Unpacking Self-Rated Health and Quality of Life in Older Adults and Elderly in India: A Structural Equation Modelling Approach

The Study on global AGEing and adult health (SAGE) aims at improving empirical understanding of the health and well-being of older adults in low- and middle-income countries. A total of 321 adults aged 50 years and older were interviewed in rural Pune district, India, in 2007. We used Structural Equation Modelling (SEM) to examine the pathways through which social factors, functional disability, risk behaviours, and chronic disease experience influence self-rated health (SRH) and quality of life (QOL) amongst older adults in India. Both SRH and QOL worsened with increased age (indirect effect) and limitations in functional ability (direct effect). QOL, socio-economic status (SES), and social networking had no significant effect on SRH. Smoking was associated with the presence of at least one chronic illness, but this did not have a statistically significant effect on SRH. Higher social networking was seen amongst the better educated and those with regular income, which in turn positively affected the QOL rating. QOL had a direct, but statistically not significant, effect on SRH. In conclusion, the indirect effects of age on SRH mediated through functional ability, and the effects of SES on QOL mediated through social networking, provide new understanding of how age and socio-economic status affect SRH and QOL. By allowing for measurement errors, solving for collinearity in predictor variables by integrating them into measurement models, and specifying causal dependencies between the underlying latent constructs, SEM provides a strong link between theory and empirics.     

Is Subjective Status Influenced by Psychosocial Factors?

Objective Associations between subjective status and health are still relatively unexplored. This study aimed at testing whether subjective status is uniquely confounded by psychosocial factors compared to objective status, and what factors that may predict subjective status. Design A cross-sectional analysis of a population-based, random sample of 795 middle-aged men and women from the southeast of Sweden. Questionnaires included subjective status, objective measures of socioeconomic status, life satisfaction, and a battery of psychosocial factors. Associations were controlled for effects of age and sex. Results Both subjective status and occupation were significantly associated with self-rated health also after control for psychosocial factors. Stepwise regression showed that subjective status was significantly influenced by self-rated economy, education, life satisfaction, self-esteem, trust, perceived control, and mastery. Conclusion The association between subjective status and self-rated health does not seem to be uniquely confounded by psychosocial factors. Both resource-based measures and psychological dimensions seem to influence subjective status ratings. Comparative studies are required to study whether predictors of subjective status vary between countries with different socio-political profiles.     

Determinants of Self-Rated Health Among Canadian Seniors Over Time: A Longitudinal Population-Based Study

Self-rated health has been found to be an effective and inexpensive measure of people’s overall health. Although cross-sectional studies have identified determinants of self-rated health (SRH), there is a limited insight into the determinants of SHR overtime and their impact on the change of SRH overtime. This present study compares determinants of SRH among a large community-dwelling cohort of Canadian seniors (N = 3255) at three points in time (1991, 1996, and 2001), and examines the effects of determinants on change in SRH over a 10-year period. Data analyzed were from the Canadian Study of Health and Aging—a large-scale longitudinal population-based study conducted between 1991 and 2001. The results showed that most seniors (over 80 %) rated their health as good, and their SRH remained surprisingly constant over time. Only a person’s physical and instrumental functioning and the number of chronic diseases were consistently associated with SRH at each point in time (1991, 1996, and 2001). Factors including cognition, daily functioning, chronic disease, and availability of help were significantly linked to self-rated health over time. These determinants should be considered important stimuli for improving health among seniors.     

The Association Between Perceived Income Inequality and Subjective Well-being: Evidence from a Social Survey in Japan

