| Abstract: | Introduction: Self-rated Health (SRH) is a commonly measured concept in gerontological studies. The single item measure of older people’s subjective rating of their current health status has proven a reliable predictor of mortality, even after controlling for numerous objective health measures. A great majority of nursing home residents are disabled elders with a poorer rating of SRH. That is, the more ADL disabilities a resident has, the poorer his/her SRH ratings and few studies have focused on the combinations of ADL disabilities and SRH among nursing home residents. In this study, frequent combinations of ADL disabilities among a group of disabled elders were identified to correlat with their ratings of their subjective health.
Methods: Data were taken from a face-to-face interview survey (N=514) on disabled elders, aged 60 or over in 2008, who had been institutionalized or users of long-terms care services in central Taiwan. Self-rated Health were measured with a single item, “regarding your state of health, would you say it is excellent (=5), good, average, poor, or very poor (=1).” There were 6 items in the ADL scale, tapping to the performance on 6 self-care tasks (toilet, bath, eat, dress, transfer, and walk). The coding for each of the tasks is: “no difficulties” = 0, “somewhat difficult” =1, “very difficult” = 2, and “can’t do it at all” = 3. Both the number of the 6 tasks with any difficulty and the summing score of the 6 items were calculated.
Results: The average self-rated health for the surveyed elders was 2.90 (Standard Deviation=1.06) and correlation between the number of ADL disability items and SRH was -.022 (p<.001, more ADL disability items, lower the SRH ratings). For the combinations of ADL disability, we found that “walking” appeared in all of the frequently identified combinations of ADL disabilities, implying that it was the first self-care disability a disabled would develop over the disablement process. The combination with highest mean SRH ratings was not from the participants who were free of any ADL disabilities (N=57, mean SRH = 3.07), instead the participants with the combination of “walking” and “bathing” (N=37, mean SRH = 3.35) and the participants with the combination of “walking,” “bathing,” and “toileting” (N=26, mean SRH = 3.27) were the combinations with the highest SRH ratings. Plus, there were disabled elders with all 6 ADL disabilities and still rated their health as “excellent.”
Conclusion: For the long-term care services users, whose self-care ability had been compromised tremendously, some of them still show resilience and find a way to interpret their health as adequate, as long as the provided services could meet some of their needs. |
