Henrike Galenkamp

Is Self-Rated Health Still Sensitive for Changes in Disease and Functioning Among Nonagenarians?

OBJECTIVES With age, there is an increasing gap between relatively stable levels of self-rated health (SRH) and actual health status. This study investigates longitudinal changes in SRH and examines its sensitivity to changes in chronic conditions and functioning among people aged 90 and older. METHODS In the Vitality 90+ Study, questionnaires were sent to all people aged 90 years and older living in Tampere, Finland. Included were respondents who provided data on the 2001 measurement and at least one follow-up measurement in 2003, 2007, or 2010 (N = 334). Generalized Estimating Equations analyses examined longitudinal change in SRH and the predictive value of number of chronic conditions and a functioning score based on 5 activities. RESULTS Within 2 years, most people (56.3%) had unchanged SRH, but declined SRH (22.3%) was associated with worse baseline functioning and declined functioning. Clear declines in SRH after 6 and 9 years were associated with increased chronic conditions (odds ratio [OR] = 1.23) and decreased functioning (OR = 1.28). The impact of chronic conditions and functioning was smaller among institutionalized people (chronic conditions OR = 0.90; functioning OR = 1.18) than among people living independently (chronic conditions OR = 1.30; functioning OR = 1.44). DISCUSSION SRH among nonagenarians was sensitive to changes in the number of chronic conditions and functioning although more pronounced on the longer than on the shorter term.

Disease prevalence based on older people's self-reports increased, but patient–general practitioner agreement remained stable, 1992–2009

OBJECTIVES Previous studies revealed increases in the prevalence of chronic diseases in older people in most countries. This study investigated if a changed inclination to report diseases underlies these increases, by comparing the agreement between self-reports and general practitioner (GP) records of chronic diseases between 1992-1993 and 2008-2009. STUDY DESIGN AND SETTINGS Cross-sectional analyses were performed on data from two waves of the Longitudinal Aging Study Amsterdam. Data from older adults aged 60-85 years came from 1992-1993 (N=1,896) and from the same age group in 2008-2009 (N=1,086). We compared respondent (R) and GP records of lung disease, cardiac disease, peripheral arterial disease, stroke, diabetes, arthritis, and cancer. Multilevel regression models were applied to examine (change in) predictors of over-reporting (R+, GP-) and under-reporting (R-, GP+). RESULTS Over-reporting of chronic diseases became significantly more common over time, whereas under-reporting became less common. Agreement and change in agreement differed across the specific diseases. Under-reporting was associated with male gender; over-reporting with female gender, worse self-rated health, and worse physical functioning. Older adults were less accurate in their self-reports than younger adults. CONCLUSION Trends in self-reported chronic diseases may be influenced by changes in reporting behavior, and future studies should take this possibility into account.

How was your health 3 years ago? Predicting mortality in older adults using a retrospective change measure of self-rated health

Studies have shown better predictive value of self‐rated health (SRH) for mortality when prospective change in SRH is considered. However, retrospective change is more feasible and might have better sensitivity to objective health changes. This study compares the predictive value for mortality of retrospectively measured change in SRH (based on a “then‐test”) with current SRH and prospectively measured change in SRH.

Increasing social participation of older people: are there different barriers for those in poor health? Introduction to the special section

European populations are ageing and policy makers are concerned with the growing proportion of people becoming dependent on old-age pensions and care, and what this will mean for the sustainability of countries’ social welfare systems. Against this background, policies that promote ‘active ageing’, defined as ‘‘the process of optimizing opportunities for physical, social and mental wellbeing throughout the life course in order to extend healthy life expectancy, productivity and quality of life in older age’’ (WHO 2002) are increasingly being called for. In addition to the societal value proffered by older people’s continued engagement in the labour market and in other areas of social participation such as volunteering and caregiving, a growing body of research has shown that participation in such activities can also contribute to better health outcomes for the individual (Glass et al. 1999; Luoh and Herzog 2002; Menec 2003), which in turn contributes to the sustainability of pension and health care systems by reducing demand for their benefits and services. Efforts to increase active ageing should not only focus on promoting individual-level engagement but also on expanding opportunities for older people to remain or become involved. With a view to the emphasis on quality of life and wellbeing in the WHO definition, participation should include all kinds of activities—both the productive ones that were mentioned above and activities that are more ‘consumptive’ in nature such as leisure time activities and educational activities (Nimrod 2007; Silverstein and Parker 2002).

Trend study on the association between hospital admissions and the health of Dutch older adults (1995–2009)

Objectives An increase in hospital admission rates in older people may reflect improved access to healthcare, but also declining health trends in the older population. Owing to a lack of individual-level data, the latter possibility has received little attention. The current study examines associations between health status and hospitalisation rates of older adults in the Netherlands. Design Observational individual-level data linked to hospital register data. Setting Data from 1995 to 2009 from the nationally representative Longitudinal Aging Study Amsterdam were linked to the Dutch Hospital Discharge Register. Participants A total of 5681 observations of 2520 respondents across 4 measurement points (each with a follow-up of 36 months; ages 65–88 years). Outcome measures The contribution of health, demographic, psychosocial and lifestyle characteristics to time trends in hospitalisation was assessed in multivariate models. Results Between 1995 and 2009, the percentage with 1 or more overnight admissions (planned or acute) increased slightly from 38.1% to 39.7%. This was due to an increase in acute admission only (22.2–27.0%). Increased prevalences of chronic diseases, functional limitations and polypharmacy accounted for part of the observed increase in acute admissions. In addition, a more than doubled prevalence of day admissions over time was observed (12.3–28.3%), a trend that was unrelated to changes in individual characteristics. Conclusions This trend study showed a contribution of declines in population health to increases in acute hospital admissions. Since these declines did not provide a full explanation, healthcare reforms and increases in treatment possibilities in this period are likely to have contributed as well.

