Does self-rated health predict survival in older persons with cognitive impairment?
OBJECTIVE
To determine whether baseline self-rated health (SRH) independently predicted survival in an older Canadian population and to investigate the role of cognition on the SRH-mortality relationship.


METHODS
Population-based prospective cohort study.


METHODS
Ten Canadian provinces, community-based.


METHODS
A total of 8,697 community-dwelling participants aged 65 and older.


METHODS
Self-reported measures of overall health, physical function, comorbidities, and demographic characteristics were obtained by interview. Cognitive ability was ascertained using the Modified Mini-Mental State Examination (3MS). Participants were followed for their survival status from the initial interview in 1991 until October 31, 1996.


RESULTS
Subjects with reports of poor SRH were significantly more likely to die during follow-up than those reporting good SRH, after adjusting for relevant covariates (adjusted hazard ratio (AHR)=1.38, 95% confidence interval (CI)=1.24-1.53). SRH was also related to other measures of health status across levels of cognitive impairment. SRH remained a significant predictor of mortality in subjects with mild to moderate cognitive impairment (AHR=1.26, 95% CI=1.01-1.59) but not in those with severe cognitive impairment (AHR=1.00, 95% CI=0.76-1.31).


CONCLUSIONS
This study supports the utility of SRH assessments in predicting survival of individuals with mild to moderate cognitive impairment. The findings highlight the potential role of complex cognitive processes underlying the SRH-mortality relationship.
Walker
Jennifer D
JD
Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
Maxwell
Colleen J
CJ
Hogan
David B
DB
Ebly
Erika M
EM
D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000401:mortality*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012649:Self Concept; D016019:Survival Analysis