The aim of the proposed research is to investigate the reasons why elderly individuals' subjective assessments of their helath status have proved to be such remarkably accurate predictors of mortality, even in comparison with physician's assessments. Some preliminary analysis of the National Health and Nutrition Examination Survey I has identified a factor not previously known to be associated with subjective assessments of health status: the discrepancy between an individual's report of joint pain and a physician's findings of joint disorder. In the NHANES I, individuals whose reports of joint pain exceeded the physician's findings were also more likely to report poorer self-assessments of health; likewise individuals with fewer reports of pain were more likely to report good health. The proposed research will further investigate the significance of these discrepancies in three ways. First, it will employ secondary analysis of the NHANES I and Rand Corporation Health Insurance Experiment to identify the demographic, social, and cultural correlates of these discrepancies with the specific aim of developing a theoretical model of the processes by which subjective evaluations of health are made. Analysis of age differences in these discrepancies will address the ways in which individuals take aging and chronic illness into account in formulating their subjective health assessments. Second, the project will investigate the possibility that such discrepancies help explain the association between better self-assessments of health and survival. This part of the analysis will employ longitudinal data from the Yale Health and Aging Project and from the NHANES I Epidemiologic Followup Study (NHEFS). Finally, the model developed in the first three analyses will be tested in a clinical setting, the International Center for the Disabled, New York. A random sample of patients in treatment at the Center will have the NHANES I musculoskeletal examination and Arthritis Supplement administered to them. Individuals with and without such discrepancies will be interviewed in depth regarding their perceptions of pain, their cognitive strategies in evaluating their overall health status, the sociocultural correlates of these processes, and an assessment of the implications of these processes for life expectancy, health, and physical functioning.
| Idler, E L (1993) Age differences in self-assessments of health: age changes, cohort differences, or survivorship? J Gerontol 48:S289-300 |
| Idler, E L; Kasl, S (1991) Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 46:S55-65 |
| Idler, E L; Kasl, S V; Lemke, J H (1990) Self-evaluated health and mortality among the elderly in New Haven, Connecticut, and Iowa and Washington counties, Iowa, 1982-1986. Am J Epidemiol 131:91-103 |
| Idler, E L; Angel, R J (1990) Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study. Am J Public Health 80:446-52 |
