Subjective health in old age from a salutogenic perspective

We applied Antonovsky's salutogenic model to healthy ageing. Basically, salutogenic theory states that generalized resistance resources build-up the sense of coherence which in turn determines an individual's health level. Specifically, we explored the status of the sense of coherence as a mediator variable.

We conducted a cross-sectional questionnaire study with 387 volunteering elders (73.4% women and 22.2% nursing home residents) at the mean age of 74 (SD=7.58) years. We assessed 19 bio-psychosocial resources, the sense of coherence, and three subjective health measures - psychological health, symptom reporting, and physical health. As nursing home residents were generally inferior, our study controlled for dependent living.

Resources, sense of coherence, and subjective health were significantly inter-related. A regression showed that optimism, self-esteem, low depressive mood, self-efficacy, and social support predicted the sense of coherence significantly. Predicting psychological health and symptom reporting, the sense of coherence remained significant when resources were added in the final step of the regression. This pattern was not found for physical health. Mediator analyses using Preacher and Hayes' paradigm showed that every eligible resource influenced both psychological health and symptom reporting, but not physical health, indirectly via the sense of coherence.

The sense of coherence is largely shaped by individual difference variables. As a mediator variable, it strongly accounts for the relation between resources and psychogenic aspects of health, whereas its relative significance for physical health is not corroborated. Our findings emphasize the importance of resource-oriented health care for elders.