Department of Internal Medicine, University of Bologna, Bologna, Italy.
Aging Clin Exp Res. 2010 Jun;22(3):255-60. doi: 10.1007/BF03324805. Epub 2009 Nov 17.
Poor self-rated health is associated with adverse outcomes but its relationship with frailty is not completely understood. We examined how self-rated health (SRH) is related to health outcomes and how this relationship might differ by individual level of fitness or frailty in older people.
In the Atlantic Canada sample of the Canadian Study of Health and Aging, individuals aged > or =65 (n=1318) completed a self-administered questionnaire, from which we constructed an index of self-rated health deficits (SRHDI). Heterogeneity in health status was evaluated (n=1260) by determining their Frailty Index (FI). Higher values on the FI indicate worse health status. We evaluated health attitudes in relation to other health markers and to mortality.
Comparing those with the lowest vs highest SRHDI, significant differences (p<0.001) were seen in the mean hospital admissions in the past year (0.2 (+/-0.02) vs 0.8 (+/-0.08)), 3MS cognitive score (85.0 (+/-0.5) vs 78.4 (+/-1.2)) and (p=0.003) for age (75.3 (+/-0.3) vs 77.1 (+/-0.6)). The SRHDI and FI were moderately correlated (r=0.49) and both predicted mortality. In the fittest older people, those with poor SRHDI had a significantly increased risk of death (OR=18, 95% CI 6.0-53.6); SRHDI did not affect mortality in those who were frail.
Measuring SRH by an index of deficits is a valid construct and is associated with adverse health outcomes. The SRHDI may facilitate exploration of the complex relationships between illness burden and health outcomes in older people.When people are frail, worse health attitude does not seem to increase mortality, but in contrast, appears to increase mortality risk in fit older people.
自我评价健康状况较差与不良结局相关，但人们对其与虚弱之间的关系尚不完全了解。本研究旨在探讨老年人的自我评价健康（SRH）与健康结局之间的关系，以及这种关系如何因个体的健康水平或虚弱程度的不同而有所差异。
在加拿大老龄化问题与健康研究的加拿大大西洋省份样本中，年龄≥65 岁的个体（n=1318）完成了一份自我管理的问卷，我们根据该问卷构建了一个自我评价健康缺陷指数（SRHDI）。通过确定其衰弱指数（FI）来评估健康状况的异质性（n=1260）。FI 值越高表示健康状况越差。我们评估了健康态度与其他健康标志物和死亡率之间的关系。
与 SRHDI 最低和最高的个体相比，在过去一年的平均住院次数（0.2（+/-0.02）vs 0.8（+/-0.08））、3MS 认知评分（85.0（+/-0.5）vs 78.4（+/-1.2））和年龄（75.3（+/-0.3）vs 77.1（+/-0.6））方面存在显著差异（p<0.001）。SRHDI 和 FI 中度相关（r=0.49），且两者均预测死亡率。在身体最健康的老年人中，自我评价健康状况较差的个体死亡风险显著增加（OR=18，95%CI 6.0-53.6）；而在虚弱的个体中，SRHDI 对死亡率没有影响。
通过缺陷指数来衡量 SRH 是一种有效的方法，并且与不良健康结局相关。SRHDI 可能有助于探讨老年人疾病负担和健康结局之间的复杂关系。当人们虚弱时，较差的健康态度似乎不会增加死亡率，相反，在身体状况较好的老年人中，较差的健康态度似乎会增加死亡风险。
