Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity

First Health Services Corporation/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA.
Journal of clinical epidemiology (Impact Factor: 3.42). 09/2008; 62(2):177-87. DOI: 10.1016/j.jclinepi.2008.05.009
Source: PubMed


To examine the impact of changes in comorbidity--as measured by the Charlson comorbidity index--on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories.
Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions.
Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia.
Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.

13 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to study brain plasticity in the visual cortex, in six subjects totally blind from birth. The protocol we used was the same as that employed in a prior study on blindfolded sighted subjects (Brain Res., 924 (2002) 176). The production of mental images from animal names versus passive listening to abstract words, involved, in the early blind subjects as well as in the blindfolded sighted subjects of our control group, the superior occipital, inferior and superior parietal areas, premotor area, visual association. Activation foci in the somatosensory areas in the left hemisphere, as well as in the temporal and fusiform gyri were only visible in the blind subjects. The experiment, which was repeated after a short period of rest, demonstrated, this time again, predominant involvement of the dorsal pathway and activation of the primary visual area (in a region of interest). With respect to the ongoing debate on brain reorganization, our study shows that the primary visual area is activated in early blind subjects, and that activation persists in a mental imagery task involving no sensory input other than verbal instructions.
    Preview · Article · Jul 2004 · Cognitive Brain Research
  • [Show abstract] [Hide abstract]
    ABSTRACT: The association of self-rated health with mortality is well established but poorly understood. This paper provides new insights into self-rated health that help integrate information from different disciplines, both social and biological, into one unified conceptual framework. It proposes, first, a model describing the health assessment process to show how self-rated health can reflect the states of the human body and mind. Here, an analytic distinction is made between the different types of information on which people base their health assessments and the contextual frameworks in which this information is evaluated and summarized. The model helps us understand why self-ratings of health may be modified by age or culture, but still be a valid measure of health status. Second, based on the proposed model, the paper examines the association of self-rated health with mortality. The key question is, what do people know and how do they know what they know that makes self-rated health such an inclusive and universal predictor of the most absolute biological event, death. The focus is on the social and biological pathways that mediate information from the human organism to individual consciousness, thus incorporating that information into self-ratings of health. A unique source of information is provided by the bodily sensations that are directly available only to the individual him- or herself. According to recent findings in human biology, these sensations may reflect important physiological dysregulations, such as inflammatory processes. Third, the paper discusses the advantages and limitations of self-rated health as a measure of health in research and clinical practice. Future research should investigate both the logics that govern people's reasoning about their health and the physiological processes that underlie bodily feelings and sensations. Self-rated health lies at the cross-roads of culture and biology, therefore a collaborative effort between different disciplines can only improve our understanding of this key measure of health status.
    No preview · Article · Jul 2009 · Social Science [?] Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: In their commentary on my article "What is self-rated health and why does it predict mortality? Towards a unified conceptual model", Martin Huisman and Dorly Deeg argue, first, that the model I suggest may exaggerate the rational elements in the process of assessment and ignore the irrational and illogical influences; and, second, that self-rated health should be best understood not as a measure of "true health", but as a measure of people's perceptions about their health. My response to these comments attempts to clarify the nature of the model as a tool for describing the conceptual and logical structure of the evaluation, not the empirical process itself. Psychological and external influences, including "irrational" elements, can be understood as belonging to the contextual framework of evaluation. There is no question that self-rated health represents individual self-perceptions, but to explain its association with self-rated health, it is crucial to understand its relationship to the biological and physiological states of the organism.
    No preview · Article · Dec 2009 · Social Science [?] Medicine
Show more