This study examines how individuals’ evaluations of health change with age. Prior research has shown that these self-evaluations predict mortality well, if not, better than disease-specific indicators (Ferraro and Farmer 1999). Researchers also recognize perceptions of health reflect patients’ symptoms and values and are essential their health-related quality of life reports (Cleary and Edgman-Levitan 1997). Schnittker's study allowed him to examine the various factors of self-related health. More importantly, these psychological health evaluations based on age can help healthcare professionals with issues related to clinical practice. Understanding the basis of age evaluations is the foundation to meeting future health care needs, specifically the need for the diagnosis and treatment of elderly persons suffering from depression. These evaluations reinforce the influence of peer groups or social environment influencing one’s own evaluation of health. Symptoms that were once overlooked are now taken into account, when the individual exhibits these same symptoms in the setting of a health diagnosis, and in turn, leads individuals to reinforce the idea of declining health. Specifically, the elderly may be especially apt to inflate their self-evaluations of health, since they are predispositioned to make downward comparisons among their peers, or social comparison. Research has labeled individuals as “lay epidemiologists” as they evaluate the severity of health conditions based on the normalcy of the condition within the age group (Croyle 1992). Similarly, the notion that illness increases with age may be attributed to the fact that simply the elderly are more aware of illness, and this awareness might, in turn, be sufficient to prompt perceptions of poor general health. In the case of depression, the elderly's belief that depression is an inevitable part of aging, loss, and grief may contribute to self-rated health evaluations, which the study measures.
The methodology of this psychological research implemented regression model analysis, and required a longitudinal design that allowed the researches to test age-based interpretations against equally viable cohort-based interpretations. This two-fold experimental design provides standard isolate age-factor results from outcomes dependent on health condition factors. This research utilized data obtained from Americans' Changing Lives (ACL), a nationally representative longitudinal study of adults aged 25 and older that is widely used in medical sociology and other disciplines to prevent any limitations normally associated with such a qualitative study. Respondents were identified using a four-stage sampling strategy, beginning with standard metropolitan statistical areas and counties, followed by smaller geographic areas, followed by houses, and last, a random selection of eligible respondents. The ACL followed an initial sample for three waves (1986, 1989, and 1994). 3,617 respondents were interviewed, with an overall response rate of 68 percent. For this experiment, the dependent variable is self-rated health. The question about self-rated health was "How would you rate your health at the present time? Would you say it is: 1 being excellent and 5 being poor?" The age groups were divided into one of six categories: 25 to 34, 35 to 44, 45 to 54, 55 to 64, 65 to 74, and 75 and older. The ACL questionnaire contained three types of morbidity indicators: chronic somatic limitations, functional limitations and a Center Epidemiological Studies Depression Scale (CES-D), which is a dimensional measure of depressive symptoms in the social sciences (Radloff 1977). In the CES-D the respondents were asked whether they experienced certain symptoms. The model used to analyze data will eliminate individual’s observed and unobserved unchanging characteristics association between self-rated health and more particular indicators, like education, income and occupation by using a fixed-effects coefficient.
The results are presented across six different tables. Table 1 presents the coefficients from 39 Age-Group Regressions of Self-Rated Health on Chronic Illness, each of the coefficients is statistically significant from zero at p < .05. Valuations of general health are correlated to a specific condition, such as cancer or arthritis, using coefficients show the strength of the relationship: the larger the coefficient is, the stronger the relationship. Social comparison predicts a decline in the size of these coefficients between age groups, and illness preoccupation predicts a coefficient increase, or a stronger relationship with age. The coefficients increase in size until approximately middle age (ages 45 to 54), when after the coefficients decrease steadily. For other chronic somatic conditions (e.g., stroke and hypertension), the coefficients fall more consistently. Although these patterns are visible, there is no clear support for the social comparison theory. Finally, the 75 and older age group had the smallest coefficient across the age groups, with the exception of cancer. Thus, even if illness is a preoccupation until late middle age, it is more than negated by social comparison in later life.
