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Self-Rated Health has been employed in a broad variety of scenarios with different population groups and for a great number of objectives ranging from screening for specific health conditions to studies designed to aid in decision making for individuals in crisis situation, like depressive states or the capacity to decide on changing domicile7.
As mentioned, in the previous paragraph the term SRH has been used to refer to the response made by individuals when asked about their state of health; hence, it can be applied to all self-reports of state of health or of specific symptoms like pain or the sensation of dyspnea, fatigue, or tiredness7. Thereby, it is considered that SRH represents the perception individuals have of the different dimensions of their state of health; accordingly, SRH can be classified as a result and integral variable, which permits inferring that it can encompass the different dimensions of the human being9.
The SRH concept has been included in different research projects since the s and ever since then diverse studies have shown its usefulness in documenting the state of health self-reported by EAs during a given moment and also in predicting future health-related events8,9. This shows the great interest in using SRH when conducting research that assesses state of health; in fact, it is already part of health surveys carried out with EAs. For the theoretical understanding of SRH, a model made up of four dimensions is proposed.
Said dimensions are defined by their content, i. In turn, between dimension and dimension there are multiple interactions. The type of self-perception we wish to assess depends on the dimension predominating in such interaction and on its characteristics, for example, if the approach tends to be more general or specific and if it seeks to evaluate social aspects, health aspects, or both7 Graphic 1.
Hereinafter, we present the different approaches of the evaluation according to the dimensions and type of self-perception, based on the proposal by Griffiths et al. This domain focuses on assessing specific health aspects and problems. Self-perception can collaborate and, on occasion substitute the assessment made by the health professional. For example, based on this domain, research has been conducted to identify elderly adults with mental disorder, hearing and vision loss, and problems with nutrition, mobility, and function.
This type of self-evaluation can help to predict current needs and some future ones. General health care approach. This domain is used for evaluating a broad range of factors related to health care. Mental health status, functional capacity, social contacts, and use of health services are among the aspects investigated in this domain. When approaching self-perception through this domain, internal and external factors of the individual are considered.
Social care and abilities for life approach. Aspects related to home safety along with risks of falling are also assessed. This provides greater elements for patient assessment and care. When approaching self-perception through this domain, internal factors of the individual are considered, as well as external factors like environment, employment, and leisure time.
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The main objective of this domain lies in identifying necessities and offering information that permits the individual to adequately satisfy such. Because of the great number of factors this domain can encompass, it is possible that it includes elements of self-assessment of social care along with life skills and the impact of the state of health. The distinction between the domain of general health care and the multidimensional approach lies on the balance and weight given to health problems and services.
For example, objective measurements often evaluate only one aspect, as with levels of glycated hemoglobin that are used in determining the state of control of diabetes mellitus.Objetividad y Subjetividad
Consequently, SRH is considered a type of self-perception employing elements from the multidimensional approach according to WHO recommendations Understanding the bio-psychosocial model requires an approach to the General Systems Theory, whose main exponent was Ludwig von Bertalanffy15, and stemming from this approach there can be integration between the parts and the whole, where relationships are not unidirectional but bidirectional and there is no cause and effect unicausal relationship, but one of multifactorial effect.
With respect to the SRH model suggested, a set of independent variables is shown that are grouped according to the state-of-health dimension to which they belong in social, demographic, biological, mental, and functional terms. From a subjective perspective, individuals will self-report their state of health. This implies that people must undergo complex reasoning involving multiple interactions of independent variables for the self-report of the state of health.
This interaction of multiple variables permits obtaining information on the state of health of the elderly adult during different moments, i. Additionally, said interaction may offer prospective elements that help to anticipate the development of any given event in the future. On this matter, SRH behaves as an intermediate variable among the independent variables that determine it and the different outcomes to which it has been associated like death, hospitalization, and functional impairment among others16 Graphic 2.
Many health professionals treating elderly adults focus mainly on factors related to physiological measurements laboratory valuesmental state presence of depressionlife styles smoking habitor functional state Basic Daily Activities. However, studies have shown that the perceptions offered by EA son their state of health and wellbeing can be as important as the clinical variables to evaluate and predict the evolution of the state of health over time9. Unfortunately, current clinical medicine practice has progressively stopped listening to patients their ailmentsand has replaced this for observation or measurements like diagnostic images or application of scales This has caused medicine to go from being a discipline involved with listening and feeling, to a discipline of seeing and doing; proof of this is the increase in the algorithms and guides for clinical practice in recent years.
