Raija Leinonen

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.

Fear of moving outdoors and development of outdoor walking difficulty in older people

OBJECTIVES: To study which individual characteristics and environmental factors correlate with fear of moving outdoors and whether fear of moving outdoors predicts development of mobility limitation.

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.

Quality of Life and Barriers in the Urban Outdoor Environment in Old Age

OBJECTIVES: To examine the association between barriers in the outdoor environment and perceived quality of life (QoL) in old age and to assess whether fear of moving outdoors and unmet physical activity need contribute to this association.

Unmet Physical Activity Need in Old Age

OBJECTIVES: To examine which individual and environmental factors correlate with unmet physical activity need in old age and predict development of unmet physical activity need (the feeling that ones level of physical activity is inadequate and thus distinct from the recommended amount of physical activity) over a 2‐year follow‐up.

The relationship between generalized resistance resources, sense of coherence, and health among Finnish people aged 65-69

The present study investigated the appropriateness of Antonovskys model, in which generalized resistance resources (GRRs) facilitate an individuals sense of coherence (SOC); which in turn is assumed to sustain health. The proposed model was tested using a sample of 320 Finnish persons (132 of them were men and 188 women) aged 65-69 years. The GRRs investigated were family income, cognitive functioning, years of formal education, marital status, and physical exercise. Health was measured by means of a multidimensional indicator composed of physical, social and mental health. Structural Equation Modelling (SEM) within the framework of LISREL models were used to test the hypothesized model. The results showed that good cognitive functioning and physical activity in the whole sample, and marital status in men, were associated with a strong SOC, which in turn was positively related to physical, and especially, social and mental health.

Customer‐oriented counseling for physical activity in older people: study protocol and selected baseline results of a randomized‐controlled trial (ISRCTN 07330512)

The objective of this study is to describe the rationale, design and selected baseline results of a 2‐year randomized‐controlled trial (RCT) on the effects of physical activity counseling in community‐living older people.

Long-term Effect of Physical Activity Counseling on Mobility Limitation Among Older People: A Randomized Controlled Study

BACKGROUND Physical activity counseling increases physical activity among older people, but its effectiveness on mobility, that is, maintaining the ability to move independently, is unknown. We studied the effect of physical activity counseling on mobility among older people and evaluated whether counseling-induced benefits persist after cessation of the intervention. METHODS In a 2-year, single-blinded, randomized controlled study, 632 sedentary participants aged 75-81 years were randomly assigned into the intervention (n = 318) or control (n = 314) group. The intervention group received a single individualized physical activity counseling session with a supportive telephone contact every 4 months for 2 years. The outcome measures-perceived difficulty in advanced (walking 2 km) and basic (walking 0.5 km) mobility-were gathered semiannually during the intervention and the 1.5-year postintervention follow-up. RESULTS The proportion of participants with difficulties in advanced mobility at the beginning and end of the intervention was 34% and 38%, respectively, in the intervention group. In the control group, the corresponding proportions were 32% and 45%. The treatment effect was significant at the 2-year follow-up (odds ratio [OR] 0.84, 95% confidence interval [CI]: 0.70-0.99; p = .04) and remained significant 1.5 years postintervention (OR 0.82, 95% CI: 0.68-0.99; p = .04). The effect on basic mobility postintervention was parallel but nonsignificant (OR 0.87, CI: 0.69-1.09; p = .22). CONCLUSIONS Among older people, a single individualized physical activity counseling session with a supportive phone contact every 4 months for 2 years had a positive effect on mobility, an important factor for maintaining independence in the community in old age.

Perceived barriers in the outdoor environment and development of walking difficulties in older people

SIR—Older people with mobility limitations often report more barriers in their outdoor environment than people with intact mobility [1]. However, it is uncertain whether older people perceive their environment as problematic because of their mobility limitations or whether the environmental barriers precede incident mobility limitation, as most studies have been limited to cross-sectional analyses [2–5]. Only a few longitudinal studies have shown that barriers in the outdoor environment, such as poor street conditions, poor lighting and heavy traffic, increase the risk for overall functional loss [6, 7] and decrease physical activity participation [8]. More knowledge is needed about the characteristics of outdoor environments that threaten the mobility of older people [9]. The aim of the study reported in this letter was to explore whether perceived barriers in the outdoor environment predict development of difficulties in advanced and basic mobility among community-dwelling people who did not have walking difficulties at baseline. (Less)

Factors affecting the increased risk of physical inactivity among older people with depressive symptoms

The purpose of this study was to investigate the association between depressive symptoms and physical inactivity, and whether motives for and barriers to exercise explain the potential association between depressive symptoms and physical inactivity in older people. The design of the study was cross‐sectional. The study population comprised 645 people born between 1922 and 1928 who were residents in a city‐center area of Jyväskylä in central Finland. Depressive symptoms were assessed using Center for the Epidemiologic Studies Depression Scale, physical activity using Grimbys (1986) validated scale, and motives for and barriers to exercise using a questionnaire and mobility limitation with a test of walking time over 10 m. The results demonstrated that the risk of physical inactivity was more than twofold among persons with depressive symptoms compared with non‐depressed people. A higher prevalence of perceived barriers to physical activity, such as poor health, fear and negative experiences, together with lack of knowledge, explained part of the increased risk of physical inactivity among those with depressive symptoms while differences in motives for physical activity did not have a material effect. Adjustment for walking time over 10 m attenuated the increased risk of inactivity further. When planning exercise promotion programs, finding ways to overcome fear and negative experiences and providing information may help to increase physical activity among people with depressive symptoms. Additionally, difficulties caused by poor mobility should not be ignored.