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      What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study

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          Abstract

          Background

          Poor self-rated health has been associated with poorer objective health outcomes across a range of conditions including stroke. Identification of factors associated with poor self-rated health in stroke survivors has received little attention compared to that in other older individuals. This study identifies determinants of self-rated health in older individuals with or without a history of stroke participating in the population-representative MRC Cognitive Function and Aging Study (MRC CFAS).

          Methods

          The MRC CFAS is a multicentred longitudinal survey of a population representative sample of people in their 65th year and older at baseline. Baseline interview included questions about functional disability, psychiatric history, independent living status, social interactions, and cognitive function. Multiple logistic regression was used to determine associations between demographic, physical, cognitive, psychological and social factors with poor self-rated health among those with and without stroke.

          Results

          After excluding those with impaired cognitive function, 776 individuals out of 11,957 reported a stroke. Factors associated with self-rated health were similar between those with or without a stroke in older individuals. Poorer self-rated health in those who had suffered a stroke was associated predominantly with the presence of comorbidity with diabetes (OR 3.5; 95% CI 1.5-8.1) and not “getting out and about” (OR 2.6; 95% CI 1.7-4.1) even after adjustment for disability levels and for depression. In those without a stroke the most important determinants were disability (OR 3.9; 95% CI 3.2-4.8) and not “getting out and about” (OR 2.9; 95% CI 2.5-3.3). The presence of disability was less strongly associated with poor self-rated health in those with a history of stroke than those without due to a substantially higher reporting of poor self-rated health in the non-disabled stroke group than the non-disabled stroke-free group, while those with disabilities reported poor self-rated health irrespective of stroke status.

          Conclusions

          Self-rated health is determined by a range of psychological and social factors in addition to disability in older patients with stroke. Addressing social integration and mobility out of the home is an important element of rehabilitation for older people with stroke as well as those without.

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          Most cited references 44

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          "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician.

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            Self-Rated Health and Mortality: A Review of Twenty-Seven Community Studies

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              Self-rated health and mortality: a review of twenty-seven community studies.

              We examine the growing number of studies of survey respondents' global self-ratings of health as predictors of mortality in longitudinal studies of representative community samples. Twenty-seven studies in U.S. and international journals show impressively consistent findings. Global self-rated health is an independent predictor of mortality in nearly all of the studies, despite the inclusion of numerous specific health status indicators and other relevant covariates known to predict mortality. We summarize and review these studies, consider various interpretations which could account for the association, and suggest several approaches to the next stage of research in this field.
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                Author and article information

                Contributors
                Journal
                BMC Geriatr
                BMC Geriatr
                BMC Geriatrics
                BioMed Central
                1471-2318
                2013
                22 August 2013
                : 13
                : 85
                Affiliations
                [1 ]Department of Public Health and Primary Care, University of Cambridge Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK
                [2 ]Department of Public Health and Primary Care, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK
                [3 ]School of Nursing Sciences, University of East Anglia Norwich Research Park, Norwich NR4 7TJ, UK
                1471-2318-13-85
                10.1186/1471-2318-13-85
                3847649
                23968389
                Copyright © 2013 Mavaddat et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Categories
                Research Article

                Geriatric medicine

                stroke self-rated health old age rehabilitation mobility

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