How the combined approach of subjective and functional health improves the early identification of the older adults at risk of adverse events?

Background

Combining the assessment of subjective health and functional health may provide a more comprehensive approach to characterize and address the health needs of the older adults.

Objective

To explore the relationship between functional (IADL-limitation) health combined with self-rated health (SRH), and the risk of adverse events: mortality, ADL-limitation and institutionalization.

Methods

The sample included 4429 participants aged 65 years and over from three French population-based cohorts followed up to 20 years. An indicator combining a SRH item and IADL-limitation was created to define four "health status" groups: (1) Good SRH without IADL-limitation (reference); (2) Poor SRH without IADL-limitation; (3) Good SRH with IADL-limitation; (4) Poor SRH with IADL-limitation. Survival models analyzed separately the association between health status and risk of death, ADL-limitation or institutionalization.

Results

Compared with participants with good SRH and no IADL-limitations, individuals without IADL-limitations who reported poor SRH also had an increased risk of death, ADL-limitation and institutionalization. In addition, those with IADL limitations, regardless of their SRH status, had at least twice the risk of death and subsequent ADL-limitations.

Conclusion

Our findings revealed that as soon as perceived a poor SRH, even in the absence of IADL-limitation, the risk of adverse health events increases. These risks are higher for individuals with IADL-limitations, regardless of their SRH status. These preliminary findings emphasize that taking into account perception of decline in absence of limitations can help to identify early symptoms before irreversible losses occur, allowing for the implementation of targeted prevention strategies for older adults.