Late-life depressive symptoms, religiousness, and mood in the last week of life

Aim of the current study is to examine whether previous depressive symptoms modify possible effects of religiousness on mood in the last week of life. After-death interviews with proxy respondents of deceased sample members of the Longitudinal Aging Study Amsterdam provided information on depressed mood in the last week of life, as well as on the presence of a sense of peace with the approaching end of life. Other characteristics were derived from interviews with the sample members when still alive. Significant interactions were identified between measures of religiousness and previous depressive symptoms (CES-D scores) in their associations with mood in the last week of life. Among those with previous depressive symptoms, church-membership, church-attendance and salience of religion were associated with a greater likelihood of depressed mood in the last week of life. Among those without previous depressive symptoms, church-attendance and salience of religion were associated with a higher likelihood of a sense of peace. For older adults in the last phase of life, supportive effects of religiousness were more or less expected. Fore those with recent depressive symptoms, however, religiousness might involve a component of existential doubt.

Measurement invariance of the SF-12 among different demographic groups: The HELIUS study

Aim To investigate whether items of the SF-12, widely used to assess health outcome in clinical practice and public health research, provide unbiased measurements of underlying constructs in different demographic groups regarding gender, age, educational level and ethnicity. Methods We included 23,146 men and women aged 18–70 of Dutch, South-Asian Surinamese, African Surinamese, Ghanaian, Turkish, or Moroccan origin from the HELIUS study. Both multiple group confirmatory factor analyses (MGCFA), with increasingly stringent model constraints (i.e. assessing Configural, Metric, Strong and Strict measurement invariance (MI)), and regression analysis were conducted to establish comparability of SF-12 items across demographic groups. Results MI regarding gender, age and education was tested in the ethnic Dutch group (N = 4,615). In each subsequent step of testing MI, change in goodness-of-fit measures did not exceed 0.010 (RMSEA) or 0.004 (CFI). Moreover, goodness-of-fit indices showed good fit for strict invariance models: RMSEA<0.055; CFI>0.97. Regarding ethnicity, RMSEA values of metric and subsequent models fell above 0.055, indicating violation of measurement invariance in factor loadings, thresholds and residual variances. Regression analysis revealed possible age-, education- and ethnicity-related DIF. Adjustment for this DIF had little impact on the magnitude of age and educational differences in physical and mental health, but ethnic inequalities in physical health–and to a lesser extent mental health—were reduced after DIF adjustment. Conclusions We found no evidence of violation of measurement invariance of the SF-12 regarding gender, age and educational level. If minor DIF would remain undetected in our MGCFA analyses, we showed that this would have negligible effect on the magnitude of demographic health inequalities. Regarding ethnicity, the SF-12 was not measurement invariant. After accounting for DIF, we observed a reduction of ethnic inequalities in health, in particular in physical health. Caution is warranted when comparing SF-12 scores across population groups with various ethnic backgrounds.

Ten-Year Course of Cosmic Transcendence in Older Adults in the Netherlands

Objectives Gerotranscendence is defined as a transition from a materialistic and rationalistic perspective to a more cosmic and transcendent view of life accompanying the aging process. Would gerotranscendence levels still increase in later life? The current prospective study investigates 10-year trajectories of cosmic transcendence (a core dimension of gerotranscendence). Methods Four interview cycles of the Longitudinal Aging Study Amsterdam with 3-year intervals from 1995 to 2006 provide data on cosmic transcendence, demographics (ages 57–85), religiousness, health, sense of mastery, and humor coping. Data are available for 2,257 respondents and 1,533 respondents in multivariate models. Results Latent Class Growth Analysis shows three course trajectories of cosmic transcendence: stable high, intermediate with a decrease, and stable low. Higher levels are predicted by age, importance of prayer, Roman Catholic affiliation, a low sense of mastery, higher cognitive ability, and humor coping. Similar results were obtained for the respondents who died during the study (N = 378). Discussion Although levels of cosmic transcendence do not show much change during 10 years of follow-up, the oldest respondents nonetheless attain the highest cosmic transcendence levels. An inclination toward relativism and contemplation may facilitate cosmic transcendence. However, lower cognitive ability probably impairs the development toward cosmic transcendence.

Gezondheid en sociale participatie van ouderen in Europa

SamenvattingDe inzet van ouderen in onze maatschappij is groot. Maar zijn het voornamelijk de gezonde en vitale ouderen die mee blijven doen, of zijn dit ook ouderen met gezondheidsproblemen? In welke mate beïnvloedt gezondheid de sociale participatie van ouderen in Europa?