Is Self-Rated Health Different for Nonagenarians?

TL;DR

This study explores how nonagenarians rate their health, finding that mobility and symptoms matter more than diseases, and that self-rated health still predicts mortality.

Contribution

The paper provides new insights into how health is perceived and evaluated by people aged 90 and older.

Findings

Nonagenarians associate health with mobility, symptoms, and daily functioning rather than diseases.

Self-rated health remains a strong predictor of mortality in the oldest-old.

Participants compared themselves to peers to maintain a relatively positive health perception.

Abstract

Self-rated health (SRH) is a well-known predictor of mortality. In younger old people, chronic conditions are a major determinant of SRH. Less is known about SRH among people aged 90 and older, a small but rapidly growing population group with rather short life-expectancy and high multimorbidity. This paper discusses the contents and meanings of ´health´ in self-ratings of nonagenarians, contrasting different types of data from the Vitality 90+ project in Tampere, Finland. The project includes repeated survey studies with all individuals aged 90+ in the area plus qualitative interviews and face-to-face health examinations with subgroups. In the 2023 qualitative life story interviews (N = 54), participants framed diseases as given facts in high age and discussed health in relation to the ability to do things, manage everyday life, experienced symptoms, cognitive capacity and medications. They used comparisons to age peers with poorer condition or already deceased, to construct a relatively positive view of their own health. This is consistent with our earlier analysis in the survey data, where mobility and subjective symptoms were more important direct associates of SRH than diseases. Perhaps surprisingly, SRH showed a robust, graded association with mortality also in nonagenarians. During 4.6 years, mortality rate was 43% for good & fairly good and 89% for fairly poor & poor SRH. Our findings invite discussion about the meaning of ´health´ and about the most relevant experienced hallmarks of physiological vitality in the oldest-old.