It has also been employed to compare the state of health of EAs from different countries, because it can be easily obtained and reflects multiple aspects of the state of health that could be difficult to gather by other methods Analyzing the factors related with SRH will permit identifying health needs and evaluating programs and interventions aimed at EA population group. Hence, it should be included in research for the following reasons9: It is a global measurement of the state of health, psychological wellbeing, and quality of life related to health, offering much more information than other variables used in traditional research, for example, the presence of chronic illness or total cholesterol values, among others.
It is easily obtained through one single question: It behaves as a screening test because it helps to identify high-risk individuals in prodromal stages for the development of adverse health events like falls, and hospitalization among others.
At the individual level, it may predict mortality in the elderly; thereby, useful in current or future behavioral models to determine, for example, the use of retirement services or plans. It may be used to tailor health services and establish priorities in healthcare.
The researchers found an important association among SRH, chronic disabling disease, and functional capacity, measured via the Barthel scale, which evaluates Basic Daily Activities in the physical aspect. Recently, Parra et al. A positive association was found between perception of neighborhood safety with good SRH and quality of life related to health. Likewise, the availability of recreational spaces like safe parks that promote social interaction and recreational activities was associated to good SRH and quality of life in the mental health domain.
On the contrary, zones with high levels of noise were associated to bad SRH and quality of life. The value of this research lies in that it is the first study conducted in a highly urbanized city in a country with low to medium economic income.
Additionally, it offers inputs to implement interventions aimed at improving the quality of life and SRH of EAs living in cities with environmental and socioeconomic characteristics that are similar in several Latin American nations.
The study sought to determine the relative contribution of past events and current experiences to the state of health of EAs for the purpose of conducting opportune sanitary interventions for said population.
It was found that past experiences of socioeconomic aspects influenced SRH, and over half of the influence exerted by past events was measured by current experiences related to the socioeconomic situation, life style, and the presence of illnesses.
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Therefore, when caring for the elderly, consideration must be made for intervention of the risk factors related to life style. The importance of this research lies on the relationship established by the authors between social and clinical determinants with SRH.
Consequently, when implementing programs to reduce poverty and increase Access to healthcare and education, long-term strategies should be considered aimed at improving the health of the elderly of the future. The purpose of that work was to determine, via SRH, the relationship between demographic, social, and economic factors along with the presence of chronic disease and functional capacity in EAs 60 years of age and older. The study also sought to evaluate if there were gender differences.
It was found that presence of chronic disease in relation to gender was the greatest association to determine SRH, i. Likewise for educational level, income, and functional capacity were related to SRH. The novel aspect of this research is the approach of SRH from the multidimensional perspective, and that it may be useful for decision makers when implementing actions from the health sector seeking to promote wellbeing and quality of life for the elderly.
The aim was to determine the relationship between religiosity and SRH. The EAs who considered religion very important in their lives had lesser opportunity of reporting bad SRH when compared to those who considered religion less important.
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This is one of the first studies carried out in urban centers in Latin America and the Caribbean showing the importance of religiosity in the state of health of elderly adults. In recent years, surveys employed to assess state of health have used diverse questions trying to integrate the different dimensions of the human being These types of surveys take into account the self-report of health, through a subjective, global, and integrating evaluation of the state of health done by the individual.
This includes the perception of small physiological-type variations, negative or positive attitudes on life and disposition for healthy conducts; these are related to clinical morbidity, which is influenced by social, cultural and emotional aspects7. To assess SRH, a variety of schemes of structured questions has been designed with their possible responses, among which there is the WHO version employed in Europe and the United States version.
The World Health Organization version, which is recommended and used in Europe, takes a range of responses from very good to very poor. It is characterized because it groups the responses into several categories, of which two are positive very good and good ; one neutral regular ; and two negative poor and very poor The better known United States version is employed by Bjorner et al. How do you rate your state of health? How would you rate your current general state of health, compared to that of the previous year?
These last additions were included because of the study conducted by Ware et al. Regarding SF, this is the instrument developed for use in the Medical Outcomes Study, from an extensive battery of questionnaires, whose final format provides a profile of the state of health It includes 36 points grouped into 8 scales: These points assess positive and negative states of mental and physical health.
For each dimension, the points are coded, aggregated, and transformed into an ordinal scale ranging from 0 the worst state of health for that dimension to the best state of healthwithout generating a global index.