Previous studies have shown that income inequality in society is negatively associated with individuals subjective well-being (SWB), such as their perceived happiness and self-rated health (SRH). However, it is not realistic to assume that individuals have precise information about actual income distribution measured by the Gini coefficient or other statistical measures. In the current study, we examined how perceived income inequality, rather than actual inequality, was associated with SWB, using cross-sectional data collected from a nationwide, Internet survey conducted in Japan (N = 10,432). We also examined how this association was confounded by individuals’ objective and subjective income status, considering the possibility that individuals with lower income status are more inclined to both perceive income inequality and feel unhappy/unhealthy. In our analysis, we focused on the perception of widening income inequality (as perceived income inequality), perceived happiness and SRH (as SWB), and household income and living standards compared with 1 year ago and compared with others (as income status). We also controlled for personality traits. We obtained three key findings: (1) perceived income inequality was negatively associated with SWB; (2) both perceived income inequality and SWB were associated with income status; and (3) the association between perceived income inequality and SWB was attenuated after controlling for income status, but not fully for perceived happiness. These findings suggest that perceived income inequality, which links actual income inequality to SWB, should be further studied.     

Exposure to Violence,Coping Strategies,and Diagnosed Mental Health Problems Among Adults in a Migrant-Sending Community in Central Mexico

Deadly violence has spread throughout Mexico, affecting the well-being of citizens. What is the impact of this violence on the daily lives of Mexican adults? Building upon the stress process model, we used a mixed-methods approach to examine relationships between multiple indicators of exposure to and fear of violence and four diagnosed mental health outcomes, as well as self-rated mental health, in a Mexican community using the Survey of Health and Mexican Migration (456 surveys; 49 interviews). The multivariate models provide evidence that perceptions of insecurity are associated with diagnosed depressive episode, agoraphobia, alcohol abuse, a total count of mental health conditions, and poor self-rated mental health. Past victimization is associated with anxiety. Stress and coping behaviors did not formally mediate these violence–mental illness associations. The qualitative results confirm that residents fear violence and cope by adjusting their personal behaviors. These results foreshadow the emergence of mental health conditions as a critical public health concern for Mexicans living under the threat of violence.     

Acculturation and Self-rated Health Among Asian Immigrants: The Role of Gender and Age

Using the 2002–2003 National Latino and Asian American Study (NLAAS), we examine the relationship between acculturation and poor-to-fair self-rated health (SRH) among Asian immigrants (N?=?1639). Using latent class analysis, we construct a multidimensional measure of acculturation that considers dimensions of involvement in U.S. culture as well as attachment to Asian ethnic cultures and identify three classes of Asian immigrants: the assimilated, who most strongly adhere to U.S. culture; the integrated, who align with both U.S. and Asian ethnic cultures; and the separated, who are almost exclusively attached to Asian ethnic cultures. Logistic regression results revealed that among the pooled sample of Asian immigrant adults, the separated are significantly more likely to report poor-to-fair SRH than the assimilated. We then tested for gender and age differences in the acculturation–SRH relationship, and found that stratifying by gender yields noticeably different patterns. Among Asian immigrant women, the probability of reporting poor-to-fair SRH increases with age for the separated and the integrated, while it declines with age for the assimilated. Conversely, among Asian immigrant men, the probability of reporting poor-to-fair SRH increases most steeply with age for the assimilated, while it is shallower for the separated and the integrated. Future research should continue to develop a dynamic understanding of acculturation and examine its association with other health outcomes, including how these relationships differ across subsets of immigrant groups.

     

Living Arrangements and the Well-Being of Single Mothers in Japan

The goal of this study is to evaluate the extent to which the well-being of single mothers in Japan is related to coresidence with other adults. Using data from a representative survey of households headed by single mothers, we examine two measures of subjective well-being: perceived economic circumstances and self-rated health. One-fourth of the single mothers surveyed were coresiding with another adult(s) and it is clear that these women fare significantly better than their non-coresiding counterparts on both measures of well-being. Net of several theoretically relevant sociodemographic, family, and employment characteristics, single mothers living with others were significantly less likely to report somewhat difficult/difficult economic circumstances or fair/poor health. Efforts to account for potential endogeneity between well-being and living arrangements suggested that self-rated health, but not subjective economic well-being, is related to selection into coresidence. Single mothers in fair/poor health appear more likely to coreside with others and, accounting for this selection, intergenerational coresidence appears to be very beneficial for self-rated health. We discuss the implications of these findings for processes of stratification in Japan in light of the limited public income support available to single mothers.     

