What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study

Abstract

BackgroundPoor self-rated health has been associated with poorer objective health outcomes across a range of conditions including stroke. Identification of factors associated with poor self-rated health in stroke survivors has received little attention compared to that in other older individuals. This study identifies determinants of self-rated health in older individuals with or without a history of stroke participating in the population-representative MRC Cognitive Function and Aging Study (MRC CFAS).MethodsThe MRC CFAS is a multicentred longitudinal survey of a population representative sample of people in their 65th year and older at baseline. Baseline interview included questions about functional disability, psychiatric history, independent living status, social interactions, and cognitive function. Multiple logistic regression was used to determine associations between demographic, physical, cognitive, psychological and social factors with poor self-rated health among those with and without stroke.ResultsAfter excluding those with impaired cognitive function, 776 individuals out of 11,957 reported a stroke. Factors associated with self-rated health were similar between those with or without a stroke in older individuals. Poorer self-rated health in those who had suffered a stroke was associated predominantly with the presence of comorbidity with diabetes (OR 3.5; 95% CI 1.5-8.1) and not “getting out and about” (OR 2.6; 95% CI 1.7-4.1) even after adjustment for disability levels and for depression. In those without a stroke the most important determinants were disability (OR 3.9; 95% CI 3.2-4.8) and not “getting out and about” (OR 2.9; 95% CI 2.5-3.3). The presence of disability was less strongly associated with poor self-rated health in those with a history of stroke than those without due to a substantially higher reporting of poor self-rated health in the non-disabled stroke group than the non-disabled stroke-free group, while those with disabilities reported poor self-rated health irrespective of stroke status.ConclusionsSelf-rated health is determined by a range of psychological and social factors in addition to disability in older patients with stroke. Addressing social integration and mobility out of the home is an important element of rehabilitation for older people with stroke as well as those without.

Gender Differences in the Predictors of Physical Activity Among Assisted Living Residents

“…Better self‐rated health predicted a higher amount of PA. Self‐rated health has been consistently identified as a predictor of PA in older adults (Dogra, ). In addition, self‐rated health has been reported to be a significant predictor of health outcomes (Mavaddat, Van der Linde, Savva, Brayne, & Mant, ). PA might play a mediating role between self‐rated health and health outcomes.…”

"Re" cognition of patients with Stroke through a Tutorial Education Program

“…Pode-se perceber, por exemplo, que sequelas motoras, e principalmente a depressão, são fatores determinantes na postura do usuário em relação à sua própria saúde. 14 Os déficits também se destacam, pois significativo porcentual de usuários declarou apresentar déficits prévios, como sequelas de AVE anteriores ou de outras doenças ou traumas. Esse fato é interessante no momento da avaliação dos novos déficits adquiridos a partir do episódio atual de AVE.…”

Interpretations of self-rated health in stroke survivors from a semi-rural community in South East Asia

“…Stroke recovery is known to be multidimensional and complex process (Vanhook, 2009) and carries long-term impacts on health. Survivors generally rated their health worse, as compared with the stroke-free general population (Larsen, Johnsen, Andersen, & Hjollund, 2016;Mavaddat et al, 2013). While poor physical health contributed significantly to poor self-rated health (Mavaddat et al, 2013), social factors that encourage activities out of the home seemed to moderate the effects of poor physical health (Larsen et al, 2016).…”

“…SRH correlated well with objective health (Hunt et al, 1980), but has been more strongly associated with physical health than mental health (Smith, Avis, & Assmann, 1999). Studies of older adults have shown that mental, social and physical dimensions contributed to an individual's assessment of their SRH (Mavaddat, Van der Linde, Savva, Brayne, & Mant, 2013), which may involve complex cognitive processes (Jylhä, 2009) that are also influenced by the personal, social and cultural identities of the individual (McMullen & Luborsky, 2006), otherwise known as the environmental and contextual factors that surrounds and shapes the individual. Therefore, SRH may capture elements of health that structured questionnaires may not due to its inclusive nature (Jylhä, 2009).…”