Leinonen R, Heikkinen E, Jylhä M
The Finnish Centre for Interdisciplinary Gerontology, University of Jyväskylä.
Soc Sci Med. 2001 May;52(9):1329-41. doi: 10.1016/s0277-9536(00)00249-5.
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.
在“常青”项目框架内，我们通过两种不同测量方式研究了健康、功能及身体活动的多项指标变化如何预测老年人在5年期间健康自评的下降情况：自评健康（SRH）和健康自评变化（SACH）。研究对象包括所有1914年出生、居住在芬兰中部城市于韦斯屈莱的75岁老人（N = 382）。1989年基线时，91.6%的符合条件者参与了访谈；5年后的1994年随访时，87.3%的符合条件者参与了访谈，分别有77.2%和71.3%的人在研究中心接受了检查，检查重点为健康和功能能力的不同领域。五分之一的受试者报告称其SRH在5年期间恶化，五分之一报告称有所改善。其余受试者在回答相同问题时，对其基线和随访时的健康状况给出了相同的自评。SRH下降与身体活动及认知能力降低有关。然而，当直接询问他们的健康变化（SACH）时，一半的受试者表示其健康状况下降。5年期间SACH为负与慢性病数量增加、功能表现及身体活动恶化以及基线时的慢性病数量有关。我们认为，老年人会适应其客观健康和功能表现的变化：尽管慢性病增加且功能表现下降，但大多数人随着年龄增长倾向于将自己的健康评估为相似甚至更好。然而，SACH为负表明老年人对这些负面变化持现实态度。这些结果支持以下假设：两种健康变化的主观测量基于不同标准：当前总体健康状况评估往往基于个体间比较，而给定时间段内的健康变化评估可能基于个体内比较。身体活动似乎是老年人评估自身健康时的一个重要因素。
