Marja Jylhä

What is self-rated health and why does it predict mortality? Towards a unified conceptual model

The association of self-rated health with mortality is well established but poorly understood. This paper provides new insights into self-rated health that help integrate information from different disciplines, both social and biological, into one unified conceptual framework. It proposes, first, a model describing the health assessment process to show how self-rated health can reflect the states of the human body and mind. Here, an analytic distinction is made between the different types of information on which people base their health assessments and the contextual frameworks in which this information is evaluated and summarized. The model helps us understand why self-ratings of health may be modified by age or culture, but still be a valid measure of health status. Second, based on the proposed model, the paper examines the association of self-rated health with mortality. The key question is, what do people know and how do they know what they know that makes self-rated health such an inclusive and universal predictor of the most absolute biological event, death. The focus is on the social and biological pathways that mediate information from the human organism to individual consciousness, thus incorporating that information into self-ratings of health. A unique source of information is provided by the bodily sensations that are directly available only to the individual him- or herself. According to recent findings in human biology, these sensations may reflect important physiological dysregulations, such as inflammatory processes. Third, the paper discusses the advantages and limitations of self-rated health as a measure of health in research and clinical practice. Future research should investigate both the logics that govern peoples reasoning about their health and the physiological processes that underlie bodily feelings and sensations. Self-rated health lies at the cross-roads of culture and biology, therefore a collaborative effort between different disciplines can only improve our understanding of this key measure of health status.

Predictors of decline in self-assessments of health among older people -- a 5-year longitudinal study

Within the framework of the Evergreen project we examined how changes in several indicators of health and functioning and physical activity predicted a decline in self-assessments of health evaluated over a 5-year period in older people by two different measurements: self-rated health (SRH) and self-assessed change in health (SACH). The study group comprised all 75-year-old persons born in 1914 (N = 382) and living in Jyväskylä, a town in central Finland. At baseline in 1989, 91.6%, and at follow-up 5 years later in 1994, 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 different domains of health and functional capacity. One-fifth of the subjects reported a deterioration in and one-fifth an improvement in SRH over the 5 years. The rest gave identical self-assessments of their health at baseline and at follow-up in response to the same question. Decline in SRH was associated with a decrease in physical activity and cognitive capacity. When asked directly about changes in their health (SACH), however, half the subjects said their health had declined. Negative SACH over the 5-year period was related to an increased number of chronic conditions, deterioration in functional performance and physical activity, and to the number of chronic conditions at baseline. We suggest that ageing people adapt to changes in their objective health and functional performance: the majority tend to assess their health as similar to or even better with increasing age despite an increase in chronic diseases and decline in functional performance. However, a negative SACH indicates that older people are realistic about these negative changes. These results support the assumption that the two subjective measurements of change in health are based on different criteria: assessment of current general health status tends to be based on inter-individual comparison, whereas assessment of change in health over a given time period may be based on intra-individual comparison. Physical activity seems to be an important factor when older people assess their health.

Individual Experiences as Cultural – a Cross-cultural Study on Loneliness Among the Elderly

Data from six European regions participating in the Eleven Country Study on Health Care of the Elderly suggested that feelings of loneliness were more prevalent in areas where living alone was rarest and where community bonds were strongest. Individual variables describing life-situation did not explain the differences. The article examines loneliness as an historical and cultural phenomenon. It is argued that loneliness reflects, through complex mediations, the mutual relationship between the individual and the community and the extent to which the ideology of individualism prevails in society. In attempts to understand the differences between the study areas, the article looks more closely into the role of the community and the family in two selected areas: the industrial town Tampere in Finland and rural Greece.

Self-rated health and self-assessed change in health in elderly men and women — A five-year longitudinal study

The purpose of the present investigation was two fold: (1) to examine how men and women self-rate their health as they age from 75 to 80 yr and how they assess the change in their health over the five year period; and (2) to ascertain how self-assessed change in health over the follow-up period corresponded to the difference in self-ratings of health between the assessments performed at baseline and at follow-up. The study was part of the Evergreen-project with the study group comprising all inhabitants born in 1914 (N = 388) living in Jyväskylä, central Finland. At baseline, 93.4%, and at follow-up, 93.3%, of those who were eligible participated in the interview. Self-rated health, when asked using the same questions, did not change at follow-up compared to baseline. However, nearly half of the follow-up group reported that their health had become worse over the five year period. Gender differences in self-rated health were not found, although women reported more often than men that their health had become worse and some of the men said their health had become better. It is concluded that self-rated health seems to be age-adjusted; elderly people who say their health has become worse as they age actually self-rate their health as the same or better than before.

