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Self-rated health in old age, related factors and survival: A 20-Year longitudinal study within the Silver-MONICA cohort
Luleå University of Technology, Department of Health, Education and Technology, Nursing and Medical Technology.ORCID iD: 0000-0001-9968-3937
Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.ORCID iD: 0000-0002-1022-8741
Department of Public Health and Clinical Medicine, Sustainable Health, Umeå University, Umeå, Sweden.
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
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2024 (English)In: Archives of gerontology and geriatrics (Print), ISSN 0167-4943, E-ISSN 1872-6976, Vol. 122, article id 105392Article in journal (Refereed) Published
Abstract [en]

Introduction: Self-rated health (SRH) offers insights into the evolving health demographics of an ageing population.

Aim: To assess change in SRH from old age to very old age and their associations with health and well-being factors, and to investigate the association between SRH and survival.

Methods: All participants in the MONICA 1999 re-examination born before 1940 (n = 1595) were included in the Silver-MONICA baseline cohort. The Silver-MONICA follow-up started in 2016 included participants in the Silver-MONICA baseline cohort aged 80 years or older. Data on SRH was available for 1561 participants at baseline with 446 of them also participating in the follow-up. The follow-up examination included a wide variety of measurements and tests.

Findings: Most participants rated their health as "Quite good" (54.5 %) at baseline. Over the study period, 42.6 % had stable SRH, 40.6 % had declined, and 16.8 % had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p < 0.05).

Conclusion: This study demonstrates associations between changes in SRH and a multitude of health- and wellbeing-related factors, as well as a relation between survival and SRH, accentuating their relevance within the ageing population.

Place, publisher, year, edition, pages
Elsevier, 2024. Vol. 122, article id 105392
Keywords [en]
aged 80 and over, aging/psychology, diagnostic self evaluation, longitudinal studies, population characteristics, self-rated health, survival analysis
National Category
Gerontology, specialising in Medical and Health Sciences
Research subject
Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-104692DOI: 10.1016/j.archger.2024.105392PubMedID: 38492492OAI: oai:DiVA.org:ltu-104692DiVA, id: diva2:1845871
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2016-01074Swedish Research Council, K2014-99X-22610-01-6Visare NorrSwedish Dementia CentreFoundation for the Memory of Ragnhild and Einar LundströmThuréus stiftelse för främjande av geriatrisk forskningKonung Gustaf V:s och Drottning Victorias Frimurarestiftelse
Note

Validerad;2024;Nivå 2;2024-03-21 (signyg);

Funder: the Borgerskapet in Umeå Research Foundation, the Erik and Anne-Marie Detlof Research Foundation, the Swedish Society of Medicine, the Strategic Research Program in Care Sciences (SFO-V, Sweden);

Full text license: CC BY

Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-03-21Bibliographically approved
In thesis
1. Health in later life: A nursing perspective
Open this publication in new window or tab >>Health in later life: A nursing perspective
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The ongoing demographic shift towards an older population calls for a corresponding shift to a proactive approach, aiming for health and well-being in old age. This dissertation addresses the need for increased knowledge about health in the context of aging at home. It explores the roles of relationships, home, health, and well-being while examining the various factors influencing health. The disseration also explores how key stakeholders in home care organizations percive a good life for older persons. From a nursing perspective, the disseration explores pathways of change and experiences related to health, guided by the caritative caring theory, which underscores health as wholeness and holiness. By thoroughly examining self-rated health, relationships, and the experiences of older persons receiving home support, along with key stakeholders' perceptions, the dissertation aims to provide valuable insights for nursing practices and the promotion of health in later life.

This dissertation aims to explore health in later life, specifically concentrating on widowed women living alone with extensive home care needs. This exploration encompasses both the perspective of older widows and that of key stakeholders. For a comprehensive understanding health, the disseration also study self-rated health among older persons over a 20-year period, exploring its associations to health and well-being factors, including survival. Additionally, the dissertation explores the shared relationship between older women and nurses.

This dissertation comprises one quantitative and three qualitative studies, all centred around older persons aged 80 years and older. Paper I is a quantitative, longitudinal study investigating changes in Self-Rated Health (SRH) across the aging spectrum. The study included 1595 participants initially (aged 59-79) and 541 participants at follow-up (age 80-96). Most participants rated their health as "Quite good" (54.5%) at baseline. Over the study period, 42.6% had stable SRH, 40.6% had declined, and 16.8% had improved. Changes in SRH were at follow-up significantly associated with age, pain, nutrition, cognition, walking aid use, self-paced gait speed, lower extremity strength, independence in activities of daily living, weekly physical exercise, outdoor activity, participation in organized activities, visiting others, morale, and depressive symptoms. SRH at baseline was significantly associated with survival (p<0.05). Paper II is a qualitative study about the concept of a good life for single-living older women with extensive care needs. This involved individual interviews with 11 participants aged 82-95, analysed through reflexive thematic analysis. Paper III is a qualitative description of key stakeholders' perceptions regarding a good life for the oldest old persons living at home with extensive care needs. The study utilized qualitative focus groups with 28 participants aged 31-69 (1 man, 27 women), analysed through qualitative content analysis. Paper IV is a qualitative study that aim to explore the meaning of relationship between older women and registered nurses in home care. The research employed qualitative methods, including focus groups and individual interviews, with 11 older women (aged 82-95) and 5 registered nurses (aged 35-47), analysed using qualitative content analysis. 

In conclusion, health in later life is not merely about avoiding a decline in health; rather, it involves integrating existing aspects into an ever-changing situation. However, challenges such as living alone, experiencing depressive symptoms, and coping with illness and/or functional disability can pose threats, risking overall health and survival. In contrast, for those living with disabilities and illnesses with extensive care needs, the significance of daily life becomes paramount. Simultaneously, the relationship between older women and registered nurse emerges as a recurring connection with the potential not only to enhance daily life but also to serve as a consistent and supportive presence in the home.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2024
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
Keywords
Aging Population, Home Care Services, Self-Rated Health, Geriatric Nursing, Nurse-Patient Relationship, Health
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-104693 (URN)978-91-8048-507-4 (ISBN)978-91-8048-508-1 (ISBN)
Public defence
2024-05-24, E632, Luleå university of technology, Luleå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-03-21 Created: 2024-03-20 Last updated: 2024-04-12Bibliographically approved

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Almevall, ArielAlmevall, Albin DahlinZingmark, Karin

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