The functional limitations results had coefficients that are important: the coefficients for the least severe impairment were as large as or larger than the coefficients for Table’s1 chronic conditions. This suggests that individuals may judge their health more on the basis of successful role performance than on any other single factor. The regression models explored linear declines with age. Except for arthritis and stroke, all the declines were statistically significant. In marked contrast to the preceding patterns of chronic conditions and functional limitations, the CES-D results supported the association between self-rated health and depressive symptoms increase with age. Indeed, the coefficient doubled in size: for those aged 25 to 34, the coefficient for depression is .236, while for those over the age of 75, the coefficient is .472. Later, in table 4, multiultivariate sensitivity analyses are employed to correlate more than one of the morbidity factors. As expected by researchers, the interaction between age and depressive symptoms in Model 1 is positive and statistically significant. Model 2 suggests that this interaction remains significant even when controlling for functional limitations and the number of chronic conditions. Overall, this study illustrates the clear correlation among chronic conditions, functional impairments, and depressive symptoms, so that when all three factors are considered in the model, the relationship between depressive symptoms and self-rated health may be very different.
This study provides many implications for self-related health evaluations. Most importantly, these health evaluation results encourage additional emphasis on depression an aspect of health, especially for the elderly. The study as a whole encourages additional research on the subjectivity, construal, and social psychology of health. Although self-evaluations of general health overlap with clinical outcomes, the division between the two provides important clues to how different groups, in this case, age-groups evaluate health. This study’s results offer insights into the specific health care needs of different populations. These results highlight the connection between the decline of self-rated health, and both functional limitations and chronic conditions. For all seven chronic conditions and all levels of functional limitation, the association with self-rated health was weakest among those 75 and older. The second pattern indicates that the striking connection between depressive symptoms and self-rated health sharply increases with age. After the age of 74, some depressive symptoms become more strongly associated with self-rated health compared to other chronic-and generally severe-conditions. Although the first pattern’s functional limitations are associated with self-rated health as well as depressive symptoms, these limitations have a lesser correlation and impact with self-rated health. The implication to nursing is that we as nurses must be aware of depressive symptoms in the elderly, and increase our knowledge as to why the elderly population is depressed.
Though patterns and not clear support are attributed to social comparison theory, there are larger conclusions regarding psychological health and quality of life. It is true that social comparison accurately anticipates the declining significance of both chronic illness and functional limitations. More importantly, self-assessments of general health may appear more optimistic and more relevant than those based on the presence or absence of disease or limitations. The results suggest that emotions are an increasingly salient dimension of health, even almost outweighing other conventional morbidity indicators. Therefore, it is important to maintain a positive sense of health and evaluative tendencies used in social comparison. For nursing practice, the study gives us a deeper understanding of depression in the elderly. It tells us that in caring for them holistically, we must address the way they self-rate their health for better insight on how to care for their mental status.
Elderly interpretations of psychological health have larger implications for the diagnosis and treatment of this age group. Depressive symptoms may be increasingly relevant to self-evaluations of general health. Older generations may be more inclined to view depression as an important feature of health but less inclined to articulate and present their symptoms in ways that lead to treatment. Furthermore, these symptoms and psychological inclinations do not mean that the elderly are any more supportive of psychiatric treatment.
Works Cited
Cleary, PD., and S. Edgman-Levitan. 1997. Health Care Quality: Incorporating Consumer
Perspectives. Journal of the American Medical Association, 278:1608-12.
Ferraro, K.F., and M.M. Farmer. 1999. Utility of Health Data from Social Surveys: Is There a Gold
Standard for Measuring Morbidity? American Sociological Review, 64:303-15.
Hornstein, H., E. Fisch, and M. Holmes. 1968. Influence of a Model's Feelings about his
Behavior and his Relevance as a Comparison Other on Observers' Helping Behavior,
Journal of Personality and Social Psychology, 10: 220-6.
Schnittker, J. (2005). When Mental Health becomes Health: Age and the Shifting Meaning of
Self-evaluations of General Health. The Milbank Quarterly, 83(3), 397-423. JSTOR.
16 Sept 2010
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