Reporting biases in self-assessed physical and cognitive health status of older Europeans

Abstract

This paper explores which demographic characteristics substantially bias self-reported physical and cognitive health status of older Europeans. The analysis utilises micro-data for 19 European countries from the Survey of Health, Ageing and Retirement in Europe to compare performance-tested outcomes of mobility and memory with their self-reported equivalents. Relative importance analysis based on multinomial logistic regressions shows that the bias in self-reported health is mostly due to reporting heterogeneities between countries and age groups, whereas gender contributes little to the discrepancy. Concordance of mobility and cognition measures is highly related; however, differences in reporting behaviour due to education and cultural background have a larger impact on self-assessed memory than on self-assessed mobility. Southern as well as Central and Eastern Europeans are much more likely to misreport their physical and cognitive abilities than Northern and Western Europeans. Overall, our results suggest that comparisons of self-reported health between countries and age groups are prone to significant biases, whereas comparisons between genders are credible for most European countries. These findings are crucial given that self-assessed data are often the only information available to researchers and policymakers when asking health-related questions.

Role of cognitive resources on everyday functioning among oldest-old physically frail

“…However, when an incongruence between performance and reported IADL (and more precisely an overestimation of difficulties compared to the actual performance) is observed among cognitively healthy elders, while some authors proposed the influence of age [38,39], cognition [10,39] or culture [40], this can be an early indicator of physical decline and cognitive compensation process involved. Hence, ADL performance during performance-based assessments probably relies more heavily on cognitive resources than on physical functioning, which is supported by the strong correlation observed between cognitive resources and TIADL scores (irrespective of physical functioning conditions).…”

Biases in health expectancies due to educational differences in survey participation of older Europeans: It’s worth weighting for

“…Low-educated survey respondents are particularly prone to misreporting their health. Some evidence suggests that loweducated individuals have the tendency to overestimate their physical health; whereas, highly educated persons tend to underestimate their physical health [57]. If that is the case, the bias in HEX that is associated with underrepresentation of low education could appear smaller than it actually is, because low-educated individuals are overstating their physical abilities.…”

“…GALI is a self-assessed health measure, and as such, is likely biased depending on the respondent's individual characteristics [50][51][52][53] and cultural background [54][55][56][57]. Low-educated survey respondents are particularly prone to misreporting their health.…”

“…If that is the case, the bias in HEX that is associated with underrepresentation of low education could appear smaller than it actually is, because low-educated individuals are overstating their physical abilities. Furthermore, self-assessed measures are often upward biased at older ages [57,58], presumably due to peer effects [59]. Thus, as a robustness analysis, the prevalence of bad health is also estimated based on grip strength, a tested measure that is expected to be less biased by systematic misreporting.…”

The cross-sectional average length of healthy life (HCAL): a measure that summarizes the history of cohort health and mortality

“…GALI is strongly associated with limitations in activities of daily living (such as washing, getting dressed or out of the bed), intermediately associated with limitations in instrumental activity of daily living (such as the need of assistance in doing light housework or managing medication), and somewhat lower association with physical limitations (biting, chewing, or kneeling) in most European countries [43]. Nevertheless, self-reported survey questions might still be influenced by age, culture, and social background of the respondent [44]. For these reasons, the presented trends should be interpreted with caution.…”