University of Manitoba, Canada.
Concordia University, Canada.
Soc Sci Med. 2019 Jul;232:444-452. doi: 10.1016/j.socscimed.2018.08.030. Epub 2018 Aug 27.
Whether expectations about future health are adaptive or maladaptive in late life likely depends on the extent to which they conform to or defy a future reality of declining health. Our premise was that, when adults face a downward spiral in health, it can be adaptive to realistically expect poorer future health and maladaptive to unrealistically expect good health.
This 18-year-long study of community-dwelling older Canadians (n = 132, 72-98 years) involved a baseline interview to identify those who anticipated heath would decline (pessimistic expectation) or improve/remain stable (optimistic expectation). We determined initial (baseline) health status by assessing the severity of chronic conditions. An objective within-person measure of actual health change was derived by documenting hospital admissions (HAs) over time to capture a continuum that ranged from no declines (HAs remained stable) to greater declines in health (increasing numbers of HAs). Our a priori hypotheses examined the effects of health expectations (pessimistic, optimistic) and actual health change on the outcomes of depressive symptoms and mortality.
Support was found for our premise that it is adaptive to be realistic when forecasting future health, at least at low levels of initial chronic condition severity. Regression analyses showed that realistically pessimistic (vs. unrealistically optimistic) expectations predicted significantly fewer depressive symptoms and a lower risk of death. The results also supported our premise that it is maladaptive to be unrealistically optimistic when health subsequently declines in reality: The risk of death was 313% higher for those with optimistic expectations that were unrealistic (vs. realistic).
These findings provide insights for health care professionals regarding the messages they communicate to their patients. Together, they imply that, when good health is slipping away, it seems optimal to encourage a healthy dose of realism.
在晚年，对未来健康的预期是适应性的还是适应性的，可能取决于它们在多大程度上符合或违背健康状况下降的未来现实。我们的前提是，当成年人面临健康状况的螺旋式下降时，现实地预期未来健康状况较差是适应性的，而不现实地预期健康状况良好则是适应性的。
这项对加拿大社区老年人（n=132，72-98 岁）进行的 18 年长期研究包括基线访谈，以确定那些预计健康状况会下降（悲观预期）或改善/保持稳定（乐观预期）的人。我们通过评估慢性疾病的严重程度来确定初始（基线）健康状况。通过记录随时间推移的住院治疗（HA）来确定实际健康变化的个体内客观指标，以捕获从无下降（HA 保持稳定）到健康状况下降更大（HA 数量增加）的连续体。我们的先验假设检验了健康预期（悲观、乐观）和实际健康变化对抑郁症状和死亡率结果的影响。
我们的前提得到了支持，即至少在初始慢性疾病严重程度较低的情况下，对未来健康进行现实预测是适应性的。回归分析表明，现实悲观（与不现实乐观相比）预期显著预测了较少的抑郁症状和较低的死亡风险。结果也支持了我们的前提，即在健康状况随后在现实中下降时，不现实地乐观是适应性的：对于那些不现实的乐观预期（与现实相比）的人，死亡风险增加了 313%。
这些发现为医疗保健专业人员提供了有关他们向患者传达信息的见解。总的来说，这意味着当健康状况逐渐消失时，鼓励适度的现实主义似乎是最佳选择。
