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Why so many older Americans rate their health as good or even excellent

Judith Graham, Kaiser Health News on

Published in Health & Fitness

"Older people expect some deterioration in health and aren't thrown off course in the same way when it occurs," said Jason Schnittker, a professor of sociology at the University of Pennsylvania who has studied self-rated health.

Resilience is also at play. As older adults adapt to illness and other physical changes, they tend to adjust their outlook. "I may be handicapped, but I can still walk," one 86-year-old woman told Swiss researchers after being hospitalized due to a fall and forced to use a stick to get around. She considered herself fortunate and rated her health positively. "As long as you can get to church, as long as you can walk, you can say all's well," a man in his 80s declared after becoming severely disabled because of a slipped disc in his spine and an embolism. He, too, felt good about his health.

Lest you think older adults' bias toward positivity is a sign of denial or a lack of objectivity, a large body of research shows it's highly meaningful. "Self-rated health is very strongly predictive of longevity" as well as other outcomes such as cognitive health and use of health care services, Schnittker noted.

Idler and Yael Benyamini, a professor at Tel Aviv University's Bob Shapell School of Social Work, were among the first scholars to highlight the association between self-rated health and mortality in a much-cited 1997 study that examined research reports from around the world. The link was consistent even when adjustments were made for respondents' medical conditions, medication use, health care utilization, socioeconomic status and other factors.

In a phone conversation, Benyamini offered two explanations for this finding, which has been widely replicated. People may be acutely attuned to subtle changes in their bodies, like increased pain or fatigue, that end up being significant but may be hard for doctors to detect. Also, people may factor in how multiple medical conditions interact and affect them -- something that medical tests don't pick up.

"Say you have diabetes, angina and osteoarthritis. How does this affect your life? It's very individual -- no one can tell from the outside -- and it's hard to put your finger on as a physician," she said.

Another possible explanation is that people who feel healthy are more likely to be active and take care of themselves, making it likely they'll survive longer, Benyamini said.

Of course, this positivity isn't universal. African Americans, Hispanics, people with lower levels of income and education, and individuals with poor social connections are more likely to rate their health negatively as they age. At younger ages, women rate their health more poorly than men, but this changes in later life, with men becoming more likely to report worse health and women becoming more optimistic.

Sometimes, surveys assess self-rated mental health separately, and results for older adults again overturn common assumptions about negativity associated with older age. The National Social Life, Health, and Aging Project, spearheaded by investigators at the University of Chicago, found that fewer than 1% of adults (ages 57 to 97) rated their mental health as poor; just under 8% considered it fair; nearly 23% thought it was good; nearly 41% believed it was very good; and 28% judged it excellent. This data, based on a representative sample of 3,101 individuals surveyed in 2015, was provided upon request and has not yet been published.

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"Mental health becomes an even more important component of self-rated health with age," Schnittker said. Depression, in particular, appears to be a negative influence, affecting how people view their circumstances.

Although Laurie Brock, 69, of Denver, has severe arthritis and systemic lupus erythematosus, she considers her health "very good" and credits her optimism, her close relationships and her "extremely active life." Poor health would mean being bedridden, "not being able to go out or be as mobile as I am" or extended suffering, she said.

"My attitude now is 'I've lived 70 good years, and I hope the next years are rich as well," Brock said. "I think most people fear old age. But once they get there, it's like, 'Oh, I'm still going, I'm still OK.' And fear becomes acceptance."

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Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

(c)2019 Kaiser Health News

Visit Kaiser Health News at www.khn.org

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