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FUNCTIONAL DEFICITS IN PATIENTS OVER 44 YEARS OF AGE AND THEIR EFFECT ON SELF-RATED HEALTH
Simeonova Joana Ivanova
Medical university, Department of Public health sciences, Pleven
Kostadinova Penka Stefanova2
Medical university, Department of Public health sciences, Pleven
Stoilova Irena Iordanova
Medical university, Department of Hygiene and occupational diseases, Pleven
ABSTRACT
Background: Many studies found significant association between the poor functional status of individuals and the negative self-rated health. The aim of that study was to identify the problems of functioning in patients and to establish their effect on self-rated health.
Methods: A cross-sectional study was carried out in 2014. Two hundred and twelve patients over 44 years of age were included in the study. The study was a part of the Project N0 11/2014 which was funded by the Medical University of Pleven.
Standardized questionnaire EQ-5D-3L was used to identify the functional deficits in patients. Self-rated health was measured by 5-ordinal scale including 3 positive categories (excellent health, very good health and good health) and 2 negative categories (fair health and poor health).
Data were processed by SPSS.v.19. Group differences were tested for statistical significance by Pearson's chi-square (p< 0.05).
Results: Most of the patients (42.5%) assessed their health as good. Almost 20% had poor health and only 2.3% - excellent health. Each of five dimensions significantly associated with self-rated health of patients. Many respondents who had the deficits with mobility, self-care, usual activity performance and experienced anxiety/depression or pain/discomfort, assessed more frequent their health as fair or poor (p<0.05).
Conclusion: Our study confirmed the findings by the other researchers. Deteriorated functioning in most patients had a significant role for the negative SRH. However, the predictive abilities of EQ-5D-3L regarding to self-rated health can be confirmed by longitudinal study.
Keywords: self-rated health, EQ-5D-3L, mobility, self-care, usual activity performance, pain/discomfort, anxiety/depression, functional deficits
Background: Many studies found significant association between the poor functional status of individuals and the negative self-rated health. The aim of that study was to identify the problems of functioning in patients and to establish their effect on self-rated health.
Methods: A cross-sectional study was carried out in 2014. Two hundred and twelve patients over 44 years of age were included in the study. The study was a part of the Project N0 11/2014 which was funded by the Medical University of Pleven. We selected 115 hospital patients and 97 patients from general practice setting. The age and sex distributions of Bulgarian population in 2013 were applied in the process of sampling. The patients were randomly selected. Written consent was obtained from every participant after being completely informed about the study.
Standardized questionnaire EQ-5D-3L was used to identify the functional deficits in patients in five dimensions: mobility, self-care, usual activity performance and experienced anxiety/
depression and pain/discomfort [6, 8 c.]. Each dimension included 3 levels: no problems, moderate problems, extreme problems. Because of the small part of respondents who had "extreme problems", that category of variable was combined with the second category in one category „functional deficits".
Self-rated health (SRH) was measured by 5-ordinal scale including 3 positive categories (excellent health, very good health and good health) and 2 negative categories (fair health and poor health). The respondent should be answering the question „How would you rate our health at present?" He should show one of these five categories of SRH.
Data were processed by SPSS.v.19. Group differences were tested for statistical significance by Pearson's chi-square (p< 0.05).
Results: The distribution of persons by gender and age was showed in Table 1. Almost 53percent were women, the mean age was 61 years old.
Table 1
Sociodemographic characteristics of patients (Number, %)
Variable Number (%) Variable Number (%)
Gender Age
Male 98 (47.1) 45-49 yrs 39 (18.5)
Female 110 (52.9) 50-59 yrs 58 (27.5)
60-69 yrs 55 (26.1)
70-79 yrs 37 (17.5)
over 80 yrs 22 (10.4)
Mean age 61.0
Most of the patients (42.5%) assessed their health as good. Almost 20% had poor health and only 2.3% - excellent health (figure 1).
42,5
27,8 Г1 1 19,4
s ■ 1 1
exellent health very good health good health fair health poor health
Figure 1. Distribution of patients by their self-rated health (%)
We found similar results in the other publications [1,2,5,7,16, c. 8,9]. The difference in some categories of the variable probably is due to the differences in population and health status of the respondents (age, chronic diseases) or applied methodology in self-rated health (phrasing the question and variable categories,
scales). DeSalvo et al (2005) have studied the patients which mean age was the same with the age of our patients.
Significant differences by gender and age were established by the second variable only. With aging self-rated health deteriorated (figure 2).
