Trajectories and Meaning of Self-Rated Health in Advanced Age A 30-Year Longitudinal Study

BackgroundSRH is widely used to subjectively gauge health status. We aimed to identify the trajectory and risk factors for poor SRH between ages 70-100 years, and associated mortality throughout the aging lifespan.MethodsThe Jerusalem Longitudinal Study (1990-2021) is prospective longitudinal study of a representative community dwelling birth cohort (born 1920-1921) at ages 70,78,85,90,95 and 100 (n=604, 1024, 1222, 729, 508, 205 respectively). Comprehensive assessment included the question "Do you feel healthy?"; “no” defined as poor SRH.ResultsPoor SRH prevalence ranged from 22%-44%, with no trend over time (p=0.09). Poor SRH was more frequent among women at all ages (P<0.001 at 70-85, P<0.03 at 90-95), and the gender gap persisted across ages 70-95. Depression was consistently the most significant risk factor for declining SRH, with a 3-4.6 times higher risk compared to non-depressed (P≤0.04). Financial difficulty, physical inactivity, impaired activities of daily living, and higher comorbidity showed numerous correlations with declining SRH. A robust statistically significant link between SRH and mortality was observed throughout, with poor SRH consistently predicting shorter life expectancy, after adjusting for known risk factors. Subjects with good SRH and high comorbidity had significantly better health outcomes and longevity compared to poor SRH and low comorbidityConclusionsSubjective health assessment is a holistic measure, encompassing the complexity of aging, and may serve as an early screening tool to identify populations at high risk for functional decline and mortality. The protective nature of good self-rated health suggests its potential role in strategies aimed at healthy aging.