Puvill Thomas, Lindenberg Jolanda, Gussekloo Jacobijn, de Craen Anton J M, Slaets Joris P J, Westendorp Rudi G J
Leyden Academy on Vitality and Ageing, Leiden, the Netherlands.
Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands.
PLoS One. 2016 Sep 22;11(9):e0163499. doi: 10.1371/journal.pone.0163499. eCollection 2016.
Self-rated health is routinely used in research and practise among general populations. Older people, however, seem to change their health perceptions. To accurately understand these changed perceptions we therefore need to study the correlates of older people's self-ratings. We examined self-rated, nurse-rated and physician-rated health's association with common disabilities in older people (the geriatric giants), mortality hazard and life satisfaction. For this, we used an age-representative population of 501 participant aged 85 from a middle-sized city in the Netherlands: the Leiden 85-plus Study. Participants with severe cognitive dysfunction were excluded. Participants themselves provided health ratings, as well as a visiting physician and a research nurse. Visual acuity, hearing loss, mobility, stability, urinal and faecal incontinence, cognitive function and mood (depressive symptoms) were included as geriatric giants. Participants provided a score for life satisfaction and were followed up for vital status. Concordance of self-rated health with physician-rated (k = .3 [.0]) and nurse-rated health (k = .2 [.0]) was low. All three ratings were associated with the geriatric giants except for hearing loss (all p < 0.001). Associations were equal in strength, except for depressive symptoms, which showed a stronger association with self-rated health (.8 [.1] versus .4 [.1]). Self-rated health predicted mortality less well than the other ratings. Self-rated health related stronger to life satisfaction than physician's and nurse's ratings. We conclude that professionals' health ratings are more reflective of physical health whereas self-rated health reflects more the older person's mental health, but all three health ratings are useful in research.
自评健康状况在普通人群的研究和实践中经常被使用。然而，老年人似乎会改变他们对健康的认知。因此，为了准确理解这些变化的认知，我们需要研究老年人自评的相关因素。我们研究了自评、护士评定和医生评定的健康状况与老年人常见残疾（老年巨症）、死亡风险和生活满意度之间的关联。为此，我们使用了来自荷兰一个中等规模城市的501名85岁具有年龄代表性的人群：莱顿85岁及以上研究。排除了患有严重认知功能障碍的参与者。参与者自己提供健康评定，还有一位出诊医生和一名研究护士。视力、听力丧失、行动能力、稳定性、大小便失禁、认知功能和情绪（抑郁症状）被纳入老年巨症范畴。参与者提供生活满意度得分，并对其生命状态进行随访。自评健康状况与医生评定（κ = 0.3 [0.0]）和护士评定健康状况（κ = 0.2 [0.0]）的一致性较低。除听力丧失外，所有三种评定都与老年巨症相关（所有p < 0.001）。除抑郁症状外，各关联强度相当，抑郁症状与自评健康状况的关联更强（0.8 [0.1] 对比 0.4 [0.1]）。自评健康状况对死亡率的预测能力不如其他评定。自评健康状况与生活满意度的关联比医生和护士的评定更强。我们得出结论，专业人员的健康评定更能反映身体健康，而自评健康状况更多地反映老年人的心理健康，但所有三种健康评定在研究中都很有用。
