European Journal of Ageing

, Volume 9, Issue 4, pp 305–318 | Cite as

Determinants of change in self-rated health among older adults in Europe: a longitudinal perspective based on SHARE data

  • Georgia VerropoulouEmail author
Original Investigation


The present study aims at detecting factors which may predict a decline or an improvement in self-rated health (SRH) of older adults (persons aged 50 or higher) among socio-demographic characteristics, physical and mental health indicators and risky health behaviours. In the analysis, multinomial logistic regression models are applied to data from waves 1 and 2 of the Survey of Health Ageing and Retirement in Europe (carried out about 3 years apart); persons who report a decline or an improvement in SRH at wave 2 are compared to those who report no change while controlling for SRH at baseline and country of residence. The analysis was carried out for the whole sample and two subgroups, persons aged 50–64 and 65 or higher. The results indicate that female sex and higher educational attainment have a strong protective effect against decline in SRH. Worse health at baseline is an important predictor of subsequent decline but changes occurring between the waves have a more pronounced effect, implying that SRH is influenced more by recent developments. The findings also indicate that improvement in SRH is a more complex concept than decline and is strongly affected by factors other than health. Among behavioural risk factors, low levels of physical activity and a decrease in the levels of activity between the waves are significantly related to decline while frequent drinking seems associated with improvement. Differentiations by age are modest and probably suggest that advancing age is related to a milder view of one’s health.


