title: The predictive value of self-rated health in the presence of subjective memory complaints on permanent nursing home placement in elderly primary care patients over 4-year follow-up.
abstract: BACKGROUND
  self-rated health (SRH) predicts nursing home (NH) placement; subjective memory complaints (SMC) too. However, the predictive value of SRH in the presence of SMC is unclear.
  
  
  METHODS
  seven-hundred fifty-seven non-nursing home residents ≥65 years from general practices in Central Copenhagen were followed for 4 years (2002-2006). Patients gave information on SRH, cognition (SMC and MMSE), quality of life (EQ-5D) and socio-demographics. Information on comorbidities and permanent NH placement came from registries. The association between SRH (dichotomised into good versus poor) and SMC, and permanent NH placement was assessed using Cox proportional hazard regression adjusted for potential confounders.
  
  
  RESULTS
  NH placement totaled 6.5% at 4-year follow-up. Poor SRH increased NH placement [hazard ratio (HR) = 2.07, 95% CI: 1.11-3.87] adjusted for age, SMC, MMSE, sex and comorbidities. SRH was not associated with NH placement if accounting for additional health information; however, SMC was (HR = 2.47, 95% CI: 1.26-4.86). Increased placement was seen for patients with good SRH and SMC (HR = 6.64, 95% CI: 2.31-19.12), but not among patients with poor SRH and SMC (HR = 1.37, 95% CI: 0.59-3.20) when compared with the reference group (good SRH and without SMC).
  
  
  CONCLUSIONS
  both poor SRH and SMC were associated with permanent NH placement risk among elderly primary care patients. However, when SMC was present a reverse association was found for SRH: good SRH increased NH placement. Since SRH is integrated in widely used psychometric instruments, further research is needed to establish the mechanism and implications of this finding.
authors.affiliation: The Research Unit and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Anni B S
authors.initials: AB
authors.lastname: Nielsen
authors.forename: Volkert
authors.initials: V
authors.lastname: Siersma
authors.forename: Gunhild
authors.initials: G
authors.lastname: Waldemar
authors.forename: Frans B
authors.initials: FB
authors.lastname: Waldorff
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000523:psychology*; D016009:Chi-Square Distribution; D003071:Cognition; D015897:Comorbidity; D015986:Confounding Factors, Epidemiologic; D003718:Denmark; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006304:Health Status; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008568:Memory; D008569:Memory Disorders / Q000175:diagnosis / Q000523:psychology*; D015999:Multivariate Analysis; D009735:Nursing Homes; D011320:Primary Health Care; D016016:Proportional Hazards Models; D011594:Psychometrics; D011788:Quality of Life; D012307:Risk Factors; D057566:Self Report; D012737:Sex Factors; D013997:Time Factors
keywords: cohort studies; family practice, older people; nursing homes; self-rated health; subjective memory complaints