How would you rate your Health: “Very Good”, “Good”, ”Fair”, “Poor”, “Very Poor”
Compared to people your age, how would you compare your health : “Better”, “Like Most others”, “Worse”.
All over the world Governements increasingly focus on the wellbeing of their citizens. Most include in their assessment one of these very simple questions.
These results are often used to create league tables. The OECD regularly publishes the data. In 2019, for example, 4.2% of Switzerland said they had health that was “poor “or “very poor”. This compared with 7.4% for the UK.
Does such a Simple “Self-Report Health (SRH) Measure” Predict Anything?
It turns out that your sense of your overall health is a good predictor of your mortality. Using longitudinal data over 20 or 30 years we can know who has died and when. Researchers collected the SRH at each wave of their study. They also collected many other variables that are associated with mortality. These included everything from smoking and obesity to physical and mental impairment. The SRH measure improved the prediction of when someone dies. It could add predictive ability even when including all the other variables.
It seems that we “may know better”. In exactly the same way as subjective measures of cognitive ability are argued to do. There is a strong relationship between cognitive and physical impairment and our SRH across multiple sudies. They measured physical impairment in simple but objective ways. Can someone get out of a chair without using their hands? Can they pick up a book from the floor from a standing position? Can they turn through 360 degrees? Simple tests of ability or recall are used to measure cognitive impairment. There is some evidence that low SRH scores precede the arrival of impairment. However people are only tested every two years at most. The evidence is therefore thinner.
It is important to remember that SRH can go up as well as down, even as we age. Sometimes we feel better about our health than we did when we were younger. It is also clear that most people do not die without feeling bad about their health!
When Does Decline Happen?
A longitudinal study of 11,000 Danes gives some insights. The SRH “very good” category declines from 45% of the population at 45 to 16% at 90. The good news is that the ”good” category stays constant across the same age groups at around 40%. This study included a comparative question. Up to the age of 85 only 10% of people said their health was worse than someone their age. In assessing our comparative performance we are generous with the benchmarks that we use.
This survey also covered a big sample of people who started the study at aged 80. Individuals were followed every two years until they were 90. They tracked the SRH. The individual averages did decline steadily over the period. They went from an average high of 4.23 to a low of 3.65, with Very Good scoring “5” and very poor “1”. Even at 90 the average was above “ fair”. There were between 50% and 55% of people whose rating did not change over the period. There is of course a inbuilt positive bias. People did die during the study and those with low scores were more likely to die.
There is an intriguing cross-sectional study which uses over 30,000 older Chinese. These are the “oldest old” and range in age from 80 to 109. The huge sample included over 1400 centenarians. They measured physical impairment and cognitive impairment. They also measured the activities of daily life. These include the ability to bathe; dress; toilet; feed; transfer or move around, and continence. The results, to me, are encouraging for those of us for whom living an independent life is important.
Up to the age of 90 there are declines but they are not huge. At 90 only 17% of the individuals could not perform 2 or more of the daily activities, the rest did better. The most common difficulty was in bathing. 34% failed at one or more of the physical tests, usually the ability to turnaround. Most showed a cognitive test score at just below normal. By age 100 the declines had increased. But over 50% could still perform all daily activities. 40% showed no physical impairment. Above 100 there was virtually no further deteriorations.
The same study showed that things are getting better over time. They looked at the performance based on when people had been born. Many had been born in the nineteenth century! There was a steady decline in the incidence of all impairments at a given age as the generations got younger. Health was improving by generation. This also suggests that because the data was cross sectional it was probably overstating the problems.
There are 17,000 care homes in the UK of which 5000 are nursing homes. There are only 408,000 people living in care homes. Of these, 70% are suffering from dementia. That is 0.62% of the UK population living in homes and only 3.9% of the over 65’s. The average age of entering a home is between 84 and 86. Even so only 15% of people over 85 are in a home. The vast majority are suffering from dementia. Most people maintain their independence.