Lack of association between human longevity and polymorphisms of IL-1 cluster, IL-6, IL-10 and TNF-α genes in Finnish nonagenarians

There has been increasing interest in research on genetic basis of longevity. Aging is accompanied by immune deterioration and dysregulation of cytokines. Increased IL-6 concentration in vivo and enhanced IL-6, IL-1beta, and TNF-alpha production in vitro have been reported in healthy elderly people. Cytokine gene polymorphisms have been demonstrated to be associated with cytokine production both in vivo and in vitro, and with some diseases. Thus, gene polymorphisms of cytokine may play a role in longevity by modulating an individuals responses to life-threatening disorders. Cytokine gene polymorphisms at IL1A-889, IL1B+3953, IL1B-511, IL1RN VNTR, IL6-174, IL10-1082, and TNFA-308 were genotyped in 250 Finnish nonagenarians (52 men and 198 women) and in 400 healthy blood donors (18-60 years) as controls. No statistically significant differences were found in the genotype distributions, allelic frequencies and A2+ carrier status of IL-1alpha, IL-1beta, IL-1RA, IL-6, IL-10, and TNF-alpha genes between nonagenarians and younger controls within Finnish population, nor between male and female nonagenarians. No differences emerged between nonagenarians and younger controls by comparing different IL-1 gene cluster haplotypes. Thus, there is no evidence of an association of IL-1 complex, IL-6, IL-10, and TNF-alpha gene polymorphisms with longevity, alone or in combination.

Self-rated health among older adults: a cross-national comparison

Self-rated health (SRH) may have different implications in various social and cultural settings. However, few studies are available concerning SRH among older persons across countries. The aim of this study was to analyse whether there are cross-national differences in the association between status characteristics, several diseases common among older persons, activities of daily living (ADL), and SRH. The study base was the Comparison of Longitudinal European Studies on Aging (CLESA), which includes data from six population-based studies on aging conducted in Finland, Israel, Italy, The Netherlands, Spain and Sweden. The study population comprised 5,629 persons, with participants from all countries except Italy. Logistic regression analyses were used to assess the relationship between status characteristics, health conditions, ADL and SRH. To examine whether the association among status characteristics, health conditions, ADL and outcome differed across the CLESA countries, interaction terms defined as “variable*country” were considered separately for each variable. Regression analyses revealed that sex, education, lifetime occupation, heart disease and respiratory disease were differently distributed across countries. Among homogeneous factors, marital status (OR=1.21), hypertension (OR=1.41), stroke (OR=1.67), diabetes (OR=2.15), cancer (OR=1.47), musculoskeletal diseases (OR=2.44), and ADL (OR=2.72) turned out to be significantly associated with fair or poor SRH. The results indicate that there are differences in self-ratings of health across countries. These differences cannot be explained entirely by status characteristics, self-reported diseases or functional ability. However, an important finding was that in all countries most of the indicators of medical and functional health were homogeneously associated with SRH.

Indoleamine 2,3-dioxygenase activity in nonagenarians is markedly increased and predicts mortality

Indoleamine 2,3-dioxygenase (IDO), an enzyme degrading tryptophan (trp) to kynurenine (kyn), suppresses T cell activity. Ageing of the immune system, immunosenescence, includes a decline in T cell function. We therefore sought to establish whether IDO activity is involved in immunosenescence and whether it predicts mortality in aged subjects. We measured kyn/trp, reflecting IDO activity, in 284 nonagenarians and 309 blood donor controls. IDO activity was significantly higher in nonagenarians compared with controls and IDO activity at study entry predicted subsequent mortality in nonagenarians. Thus, increased IDO activity might be a mechanism involved in the decline of T cell responses in immunosenescence.