Neighborhood Characteristics and Older Adults’ Well-Being: The Roles of Sense of Community and Personal Resilience

The ecological model stresses the importance of the neighborhood context to aging successfully. This cross-sectional study aimed to examine the associations between neighborhood characteristics (public space, senior population density, and senior service) and the well-being of older adults, with sense of community as a potential mediator and personal resilience as a potential moderator. The sample consisted of 628 individuals (aged 60–97 years) recruited from 32 neighborhoods in Beijing, China. They completed measures of resilience, sense of community, and well-being. Neighborhood characteristics, including per capita public space, senior population density, and senior services, were obtained from neighborhood committees. We used hierarchical linear modeling to analyze the individual data from participants’ self-reported measures and objective data regarding neighborhoods. The results showed that: (a) public space, senior population density, and senior services were positively associated with the well-being of older adults; (b) sense of community mediated the above associations; (c) the associations between neighborhood characteristics—such as per capita public space, senior services, and well-being—were strengthened by personal resilience. This study highlighted the importance of neighborhoods to older adult’s well-being, including objective characteristics and a subjective sense of community. Besides personal strength, enhancing neighborhood resources is recommended to promote the well-being of elderly people.     

Does Weighting Capture What’s Important? Revisiting Subjective Importance Weighting with a Quality of Life Measure

The present study evaluated subjective importance weighting using data collected with the Injection Drug User Quality of Life Scale (IDUQOL). Weighted and unweighted IDUQOL scores from 241 adults were correlated with convergent, discriminant, and criterion measures. Regression analysis was used to examine the contribution of importance ratings to scores on a global measure of life satisfaction and the corrected weighted IDUQOL total scores. Overall, the results showed that weighted scores did not perform better than unweighted scores in measuring quality of life. However, the mean satisfaction ratings for important domains correlated significantly higher with convergent measures than did the mean satisfaction ratings for unimportant domains. This finding suggests further attention needs to be paid to the meaning and measurement of subjective importance and how it may be incorporated more effectively into measures of quality of life.     

Gender,Widowhood, and Long-Term Care in the Older Mexican American Population

SUMMARY

The objective of this study is to examine the influences of gender on long-term care service use among older Mexican American widows and widowers. Our analysis is based on a sample of 773 widows and 183 widowers from the Longitudinal Study of Elderly Mexican American Health (H-EPESE). In this sample widows resemble widowers in terms of demographic and health characteristics. However, widows report more financial strain than widowers and a greater welfare dependency (SSI) and Medicaid use. Among those who suffered diminished health, widows were more likely than widowers to use community-based long-term care services whereas widowers were more likely to enter a nursing home. Widows also had more instrumental and socioemotional support than widowers. Serious cognitive and functional impairment, though, places widows and widowers at the same risk of institutionalization. We end with a discussion of the policy implications of these findings.     

The Latent Dimensions of Poor Self-Rated Health: How Chronic Diseases,Functional and Emotional Dimensions Interact Influencing Self-Rated Health in Italian Elderly

Self-Rated Health (SRH) is becoming one of the most popular indicator of population health. Nevertheless, a limited understanding still remains about the elements to which individuals refer when evaluating their health and how those elements act and interact in the evaluation process. In this study we use a structural equation model with latent variables to identify direct and indirect influences of various health dimensions (chronic morbidity, functional abilities and emotional health) and socio-demographic covariates (age, gender and education) on poor SRH. The sample consists of 25,183 Italian elderly aged 65 years and over, interviewed in the 2005 National Health Interview Survey. The results have pointed out the higher direct effect of psychological and emotional health on SRH, while the higher total effect is caused by chronic morbidity, which influences SRH both directly and altering functional and emotional health. Growing older, being a woman and having a low education negatively impacts on SRH. However, this is almost completely the result of the indirect effect exerted by the covariates, while their direct effect is not significant (gender), negative (age) or very modest (education).     

