Health perception and health status in advanced old age: A paradox of association
Introduction
There is a deterioration in both health status and perceived health in advanced old age. However, the perception of health declines less rapidly with the advancing years than the health status. This widening disparity can be accounted for by various psychosocial mechanisms that come into play when individuals evaluate their state of health. In this paper, we start by examining how the perceived and the objective state of health change over time among a cohort of octogenarians. Noting that the perception stands up better to the passage of time, we explain this disparity by the fact that older people evaluate their state of health, not in the absolute but rather in relation to what they can reasonably expect in the light of their circumstances and their very advanced age. We focus in particular on three processes applied by older people in assessing their health, namely, downward social comparison and, to a lesser extent, upward social comparison and temporal comparison.
Section snippets
State of health, perception of health and comparison mechanisms
The fact that the state of health deteriorates in very old age is well established (e.g., Jette, 1996, Steinhagen-Thiessen and Borchelt, 1999). The perceived health, defined as an individual's evaluation of his or her own health (Perrig-Chiello & Darbellay, 2004), is closely linked to the state of health as measured by more objective indicators (Pinquart, 2001). Many authors have shown that functional health (Idler et al., 1999, Krause and Jay, 1994), physical disorders (Borawski et al., 1996,
Data
We derive our results from data of the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (SWILSOO), which records trajectories of life and health in advanced old age, their determinants, the impact of major disturbances and the principal regulatory methods employed. The project comprises two parts of unequal size: a main quantitative part and an additional qualitative part.
SWILSOO was launched in 1994 and involves two five-year cohorts (persons born 1910–1914, N = 340, started in 1994;
Health status and perceived health in a cohort of octogenarians
Fig. 1 shows the average number of chronic conditions and self-rated health as a function of the age of participants in the SWILSOO survey.3
Comparison mechanisms
In the work on SWILSOO, we asked people to compare their state of health with that of their peers.5
In two cases out of three, people consider their health to be better than that of their peers; in only 5% of cases is it considered to be poorer. From Table 2, it can be seen that there is a strong link between health
Real and fictive comparison groups
As mentioned above, the process of comparison may refer either to specific persons or to a more abstract group of persons (Schulz and Decker, 1985, Taylor and Lobel, 1989). As people aim their comparison at individuals who belong to the same group as themselves, the points of comparison available are not numberless in the case of very old people like the participants in our survey, who even themselves sometimes feel like “survivors” (Johnson & Barer, 1997). From that point of view, nursing
Upward social comparison and temporal comparison
The process of comparing oneself with someone in better condition was applied by a few of the participants in our survey. There was, for example, the case of a woman whose self-perception benefited greatly from the presence of a cousin of 90, “interested in everything”.
« Last year, I went to see one of my cousins who was celebrating his 90th birthday. I tell you, if you saw the way he drove his car! (…) Now that gives you a boost, a man who is interested in everything. In fact, we are going to
Discussion
In this paper, we highlight the paradox that health status and health perception diverge with advancing age. The divorce between objective and perceived health raises the question of the interpretative mechanisms operative in advanced old age. We attempt to explain this divergence in terms of comparison processes. These processes are shaped not only by the target of the comparison (an individual whose situation is either more or less favourable) but also by the attitude of the person making the
Acknowledgments
This analysis forms part of the research being conducted under the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (SWILSOO), which is funded by the Swiss National Science Foundation (Principal Investigator Prof. Christian J. Lalive d'Epinay) with the support of the Departments of Health of the cantons of Geneva and Valais. The authors wish to thank Prof. Christian Lalive d'Epinay for his judicious advice, Ian Hamilton for his editorial assistance, and two anonymous reviewers for
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