Inflammatory Markers and Physical Performance Among Nonagenarians

BACKGROUND Recent studies have suggested that inflammation may play an important role in aging and the development of disabilities, but knowledge about its importance in the development of muscle weakness and functional disabilities in very old people is limited. This study examined associations between inflammatory markers and physical performance among nonagenarians. METHODS The population-based sample consisted of 197 women and 65 men aged 90 years. Physical performance was assessed according to the Barthel Index, the chair stand, and handgrip strength. Plasma levels of interleukin-6 (IL-6), interleukin-1 receptor antagonist (IL-1Ra), and C-reactive protein (CRP) were determined. RESULTS A gender-adjusted linear regression model showed that high levels of CRP, IL-6, and IL-1Ra were significantly associated with poor handgrip strength (p = .041, p = .023, p < .001, respectively). After adjustment for diseases, smoking and physical exercise high levels of IL-6 and IL-1Ra were still significantly associated with poor hand grip strength (p = .048, p = .004, respectively). In the gender-adjusted model, high levels of CRP, IL-6, and IL-1Ra were significantly associated with a worse Barthel Index (p = .009, p = .004, p = .004, respectively). High levels of CRP and IL-6 were still significantly associated with a worse Barthel Index after adjusted for diseases, smoking and physical exercise (p = .034, p = .041, respectively). In the chair stand, no significant association with inflammatory markers was found. CONCLUSIONS Associations between high levels of inflammatory markers and worse handgrip strength as well as a worse Barthel Index result were evident among nonagenarians. However, the association with the chair stand was not significant.

Ten-year change in the use of medical drugs among the elderly--a longitudinal study and cohort comparison.

Longitudinal changes and cohort differences from 1979 to 1989 in the use of prescribed and non-prescribed medical drugs were examined and the connections of drug use to various background variables were analysed in the framework of the Tampere Longitudinal Study of Ageing. In the longitudinal study random samples of men and women born in 1900-09 and 1910-19 (738 persons) were interviewed in 1979 and the survivors (62%) were interviewed again in 1989. In the cohort comparison the 60-69-year-olds studied in 1979 (364 persons) were compared with the 60-69-year-olds in 1989 (395 persons). In the longitudinal setting the number of prescribed drugs increased. In 1989 2 or 3 in 10 persons used at least five prescribed drugs simultaneously. In the cohort comparison there were no differences in the number of prescribed drugs between the two groups of 60-69-year-olds. Use was connected with multimorbidity and poor self-rated health. Both the longitudinal comparison in the group born in 1910-19 and the cohort comparison revealed a significant increase in the use of non-prescribed drugs. The use of analgesics was connected with sex, occupational class, self-rated health and feelings of loneliness. In the use of vitamins, no connection was found with health variables, but they were mostly used by white-collar employees and women. However, when all these variables were controlled for, both analgesics and, in particular, vitamins were used more in 1989 than in 1979. The results suggest that the increase in the use of non-prescribed drugs is mainly due to social and historical factors, by changes both in drug policies, health culture and health behaviour of elderly persons.

Circadian activity rhythm in demented and non-demented nursing-home residents measured by telemetric actigraphy

There is a need to develop unobtrusive methods for long‐term monitoring of sleep/wake and circadian activity patterns in the elderly both in nursing homes and at home settings as sleep is important for health and well‐being. The IST Vivago® WristCare is an active social alarm system, which provides continuous telemetric monitoring of the users activity. We examined how the activity signal measured by IST Vivago differed between demented and non‐demented subjects living in a nursing home, and how it correlated with the subjective assessment of sleep quality and daytime alertness. The activity signal data together with subjective assessments of sleep quality and daytime vigilance were collected from 42 volunteers (aged 56–97 years; 23 demented and 19 non‐demented) for at least 10 days. The demented subjects had lower daytime activity and higher nocturnal activity than the non‐demented subjects. Correlations between the activity parameters and self‐assessments were weak but statistically significant. We also found correlation between functional ability and diurnal activity. The results are in line with previous studies with demented and non‐demented elderly subjects and suggest that the IST Vivago system provides a valid instrument for unobtrusive continuous long‐term monitoring of the circadian rhythm and sleep/wake patterns in the elderly.