Olli Nummela

RURAL URBAN DIFFERENCES IN HEALTH AND HEALTH BEHAVIOUR: A BASELINE DESCRIPTION OF A COMMUNITY HEALTH-PROMOTION PROGRAMME FOR THE ELDERLY

Study objective: To (1) describe the setting and design of the Good Ageing in Lahti Region (GOAL) programme; (2) by using the baseline results of the GOAL cohort study, to examine whether living in urban, semi-urban, or rural communities is related to risk factors for chronic diseases and functional disability in ageing individuals. Design: The baseline data of a cohort study of ageing individuals living in three community types (urban, semi-urban, rural). Data were collected by two questionnaires and laboratory assessments. Setting: Fourteen municipalities in the Lahti region (Päijät-Häme County) in Finland. Participants: A regionally and locally stratified random sample of men and women born in 1946—50, 1936—40, and 1926—30. A total of 4,272 were invited and 2,815 (66%) participated. Main results: Elevated serum cholesterol, obesity, disability, sedentary lifestyle (<2 times/week walking), and high fat intake were more prevalent in rural vs. urban and semi-urban communities. After adjustment for sex, age, education, obesity, diet, physical activity, smoking, and alcohol use, rural communities remained the only community type with increased (p<0.05) probability for high BMI (OR 1.33) and high waist circumference (OR 1.43). Conclusions: The unfavourable health and lifestyle profile, together with an old population, makes health promotion for elderly citizens a special challenge for rural communities such as those in Päijät-Häme County, Finland. Most, if not all, of the differences in health between the three community types were explained by educational background, physical activity, and smoking.

Self-rated health and indicators of SES among the ageing in three types of communities

Aims: This paper examines associations between self-rated health, three indicators of SES (self-reported education, disposable household income, adequacy of income) and three types of communities (urban, densely or sparsely populated rural areas) among ageing men and women in the Province of Päijät-Häme, Southern Finland. There is a lack of knowledge regarding the magnitude of community type when examining the relation between subjective health and SES. Methods: Cross-sectional questionnaire data gathered in the spring of 2002 for a prospective follow-up of community interventions were used. These data, together with a number of clinical and laboratory measurements, yielded the baseline for a 10-year community intervention study. A representative stratified (age, gender, area) sample of men and women living in the province and belonging to the birth cohorts 1926—1930, 1936—1940, and 1946—1950 was obtained from the National Population Registry. The target sample was 4,272, with 2,815 persons responding (66% response rate). Results: Positive associations between indicators of SES and self-rated health were observed in all three community types. After adjusting for other factors, adequacy of income showed the strongest (positive) association with self-rated health in urban areas in all age groups. A similar pattern of associations, with varying statistical significance, though, was found in the two rural areas. Conclusions: This study supports the view that while actual income is positively correlated to health, adequacy of income is an even stronger predictor of it. Thus, there was a significant link between better financial standing and good health among ageing people, especially in urban areas.

The effect of loneliness and change in loneliness on self-rated health (SRH): a longitudinal study among aging people

The association between adverse health and loneliness among aging people is known, but most of the studies are cross-sectional. In addition, the associations between changes in loneliness with health are less well known, especially in the case of aging people. The present study examined whether absence of loneliness in 2005 predicted subsequent good SRH in 2008, and whether changes in loneliness were associated with SRH in 2008. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926-30, 1936-40, and 1946-50) living in southern Finland. Baseline data was collected in 2002 (n = 2815, 66%); the follow-ups were done in 2005 (n = 2476, 60%) and 2008 (n =2 064, 73%). Logistic regression analyses were used to derive the results. Never or seldom experiencing loneliness was a strong predictor for good SRH. In addition, good health was common among those who never felt lonely. Among men the group experiencing decreasing loneliness had the highest OR of good health. Thus, loneliness is a significant contributor to poor SRH among aging people. In addition, favorable SRH is indicated not only by the absence of loneliness at both measurement points, but also by decreased loneliness. Preventing loneliness is important for health promotion.