This instrument has been used in over 40 countries in the International Quality of Life Assessment Project. It is documented in more than 1, publications; its usefulness in estimating disease burden is described in over conditions and it is used worldwide because of its briefness and comprehension. It is worth pointing out that in the assessment made on Colombian adults a Spanish version was obtained showing complete coincidence with the expected original, high equivalency with the original values, and acceptable reproducibility, concluding that the SF is reliable in evaluating healthy quality of life after it was linguistically adapted in Colombian adults After evaluating self-perception with a single question, SRH was used to assess the perception individuals have of their own health in comparison to other people of the same age; this provides greater information than that offered by the concept of personal self-perception Table 1 shows the different questions that can be made when assessing state of health via SRH.
Also, when comparing the two questions with their possible responses to assess SRH, it has been found the WHO version discriminates the negative categories better, unlike the version from the United States that discriminates the positive categories better However, both types of questions are highly correlated and have shown similar associations with respect to demographic variables and health conditions, as well as having a similar variation pattern when applied in different countries Self-rated Health may be considered a global result of the measurement of multiple factors determining it.
In fact, it is influenced by demographic variables like gender and age; social variables like social networks and family functioning; biological variables like the presence of illnesses and taking of medications; mental variables like suffering anxiety, depression, dementia, or grief; and, lastly, functional variables like presenting commitment in the physical and instrumental Daily Basic Activities8.
The different factors determining SRH by group of variables are: Regarding differences in SRH according to gender, diverse explanations have been considered among which there are differences in the state of health, wellbeing, and functionality and not in the greater or lesser possibility of one or the other sex reporting a determined state of health.
This means the relationship between SRH and gender is mediated by other factors like educational level, illnesses, depression, and functional state. Here, it is worth mentioning that women report a greater proportion of health problems and have greater diagnosis of diseases like arterial hypertension, diabetes, musculoskeletal disorders, and accidents, aside from presenting greater frequency of affective disorders when compared to men. Given that women have higher life expectancies and, therefore, a greater possibility of enduring chronic disease that deteriorate their functionality, as those already mentioned, this could explain why they evidence greater association with the self-report of a bad SRH Adding to the aforementioned, women have a higher life expectancy than men.
This occurs at the expense of years lived with greater functional deterioration, that is, the consequences of the disease affect the internal and external perception of reality and translate to diminished quality of life when diminishing the possibilities of being and doing, which leads women to deteriorated perception of their own health and limitation of activities, functions, and opportunities Thus, better SRH has been constantly found in men than in women and this is more notorious in the elderly.
Another factor to bear in mind and that may explain a greater frequency of bad SRH in women is their lower income, which diminishes as they get older, and especially when they are very old It has also been postulated that with the passage of time in the elderly, SRH tends to regular or poor, which can be explained by multiple factors, including the loss of social roles, chronic disease and disability among others In spite of this, individuals over 90 years of age may paradoxically manifest good or excellent SRH, explained by different factors among which include: Heterogeneity of the aging process, which postulates that over the years —in spite of higher risk of illness and deterioration of the functional state, the elderly do not necessarily uniformly or inevitably manifest bad SRH Elderly adults take as reference groups other older individuals in whom disabilities are the norm, which leads them t orate their health positively; additionally, over time they start establishing adaptive mechanisms to accept their own aging process, the presence of chronic disease, and functional limitations Elderly individuals are more optimistic regarding their health as they age, because they have become accustomed and perceive illnesses and functional impairment more optimistically than the younger individuals The survival effect, i.
Elderly adults are a group that along the years has been exposed to multiple stressing events and subject to natural selection so survivors tend to be stronger and healthier In addition, with the passage of years SRH may have multiple paths, which are determined by diverse bio-psychosocial factors, consequently presenting great variability among individuals, which could also be related with the type of aging shown by the EA. The types of aging that have been described are successful, usual, or pathological EAs with successful aging, unlike those with usual or pathological aging, show high levels of physical, mental, and cognitive functioning, as well as lack of or low probability of developing disease or disability and an active commitment with life.
EAs with usual aging present non-pathological losses related with age and in pathological aging there is evidence of disease with disability and its multiple bio-psychosocial consequences Regarding the relationship between the type of aging and SRH, it has been suggested that EAs with successful aging show good and stable SRH over time; however, SRH begins to deteriorate after 80 years of age.