The Effects of Children’s Migration on Elderly Kin’s Health: A Counterfactual Approach

Recent studies of migration and the left-behind have found that elders with migrant children actually experience better health outcomes than those with no migrant children, yet these studies raise many concerns about self-selection. Using three rounds of panel survey data from the Indonesian Family Life Survey, we employ the counterfactual framework developed by Rosenbaum and Rubin to examine the relationship between having a migrant child and the health of elders aged 50 and older, as measured by activities of daily living (ADL), self-rated health (SRH), and mortality. As in earlier studies, we find a positive association between old-age health and children’s migration, an effect that is partly explained by an individual’s propensity to have migrant children. Positive impacts of migration are much greater among elders with a high propensity to have migrant children than among those with low propensity. We note that migration is one of the single greatest sources of health disparity among the elders in our study population, and point to the need for research and policy aimed at broadening the benefits of migration to better improve health systems rather than individual health.     

Life Satisfaction of Older Adults in Hong Kong: The Role of Social Support from Grandchildren

This study explores the relationship between the life satisfaction of older adults and the social support from grandchildren in Hong Kong. Two hundred and fifteen older people (from the ages of 64 to 101, mean age 79.3), whose youngest grandchild was aged 12 or older, were recruited from elderly service agencies to participate in the study. Face-to-face interviews were conducted by trained interviewers using a standardized questionnaire, which included the Life Satisfaction Scale for Chinese, the Lubben Social Network Scale, the Chinese Tradition Scale, grandchildren social support measures, self-rated health, self-rated financial adequacy, and demographic variables. Hierarchical regression showed that the life satisfaction of older adults benefitted significantly from the social support from grandchildren (R ² change = .05, F _change = 7.15, p < .001); while controlling demographic characteristics, general social support, attitude towards Chinese tradition, self-rated health, and self-rated financial adequacy. The total explained variance was 51%. Emotional support and appraisal support from grandchildren were identified as significant contributing factors. The policy and practice implications for active aging policies are discussed in a Chinese context.     

Migration, health, and environment in the desert southwest

The “immigrant health paradox” has captured the attention of researchers struggling to understand why immigrants to the United States appear to have health advantages that would not be predicted by their socioeconomic position. This research extends prior analyses through examination of the potential role of environmental factors in explaining the immigrant health paradox. We use data from the Phoenix Area Social Survey, a survey conducted in 2006 of approximately 800 individuals. Multilevel ordered logistic models examine three health outcomes: self-rated health, heat stress, and asthmatic symptoms. An innovation is our multiple considerations of contextual factors, including neighborhood amenities, disorder, traffic counts, and the heat index. We have three key findings: (1) frequent local migration has negative impacts on health, (2) the local neighborhood environment partially mediates differences between US-born non-Hispanic Whites and foreign-born Hispanics, and (3) subjective measures of the local environment tend to have greater effects than objective measures. In sum, our analyses suggested a need for studies of place and health to consider migration and residential history as a factor shaping health outcomes. Further, regarding the immigrant paradox, the results suggest the need to move beyond a dichotomous measure of immigration contrasting international migrants with native-born residents.     

Overeducation,Skills and Wage Penalty: Evidence for Spain Using PIAAC Data

Despite well documented high levels of socioeconomic inequalities, health gradients by socioeconomic status (SES) in contemporary China have been reported to be limited. Using data from the 2010–2012 China Family Panel Studies, we reexamine associations between three sets of SES—human capital, material conditions, and political capital—and self-rated health among Chinese adults 18–70 years old, capitalizing on anchoring vignette data to adjust for reporting heterogeneity. We find strong evidence of substantial variations in reporting behaviors by education, cognition, and family wealth but not by family income or political capital. Failing to correct for reporting heterogeneity can bias the estimates of SES gradients in self-rated health as much as nearly 40 %. After vignette adjustment, we find significantly positive associations of education, family income, wealth, and political capital with self-rated health. Individuals’ cognitive capacity, however, does not predict self-rated health.     

