The contribution of self-rated health and depressive symptoms to disability severity as a predictor of 10-year mortality in European elderly men.

OBJECTIVES To investigate the effect of disability severity and the contribution of self-rated health and depressive symptoms to 10-year mortality. METHODS Longitudinal data were collected from 1141 men aged 70 to 89 years from the Finland, Italy, and the Netherlands Elderly Study from 1990 to 2000. Disability severity was classified into 4 categories: no disability, instrumental activities, mobility, and basic activities of daily living. Self-rated health and depressive symptoms were classified into 2 and 3 categories, respectively. Multivariate Cox proportional hazard models were used to calculate mortality risks. RESULTS Men with severe disability had a risk of mortality that was more than 2-fold higher (hazard ratio [HR]=2.41; 95% confidence interval [CI]=1.84, 3.16) than that of men without disability. Men who had severe disability and did not feel healthy had the highest mortality risk (HR = 3.30; 95% CI = 2.52, 4.33). This risk was lower at lower levels of disability and higher levels of self-rated health. The same trend was observed for depressive symptoms. CONCLUSIONS For adequate prognoses on mortality or for developing intervention strategies, not only physical aspects of health but also other health outcomes should be taken into account.

[1]  M. Hirvensalo,et al.  Mobility Difficulties and Physical Activity as Predictors of Mortality and Loss of Independence in the Community‐Living Older Population , 2000, Journal of the American Geriatrics Society.

[2]  E. Feskens,et al.  Physical activity and cardiovascular risk factors among elderly men in Finland, Italy, and the Netherlands. , 1996, American journal of epidemiology.

[3]  Y. Benyamini,et al.  Community Studies Reporting Association between Self-Rated Health and Mortality , 1999 .

[4]  R A Kronmal,et al.  Risk factors for 5-year mortality in older adults: the Cardiovascular Health Study. , 1998, JAMA.

[5]  E. Feskens,et al.  Ageing and the relationship between functional status and self-rated health in elderly men. , 1997, Social science & medicine.

[6]  Niek S Klazinga,et al.  Self‐Reported Disability and Its Association with Performance‐Based Limitation in Elderly Men: A Comparison of Three European Countries , 2003, Journal of the American Geriatrics Society.

[7]  W. Zung.  A SELF-RATING DEPRESSION SCALE. , 1965, Archives of general psychiatry.

[8]  G. DeFriese,et al.  Predicting mortality from community surveys of older adults: the importance of self-rated functional ability. , 1997, The journals of gerontology. Series B, Psychological sciences and social sciences.

[9]  B. Modan,et al.  Gender differences in the self-rated health-mortality association: is it poor self-rated health that predicts mortality or excellent self-rated health that predicts survival? , 2003, The Gerontologist.

[10]  D. Melzer,et al.  The predictive validity for mortality of the index of mobility-related limitation--results from the EPESE study. , 2003, Age and ageing.

[11]  H. Blackburn,et al.  Epidemiological studies related to coronary heart disease: characteristics of men aged 40-59 in seven countries. , 2009, Acta medica Scandinavica. Supplementum.

[12]  E V Gama,et al.  Association of individual activities of daily living with self-rated health in older people. , 2000, Age and ageing.

[13]  B. Penninx,et al.  Association of depression and gender with mortality in old age. Results from the Amsterdam Study of the Elderly (AMSTEL). , 2000, The British journal of psychiatry : the journal of mental science.

[14]  Nandini Dendukuri,et al.  Risk factors for depression among elderly community subjects: a systematic review and meta-analysis. , 2003, The American journal of psychiatry.

[15]  L. Russell,et al.  Survival, functional limitations, and self-rated health in the NHANES I Epidemiologic Follow-up Study, 1992. First National Health and Nutrition Examination Survey. , 2000, American journal of epidemiology.

[16]  Benoit H Mulsant,et al.  Rates and predictors of mortality in an aging, rural, community-based cohort: the role of depression. , 2002, Archives of general psychiatry.

[17]  D B Reuben,et al.  Value of functional status as a predictor of mortality: results of a prospective study. , 1992, The American journal of medicine.

[18]  B. Winblad,et al.  Women are more disabled in basic activities of daily living than men only in very advanced ages: a study on disability, morbidity, and mortality from the Kungsholmen Project. , 2003, Journal of clinical epidemiology.

[19]  D. Deeg,et al.  Concepts of self-rated health: specifying the gender difference in mortality risk. , 2003, The Gerontologist.

[20]  M. Bruce,et al.  Depression and disability in late life: directions for future research. , 2001, The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry.

[21]  A. Tylee.  Depression in the community: physician and patient perspective. , 1999, The Journal of clinical psychiatry.

[22]  E. Feskens,et al.  The contribution of chronic conditions and disabilities to poor self-rated health in elderly men. , 1999, The journals of gerontology. Series A, Biological sciences and medical sciences.

[23]  R. D. de Andino,et al.  Functional disability and mental impairment as predictors of mortality in community-dwelling elderly Puerto Ricans. , 1995, Puerto Rico health sciences journal.

[24]  R. Mayeux,et al.  Persistent Mobility Deficit in the Absence of Deficits in Activities of Daily Living: A Risk Factor for Mortality , 2001, Journal of the American Geriatrics Society.

[25]  A. Nissinen,et al.  Self-reported and performance-based functional status and associated factors among elderly men: the Finnish cohorts of the Seven Countries Study. , 1998, Journal of clinical epidemiology.

[26]  P. Barberger‐Gateau,et al.  Subjective health and mortality in French elderly women and men. , 1999, The journals of gerontology. Series B, Psychological sciences and social sciences.

[27]  K. Anstey,et al.  Mortality Risk Varies According to Gender and Change in Depressive Status in Very Old Adults , 2002, Psychosomatic medicine.

[28]  J. Stessman,et al.  Independence in Instrumental Activities of Daily Living and its effect on mortality , 1999, Aging.

[29]  R. J. Johnson,et al.  Changes in functional status and the risks of subsequent nursing home placement and death. , 1993, Journal of gerontology.

[30]  D Kromhout,et al.  Measuring functional status: cross-sectional and longitudinal associations between performance and self-report (Zutphen Elderly Study 1990-1993). , 1996, Journal of clinical epidemiology.

[31]  J. Vaupel,et al.  Predictors of Mortality in 2,249 Nonagenarians—The Danish 1905‐Cohort Survey , 2003, Journal of the American Geriatrics Society.

[32]  W. Scott,et al.  Functional health status as a predictor of mortality in men and women over 65. , 1997, Journal of clinical epidemiology.

[33]  Rick Chappell,et al.  Self-reported health and survival in the Longitudinal Study of Aging, 1984-1986. , 1995, Journal of clinical epidemiology.