Figure 2. Distribution of patients by their self-rated health and age (%)
About 16 percent of patients assessed their health as poor in the 45-49 age group. The proportion of poor SRH in the group over 80 years of age was two times higher as compared to the youngest age group (31.8%, p=0.001). These results were similar to the results by Chan et al (2015), Haseen et al (2010), Nutzel
et al (2014), Velkova et Grancharova (2000), as partly explained by physical health deterioration with aging. Rarely, we found the publications disproved that self-rated health deteriorated with aging. Hoeymans et al (1997) made two assumptions about the smaller age-related changes in SRH. The first mechanism
is the reference group theory according to which persons rate their health relative to the health of their peers. The second mechanism is adaptation to worsening health conditions.
The information about functional status of patients in each of five dimensions of EQ-5D-3L was showed in Table 2.
Over 40% reported about deficits in mobility, almost 15% had deficits in self-care; about 40% had deficits in usual activity performance. A higher proportion of patients experienced pain/ discomfort (68%) or anxiety/depression (56.9%).
Table 2
Distribution of patients by EQ-5D-3L (%)
Dimension (%)
Mobility
a) No problems 59.6
b) Moderate problems 39.4
c) Extreme problems 1.0
Self-care
а) No problems 85.6
6) Moderate problems 12.9
b) Extreme problems 1.5
Usual activity performance
a) No problems 62.0
b) Moderate problems 31.3
c) Extreme problems 6.7
Pain/Discomfort
d) No problems 32.0
e) Moderate problems 60.6
a) Extreme problems 7.4
Anxiety/Depression
f) No problems 43.1
g) Moderate problems 52.5
h) Extreme problems 4.4
The significant differences in the three dimensions of EQ-5D-3L by age were established. The proportion of patients who had deficits in mobility, self-care and reported about pain or discomfort was significantly higher in the oldest age group in compare with the youngest age group (p<0.05). These
results were similar to results reported by Haseen et al (2010), Hoeymans et al (1997), Velkova et Grancharova (2000). The gender differences in EQ-5D-3L were not significant (p>0.05).
Additionally, we discussed the problem about any significant association between SRH h EQ-5D-3L (figure 3-7).
Figure 3. Distribution of patients by mobility deficits and their SRH (%)
%юо
90 80 70 60 50 40 30 20 10 О
45,5
30,6
26,7
раш health fair health goo d health I very gootl health ■ ejidknt health
fLinclionaI deficits without functional deficits
Figure 4. Distribution of patients by self-care deficits and their SRH (%)
Over 35 percent of patients who had deficits in mobility assessed their health as poor in compare with the patients without deficits on the same dimension (8,3%, p=0.001). Similar statistics was found in the others [4,8,13,16, c. 8,9].
The proportion of respondents with poor SRH and self-care deficits was significantly higher as compared to those with poor SRH and without self-care deficits (figure 4). The same was confirmed by Cott et al (1999), Velkova et Grancharova (2000), Herman et al (2001).
without functional deficits
functional deficits
19 44,3 36,7
-
ife 12,7 34,1 42,1 9,5
0% 20% 40% 60% 80% 100%
I exellent health ■ very good health good health fair health poor health
Figure 5. Distribution of patients by usual activity performance deficits and their SRH (%)
Almost 40 percent of patients reported about deficits of usual activity performance and assessed their health as poor in compare with these without functional deficits (figure 5). Similar results have been found by the other researchers [4,8,
16, c. 8,9]. It has been important to emphasize that most of these publications revealed the significant association in elderly who were selected by general population.
■ eiielleiit health ■ verygoodheaith good health {¡»health poor health
functional deficits without functional deficits
Figure 6. Distribution of patients by experienced pain or discomfort and their SRH (%)
Figure 7. Distribution of patients by experienced anxiety or depression and their SRH (%)
Experienced pain was significantly associated with more frequent assessment of self-rated health as poor. That was established in patients with chronic diseases and poor functioning, and in patients without serious health problems [4,10,11,13,14, c. 8,9]. Our study found that the negative SRH was significantly three times more frequent in patients with pain or discomfort as compared to persons without these symptoms (figure 6). That was confirmed by experienced anxiety/depression and SRH (figure 7) and has been confirmed by the others [13,11,12,15, c. 9].
Conclusion: Our study confirmed the findings by the other researchers. Deteriorated functioning in most patients had a significant role for the negative SRH. The use of EQ-5D-3L integral indicator in our study shown that indicator reflected the effect of physical, mental and social factors on self-rated health. However, the predictive abilities of EQ-5D-3L can be confirmed only by longitudinal study.
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