Nevertheless, paradoxically in some EAs 85 years of age and above SRH can stabilize or improve, which is explained, as mentioned before, because it is an optimistic group and because it is the result of natural selection The elderly with usual aging report SRH similar to EAs with successful aging although the SRH impairment process begins earlier, around 70 years of age.
Finally, EAs with pathological aging have bad SRH as a base and their impairment accelerates after 60 years of age Graphic 3 displays the relationship among age, functional capacity, type of aging, and SRH. However, exceptions are possible, particularly in certain populations of elderly adults, because this is a very heterogeneous group and this aspect may lead to important differences in the self-report of health19, Educational level is considered an important aspect determining better or worse SRH, inasmuch as individuals tend to have a better perception of their health when they have higher educational levels although they may have a greater number of illnesses It is considered that according to the educational level, the individual may have better tools to face vital stressing moments and, consequently, may modulate the result of SRH Regarding geographical location factors influencing SRH assessment, it has been found that these differ from one country to another This diversity of patterns may be due to the demographic and epidemiological transition stage in which the populations are found For example, in healthier populations the perception of better health may depend to a greater extent on emotional health, on chronic disease, or on functionality problems; while in populations with the worse health, the general self-evaluation of health may be more affected by other health problems like infectious disease Another possible explanation for the differences found is that individuals with similar levels of health perceive their state of health differently in relationship with determined structural elements of the national sanitary systems like quality of healthcare services or the importance given to the illnesses they suffer Likewise, the use of healthcare services may be associated with the evaluation of SRH; lowered use of sanitary services indicates better self-perception Results of longitudinal studies have revealed that survival is more related with subjective than with objective health and that healthcare is one of the factors associated with satisfactory aging Although the subjectivity of SRH is acknowledged because it accounts for the perception people have of their own health, this may have advantages in cases where the population does not have generalized access to healthcare services Much of the information about the use of SRH in elderly adults and its relationship with other indicators comes from developed nations8.
The assessment of the usefulness of this indicator in developing nations recently emerged with studies carried out in some countries in Latin America and Asia However, even in developed nations, the self-report of specific disease may enclose large bias In general, it is suggested that during old age the decline of the ego is intensified, deriving into a loss of identity, low self-esteem, and decrease of social conducts2.
In spite of the aforementioned, having a stable relationship like a matrimony, participation in community activities, and joining social groups may help to maintain a sense of continuity including a more positive SRH, even after retirement Prior awareness of an illness, particularly of chronic disease, suffered by the person, may affect the judgment the individual has of SRH Self-Rated Health is specially influenced by somatic experience that generates the illness.
Somatic experiences are physical manifestations that may be represented, for examples, by fatigue or a sensation of dyspnea, which can make individuals interpret they are suffering a serious condition and, consequently, modify their SRH. Knowledge of a potentially life threatening, serious disease like coronary disease or cancer, may have a greater impact on the individual, unlike knowing of a disease that impairs functionality but is not life threatening like osteoarthritis or hypertension, may lead to modifications of activities or behaviors and especially a change in SRH.
Hence, SRH is considered the product of a process depending to a great extent on the information the individual has of the subjective experience generated by the disease The presence of a disease may modify SRH, as can the clinical course; some diseases, especially those involving organic systems, like congestive heart failure, have periods of clinical stability but can also be intercalated with periods of exacerbation.
Thus, SRH represents a complex judgment made by the individual at a given moment on the severity of the current state of health, because the course of a disease can be modified over time. Also, in spite these being personal perceptions EAs of their own health, some studies have shown that the morbidity they perceive coincides by two thirds with that diagnosed by health professionals In studies, it has often been found an excellent or very good SRH in individuals with good physical health; however, paradoxically, it has also been noted that individuals with these same physical health characteristics have regular or poor SRH.
Later analyses have shown that these individuals have symptoms of depression or dissatisfaction with their lives One of the reasons why the self-concept, SRH, and their relationship with age suppose a problem is the perception by EAs of feeling psycholo-gically worse Indeed, depression is one of the most frequent mental disorders for EAs.
The prevalence is greater in hospitalized elderly subjects, and in those living nursing homes Frequently, depression emerges in EAs in atypical manner and does not fulfill the clinical criteria for major depression. These incomplete syndromes are denominated minor depression or subsyndromal depression according to the diagnostic statistical manual for mental disorders DSM-IV and have the same repercussions, in terms of morbidity and mortality, as major depression At the beginning of pneumogastry that heavy no hidden cost dating sites towers?
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