title: Among older adults, the responsiveness of self-rated health to changes in Charlson comorbidity was moderated by age and baseline comorbidity.
abstract: OBJECTIVE
  To examine the impact of changes in comorbidity--as measured by the Charlson comorbidity index--on self-rated health in a large sample of community-dwelling elderly over a 1-year period, and to examine the differential effects of changes in specific Charlson diagnostic categories.
  
  
  METHODS
  Longitudinal survey data on self-rated health were linked with Medicare inpatient, outpatient, and physician visit data for 30,535 U.S. elderly residing in Pennsylvania. Multivariate logistic regression with fractional polynomials was used to model relationships involving baseline and changing Charlson comorbidity with self-rated health decline, and to evaluate covariate interactions.
  
  
  RESULTS
  Comorbidity change was associated with greater likelihood of worsened self-rated health, but the relationship was nonlinear and was moderated by age and baseline comorbidity. The impact of comorbidity change appeared to be less among older individuals and those with higher baseline comorbidity. Declines in self-rated health were most likely following new diagnoses for metastatic tumors, paralysis, and dementia.
  
  
  CONCLUSIONS
  Self-rated health is responsive to changes in Charlson comorbidity, but nonlinearity and interactions suggest complexity in how elderly respond to comorbidity change. Younger individuals and those with initially low comorbidity are more likely to reduce self-ratings of health following new diagnoses for chronic conditions.
authors: First Health Services Corporation/PACE, 4000 Crums Mill Road, Suite 301, Harrisburg, PA 17112, USA. DebraHeller@firsthealth.com
authors: Debra A
authors: DA
authors: Heller
authors: Frank M
authors: FM
authors: Ahern
authors: Kristine E
authors: KE
authors: Pringle
authors: Theresa V
authors: TV
authors: Brown
mesh_terms: D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D005260:Female; D015577:Geriatric Assessment; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010414:Pennsylvania / Q000453:epidemiology; D011788:Quality of Life; D012111:Residence Characteristics