNOPTA) project, which has pooled nine Australian longitudinal studies. Alcohol consumption was classified using standard drinks (10 g alcohol)/day as: abstinent, low risk (<0-≤ 2 standard drinks), long-term risk (>2-≤ 4) and short-term risk (>4). Probable depression was classified from harmonized scores on various standard instruments (e.g. Centre for Epidemiological Studies Depression scale). RESULTS Overall, 39,104 (86%) participants contributed data. Alcohol classification at baseline showed 7,526 abstinent, 28,112 low risk, 2,271 long-term risk, and 1,195 short-term risk participants. Age ranged from 45 to 103 year (median 60). Using generalized estimating equations (GEE), there were significant gender by alcohol and gender by age interactions, so the analysis was split by gender. Among males, the abstinent and short-term risk groups had increased likelihood of depression: in females the abstinent, long- and short-term risk groups had increased odds of depression. Increased odds of depression was also associated with former and current smoking, younger age-group, not being partnered, leaving school before age 15 and increasing levels of health-impaired walking, dressing, or bathing. CONCLUSION The impact of alcohol use differs by gender, nevertheless those using higher levels of alcohol or who smoke should be screened for depression and may benefit from interventions.

Cross-national insights into the relationship between wealth and wellbeing: a comparison between Australia, the United States of America and South Korea

ABSTRACT The positive relationship between wealth and wellbeing has received considerable attention over the last three decades. However, little is known about how the significance of wealth for the health and wellbeing of older adults may vary across societies. Furthermore, researchers tend to focus mainly on income rather than other aspects of financial resources even though older adults often rely on fixed income, particularly after retirement. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) survey (N=1,431), the Health and Retirement Study (HRS) in the United States of America (USA; N=4,687), and the Korean Longitudinal Study of Ageing (KLoSA; N=5,447), this exploratory cross-national study examined the relationship between wealth satisfaction and objective wealth and wellbeing (measured as self-rated health and life satisfaction) among older Australians, Americans and Koreans (50+ years). Regression analyses showed that wealth satisfaction was associated with wellbeing over and above monetary wealth in all three countries. The relationship between monetary wealth and self-rated health was larger for the US than Australian and Korean samples, while the additional contribution of wealth satisfaction to life satisfaction was larger for the Korean than the Australian and US samples. These findings are discussed in terms of the cultural and economic differences between these countries, particularly as they affect older persons.

Rumination, substance use, and self-harm in a representative Australian adult sample.

BACKGROUND There are few data on self-harm in the general population, especially examining the roles of rumination and substance use. OBJECTIVES To evaluate the inter-relationships of rumination, self-harm, and potential mediating variables. METHOD A cohort with follow-up every 4 years involving a random sample of adults aged 20-24 and 40-44 years (at baseline) living in Australia. The survey included items on three common forms of self-harm. Other measures included rumination, Goldberg Anxiety and Depression scales, substance use, coping style (Brief COPE), and demographic risk factors. RESULTS The sample comprised 2,184 women and 1,942 men with 287 self-harm cases (7.0%). Depression and coping style were significant mediators of rumination on self-harm for men, with depression being the only robust mediator for women. For males, age and education were also significantly associated, while for women, age, smoking, trauma, and sexual abuse were significant. CONCLUSIONS Men and women differ on mediators of self-harm.