How is Change in Physical Health Status Reflected by Reports of Nurses and Older People Themselves?

Self-rated health is assumed to closely reflect actual health status, but older people's shifting norms and values may influence this association. We investigated how older people's change in self-ratings, in comparison to their retrospective appreciation and change in nurse ratings, reflect functional decline and mortality risk.

A representative sample of 85-year olds from a middle-sized city in the Netherlands, excluding those with severe cognitive dysfunction, was followed for 6 years. Participants and a research nurse annually provided ratings of health, and participants retrospectively appreciated their annual change in health. Functional status was assessed with the Groningen Activity Rating Scale and all were followed for vital status.

Functional decline was reflected by all reports of change in health (all p < .001). When incongruent, change in nurse-ratings reflected functional decline better than change in self-ratings but retrospective appreciation reflected functional decline best (p < .001 vs change in self-ratings and p < .05 vs change in nurse-ratings). Mortality risk was only reflected by retrospective appreciation (p < .01).

Retrospective appreciation of health by older people is superior to change in self-ratings and nurse-ratings in reflecting change in physical health, possibly because similar norms and values are applied in the assessment. The nurse's norms, like the norms of older people, may shift with the ageing of the researched cohort. Asking people to retrospectively appreciate their change in health is a valuable addition to usual enquiries in practice and research.