Self-rated Health and Social Capital Among Aging People Across the Urban–Rural Dimension

BackgroundPrevious studies have found self-rated health to be associated with social capital. However, there is lack of studies examining social capital among aging people and its impact on self-rated health in the urban–rural context.PurposeThe purpose of this study was to investigate associations between self-rated health and indicators of social capital (trust, various social contacts, social participation, and access to help) among aging people living in urban and rural areas in Finland.MethodA postal survey was conducted in 2002 among men and women born in 1926–1930, 1936–1940, or 1946–1950 and dwelling in 14 municipalities in the Päijät-Häme hospital district in Finland. A total of 2,815 participants represented 66% of the original stratified (by age, gender, and municipality) sample. Logistic regression analyses were used to examine the associations.ResultsActive social participation and easy access to help from others were associated with good self-rated health, especially in the urban and sparsely populated rural areas. Trust was a particularly important correlate of subjective health in the urban area, though its significance diminished after adjusting to all background variables. No overall disparities in self-rated health between the areas emerged. Social participation and access to help as indicators of social capital seem to be important resources when aging men and women assess their subjective health.ConclusionIncreasing efforts to encourage social participation and facilitate access to help from other persons should be included among the key priorities in community health promotion.

Register-based data indicated nonparticipation bias in a health study among aging people

OBJECTIVES To examine nonparticipation in a survey by linking it with register information and identify potential nonresponse bias of inequalities in health status among aging people. STUDY DESIGN AND SETTING Cross-sectional questionnaire survey with clinical checkups carried out in 2002 among persons born in 1926-1930, 1936-1940, and 1946-1950 in Southern Finland. The sample was linked with register information from Statistics Finland and analyzed in terms of participation and health status as measured by medicine reimbursements. RESULTS Participation in the survey was more frequent among those who were older, female, married or cohabiting, higher educated and nonurban residents, and those with higher income and moderate health. Among nonrespondents, women were less healthy than men, whereas among respondents, the results were reversed. Among nonrespondents, better income was associated with unfavorable health. Poor health was generally more common among nonrespondents than respondents in several subgroups. CONCLUSION Differences in response rates were found in sociodemographic factors, health, and socioeconomic position. Favorable health was generally more frequent among respondents than nonrespondents. In particular, health inequalities by gender and income differed between respondents and nonrespondents. Thus, nonresponse may lead to bias in analyses of health inequalities among aging people.

Associations of self-rated health with different forms of leisure activities among ageing people

SummaryObjectives:This study examined associations between self-rated health and specific forms of leisure activities – i. e. singing in a choir, art painting, playing music; art exhibitions, theatre, movies, concerts; religious events; studying and self-development; voluntary work – and investigated how confounding factors contribute to these associations among ageing people in Finland.Methods:A postal survey was conducted in 2002 among men and women born in 1926–30, 1936–40 and 1946–50. The final 2,815 participants represented 66% of the original sample drawn, stratified by age, gender, and municipality. Logistic regression analyses were used to investigate associations between specific forms of leisure activities and self-rated health.Results:Going to art exhibitions, theatre, movies, and concerts among women and studying and self-development among men were significantly positively related to self-rated health, even after adjusting for socioeconomic status (SES), other sociodemographic variables, obesity, and health behaviours. Among women, active participation in religious events and voluntary work were negatively associated with self-rated health.Conclusions:The association of leisure activities and good self-rated health may differ for genders due to their nature or meaning. Partial support was found for the assumption that leisure activities go together with better self-rated health among ageing people.

The effect of trust and change in trust on self-rated health: A longitudinal study among aging people

This study examined whether trust predicted subsequent self-rated health over time at 3 years follow-up among aging people, and whether changes in trust were associated with self-rated health. Longitudinal, questionnaire-based data were collected from three age cohorts (born in 1926-1930, 1936-1940, and 1946-1950) living in the Province of Päijät-Häme, southern Finland. The response rate at the baseline in 2002 was 66% (n=2815). The follow-up was carried out in 2005, with 79% of eligible individuals participating (n=2216). Logistic regression analyses were used to derive the results. High trust was a strong predictor for good self-rated health at the follow-up. Adjusting for background variables, however, attenuated the association. In addition, good self-rated health was most common among men with sustained high trust, among women the association was somewhat weaker. Among men improvement in trust was associated with good self-rated health, but this correlation weakened after multiple adjustments. Thus, longitudinally trust is an important contributor to self-rated health among aging people. Moreover, improvement of trust but also the stability of high trust especially among men indicate better self-rated health. Trust has a positive effect on health and should therefore be seen as a significant element in health promotion.