Gender, widowhood, and long-term care in the older Mexican American population

The objective of this study is to examine the influences of gender on long-term care service use among older Mexican American widows and widowers. Our analysis is based on a sample of 773 widows and 183 widowers from the Longitudinal Study of Elderly Mexican American Health (H-EPESE). In this sample widows resemble widowers in terms of demographic and health characteristics. However, widows report more financial strain than widowers and a greater welfare dependency (SSI) and Medicaid use. Among those who suffered diminished health, widows were more likely than widowers to use community-based long-term care services whereas widowers were more likely to enter a nursing home. Widows also had more instrumental and socioemotional support than widowers. Serious cognitive and functional impairment, though, places widows and widowers at the same risk of institutionalization. We end with a discussion of the policy implications of these findings.     

Migration Selection, Protection, and Acculturation in Health: A Binational Perspective on Older Adults

In this article, we test for four potential explanations of the Hispanic Health Paradox (HHP): the “salmon bias,” emigration selection, and sociocultural protection originating in either destination or sending country. To reduce biases related to attrition by return migration typical of most U.S.-based surveys, we combine data from the Mexican Health and Aging Study in Mexico and the U.S. National Health Interview Survey to compare self-reported diabetes, hypertension, current smoking, obesity, and self-rated health among Mexican-born men ages 50 and older according to their previous U.S. migration experience, and U.S.-born Mexican Americans and non-Hispanic whites. We also use height, a measure of health during childhood, to bolster some of our tests. We find an immigrant advantage relative to non-Hispanic whites in hypertension and, to a lesser extent, obesity. We find evidence consistent with emigration selection and the salmon bias in height, hypertension, and self-rated health among immigrants with less than 15 years of experience in the United States; we do not find conclusive evidence consistent with sociocultural protection mechanisms. Finally, we illustrate that although ignoring return migrants when testing for the HHP and its mechanisms, as well as for the association between U.S. experience and health, exaggerates these associations, they are not fully driven by return migration-related attrition.     

Which Life Domains Impact Most on Self-Rated Health? A Cross-Cultural Study of Switzerland and its Neighbors

General life satisfaction (GLS) is a strong health correlate and can be conceptualized as an aggregate of satisfactions in different life domains and as a proxy for quality of life. Little is known about which life domains—measured as domain satisfactions—contribute most to GLS and are the best predictors of self-rated health (SRH) and whether these associations differ between countries and/or language areas. We used stepwise logistic regression models to investigate how domain satisfactions, GLS and SRH are interrelated and compared German-speaking and French/Italian-speaking Switzerland with the corresponding neighboring countries of Germany, Austria, France and Italy. The associations of domain satisfactions with GLS and SRH varied significantly in magnitude and between countries and language areas. GLS was strongly related to self-rated health in all populations, but more so in the German-speaking than the French/Italian-speaking regions. Adjusted for all domain satisfactions, satisfaction with one’s financial situation and job satisfaction showed independent effects on SRH and were the most important predictors of GLS, although no clear geographical pattern emerged. Domain-specific satisfactions were similarly associated with GLS and SRH, but the strength of the association varied between German-, French- and Italian-speaking populations. Any similarity between Swiss language areas and neighboring countries was limited to German-speaking populations. Country- and language-specific life domain satisfactions may provide useful pointers for targeting policies in the respective domains.     

The Importance of Spousal Education for the Self-Rated Health of Married Adults in the United States

Education’s benefits for individuals’ health are well documented, but it is unclear whether health benefits also accrue from the education of others in important social relationships. We assess the extent to which individuals’ own education combines with their spouse’s education to influence self-rated health among married persons aged 25 and older in the United States (N = 337,846) with pooled data from the 1997–2010 National Health Interview Survey. Results from age- and gender-specific models revealed that own education and spouse’s education each share an inverse association with fair/poor self-rated health among married men and women. Controlling for spousal education substantially attenuated the association between individuals’ own education and fair/poor self-rated health and the reduction in this association was greater for married women than married men. The results also suggest that husbands’ education is more important for wives’ self-rated health than vice versa. Spousal education particularly was important for married women aged 45–64. Overall, the results imply that individuals’ own education and spousal education combine to influence self-rated health within marriage. The results highlight the importance of shared resources in marriage for producing health.