Trust, self-rated health and mortality: A longitudinal study among ageing people in Southern Finland

Poor self-rated health (SRH) predicts mortality significantly. High trust has been shown to associate with better SRH in cross-sectional studies and survival in longitudinal studies. However, little is known about the associations between trust, SRH and mortality among ageing people. The present study examined whether low trust at the baseline predicted higher all-cause mortality in a follow-up of over five years among ageing people, and whether the trust to mortality relationship varied by SRH. The study used longitudinal, questionnaire-based survey data gathered in 2002 (n = 2815; 66%) among three age cohorts (born in 1926-30, 1936-40 and 1946-50) living in the Lahti region, Southern Finland. Two survey follow-ups were done, the first in 2005 (n = 2476, 60%) and the second in 2008 (n = 2064, 73%). Deaths during the follow-up were obtained from the covering National Population Registry. Those who died within the first one year of follow-up were excluded from the analyses to reduce potential bias due to early deaths. Cox proportional hazard models were used to derive the results. Mortality proved to be higher among men with low trust, even if their SRH had been good at the baseline. Among women, no significant associations were found. The risk attenuated after adjustment for background health-related covariates, but the gradient remained statistically significant in all models. Initial SRH did not substantially explain the gradient of trust in mortality among men. Moreover, a Sobel test of indirect effects showed that SRH had no significant mediating role in links between trust and mortality. Thus, low trust is a sensitive indicator of higher mortality risk among ageing men.

Ten year trends in health inequalities among older people, 1993-2003

in old age is associated with increased mortality and hospitalization. Pelemans W. Serum transferrin receptor in the evaluation of the iron status in elderly hospitalized patients with anaemia. Role of transferrin, transferring receptors and iron in macrophage listericidal activity. Serum transferrin receptor assay in iron deficiency anaemia and anaemia of chronic disease in the elderly. Ten year trends in health inequalities among older people, 1993–2003 SIR—In most western societies, socioeconomic position operates as a powerful discriminator of health status and risk of premature mortality [1]. This pattern is visible throughout the life course from young people to the oldest old [2–9]. Self-rated health (SRH) has often been used in studies on health inequalities [1, 10], and it is recommended as a health measure by the WHO [11]. Associations of poor SRH with morbidity and mortality are well established among people with different ages. The associations have been shown to be maintained even when other health measures such as car-diovascular disease (CVD), diabetes, cancer and functional capacity are controlled [12–14]. Although studies of SRH among older people have gained prominence in recent years, the results lack coherence [9, 15– 18]. Studies concerning cohort changes in SRH have found both improved and deteriorated levels among older people [19]. A recent study from the US suggested a stable or a slightly improved level of SRH among older people from the early 1990s onwards [20]. Results from Sweden indicated stable figures of SRH among older people [9]. There has been a strong impetus for strategies to prevent CVDs in Finland [21]. In fact CVD mortality in Finland has declined considerably since 1970s. Results from Sweden have indicated some of the CVDs to be increased from the 1980s to the early 2000s among older population aged 65–84 years [22]. CVDs have also been found to be associated inversely with several indicators of SES, including education [23]. Reducing socioeconomic health inequalities has been a central goal in national public health programmes in several countries, including Finland [24], since the 1980s. Even though positive changes in health and functional ability have been found in many countries, health disparities have been either stable or slightly increasing among those of working age [25]. Less is known, however, about the trends of health inequalities among older people. A study from Sweden showed no changes in socioeconomic disparities in SRH among older people between the early 1990s and 2000s [9]. A …

Social Capital and Self-Rated Health among Ageing People in Urban and Rural Locations in Finland and in Europe

The main interest in this chapter concerns the associations between social capital and self-rated health in different living environments (urban, suburban and rural) among ageing people aged 65–84 years. Two social capital components used were a cognitive dimension (trust) and a structural dimension (social participation and voluntary work). The results are based on data from the nationwide survey from Finland (The Health Behaviour and Health among the Finnish Elderly) and the fourth wave of the European Social Survey. The findings show that high trust indicated better self-rated health in Finland, particularly among rural residents. High social participation indicated better self-rated health in all three areas. Without area selection, high social participation and high trust was associated with good self-rated health. Area differences were not found in self-rated health. Among older Europeans, voluntary work and high trust indicated better self-rated health consistently, regardless of the living area. As a whole, those living in urban areas were less healthy, suggesting health challenges related to urban contexts. Enhancing trust, but also voluntary work particularly among the urban Europeans may significantly contribute to social capital and may have health promotion effects. Thus, investing in a trustful environment and influencing social participation can play a significant part in health promotion.