Self-rated health SHARE Longitudinal Decline Improvement 


  1. Andersen FK, Christensen K, Frederiksen H (2007) Self-rated health and age: a cross-sectional and longitudinal study of 11,000 Danes aged 45–102. Scandinavian J Public Health 35:164–171CrossRefGoogle Scholar
  2. Angel R, Guarnaccia P (1989) Mind, body and culture: somatization among hispanics. Soc Sci Med 28(12):1229–1238CrossRefGoogle Scholar
  3. Appels A, Bosma H, Grabauskas V, Gostautas A, Sturmans F (1996) Self-rated health and mortality in a Lithuanian and a Dutch population. Soc Sci Med 42(5):681–689CrossRefGoogle Scholar
  4. Arber S, Cooper H (1999) Gender differences in health in later life: the new paradox? Soc Sci Med 48:61–76CrossRefGoogle Scholar
  5. Avendano M, Jürges H, Mackenbach JP (2009) Educational level and changes in health across Europe: longitudinal results from SHARE. J Eur Social Policy 19(4):301–316CrossRefGoogle Scholar
  6. Bailis DS, Segall A, Chipperfield JG (2003) Two views of self-rated general health status. Soc Sci Med 56:203–217CrossRefGoogle Scholar
  7. Bardage C, Pluijm SMF, Pedersen NL, Deeg DJH, Jylhä M, Noale M, Blumstein T, Otero A (2005) Self-rated health among older adults: a cross-national comparison. Eur J Ageing 2:149–158CrossRefGoogle Scholar
  8. Baron-Epel O, Kaplan G (2001) General subjective health status or age-related subjective health status: does it make a difference? Soc Sci Med 53(10):1371–1481CrossRefGoogle Scholar
  9. Borawski EA, Kinney JM, Kahana E (1996) The meaning of older adults’ health appraisals: congruence with health status and determinant of mortality. J Gerontol B Psychol Sci Soc Sci 51(3):S157–S170CrossRefGoogle Scholar
  10. Börsch-Supan A, Brugiavini A, Jürges H, Mackenbach J, Siegrist J, Weber G (eds) (2005a) Health, ageing and retirement in Europe, first results from the survey of health, ageing and retirement in Europe. Mannheim Research Institute for the Economics of Ageing (MEA), MannheimGoogle Scholar
  11. Börsch-Supan A, Hank K, Jürges H (2005b) A new comprehensive and international view on ageing: introducing the “Survey of Health, Ageing and Retirement in Europe”. Eur J Ageing 2(4):245–253CrossRefGoogle Scholar
  12. Chan YH (2005) Biostatistics 305. Multinomial logistic regression. Singapore Med J 46(6):259–269Google Scholar
  13. Chandola T, Ferrie J, Sacker A, Marmot M (2007) Social inequalities in self-reported health in early old age: follow-up of prospective cohort study. BMJ. doi: 10.1136/bmj.39167.439792.55
  14. D’Uva TB, O’Donnell O, van Doorslaer E (2008) Differential health reporting by education level and its impact on the measurement of health inequalities among older Europeans. Int J Epidemiol 37:1375–1383CrossRefGoogle Scholar
  15. Delbès C, Gaymu J, Springer S (2006) Women grow old alone, but men grow old with a partner. A European overview. Population & Societies 419 INED, FranceGoogle Scholar
  16. DeSalvo KB, Bloser N, Reynolds K, He J, Munter P (2005) Mortality prediction with a single general self-rated question: a meta analysis. J Gen Intern Med 21(3):267–275CrossRefGoogle Scholar
  17. Dewey ME, Prince MJ (2005) Cognitive function. In: Börsch-Supan A, Brugiavini A, Jürges H, Mackenbach J, Siegrist J, Weber G (eds) Health, ageing and retirement in Europe, first results from the survey of health, ageing and retirement in Europe. Mannheim Research Institute for the Economics of Ageing (MEA), MannheimGoogle Scholar
  18. Eriksson I, Undén AL, Elofsson S (2001) Self-rated health. Comparisons between three different measures. Results from a population study. Int J Epidemiol 30:326–333CrossRefGoogle Scholar
  19. Eurostat (2011) Causes of death statistics (documentation online). Accessed 10 Dec 2011
  20. Fonda S, Herzog A (2004) Documentation of physical functioning measured in the Health and Retirement Study and the Asset and Health Dynamics among the Oldest Old Study. HRS/AHEAD Documentation ReportGoogle Scholar
  21. Gilmore A, McKee M, Rose R (2002) Determinants of and inequalities in self-perceived health in Ukraine. Soc Sci Med 55:2177–2188CrossRefGoogle Scholar
  22. Grundy E, Holt G (2001) The socioeconomic status of older adults: how should we measure it in studies of health inequalities? J Epidemiol Commun Health 55(12):895–904CrossRefGoogle Scholar
  23. Hasson D, Arnetz BB, Theorell T, Anderberg UM (2006) Predictors of self-rated health: a 12-month perspective study of IT and media workers. Popul Health Metr 4(8):1–11Google Scholar
  24. Huisman M, Kunst AE, Mackenbach JP (2003) Socio-economic inequalities in morbidity among the elderly: a European overview. Soc Sci Med 57:861–873CrossRefGoogle Scholar
  25. Idler EL, Benyamini Y (1997) Self-rated health and mortality: a review of twenty-seven community studies. J Health Soc Behav 38:21–37CrossRefGoogle Scholar
  26. Idler EL, Kasl SV (1991) Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol 46(2):S55–S65Google Scholar
  27. Jang Y, Chiriboga DA, Kim G, Cho S (2009) Changes in perceived health and depressive symptoms: a longitudinal analysis with older Korean Americans. J Immigrant Minority Health 11:7–12CrossRefGoogle Scholar
  28. Jürges H (2007) True health vs. response styles: exploring cross-country differences in self-reported health. Health Econ 16:163–178CrossRefGoogle Scholar
  29. Katz S (1983) Assessing self maintenance: activities of daily living, mobility and instrumental activities of daily living. J Am Geriatr Soc 31(12):721–726Google Scholar
  30. Katz S, Ford AB, Moskowitz RW, Jackson BA, Jaffe MW (1963) Studies of illness in the aged. The index of ADL: a standardised measure of biological and psychological function. JAMA 185:914–919CrossRefGoogle Scholar
  31. Katz S, Downs TD, Cash HR, Grotz RC (1970) Progress in development of the index of ADL. Gerontologist 10:20–30CrossRefGoogle Scholar
  32. Kunst AE, Bos V, Lahelma E, Bartley M, Lissau I, Regitor E, Mielck A, Cardano M, Daalstra J, Geurts J, Helmert U, Lennartsson C, Ramm J, Spadea T, Stronegger W, Mackenbach J (2005) Trends in socioeconomic inequalities in mortality in self-assessed health in 10 European countries. Int J Epidemiol 34(2):295–305CrossRefGoogle Scholar
  33. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9(3):179–186CrossRefGoogle Scholar
  34. Leinonen R, Heikkinen E, Jylhä M (2001) Predictors of decline in self-assessments of health among older people—a 5 year longitudinal study. Soc Sci Med 52(9):1329–1341CrossRefGoogle Scholar
  35. Lindeboom M, Van Doorslaer E (2004) Cut-point shift and index shift in self-reported health. J Health Econ 23:1083–1099CrossRefGoogle Scholar
  36. Mackenbach JP, Van De Bos J, Joung IMA et al (1994) The determinants of excellent health: different from the determinants of ill-health? Int J Epidemiol 23(6):1273–1281CrossRefGoogle Scholar
  37. McCullough ME, Laurenceau JP (2004) Gender and the natural history of self-rated health: a 59-year longitudinal study. Health Psychol 23(6):651–655CrossRefGoogle Scholar
  38. Nicholas S, Huppert FA, McWilliams B, Melzer D (2003) Physical and cognitive function. In: Marmot M, Banks J, Blundell R, Lessof C, Nazroo J (eds) Health, wealth and lifestyles of the older population in England: The 2002 English Longitudinal Study of Ageing. IFS, London, pp 249–271Google Scholar
  39. Ongaro F, Salvini S (1995) Understanding self-perceived health in the elderly: an analysis of 1986 Italian data. Eur J Popul 11:123–141CrossRefGoogle Scholar
  40. Orfila F, Ferrer M, Lamarca R, Alonso J (2000) Evolution of self-rated health status in the elderly: cross-sectional vs. longitudinal estimates. J Clin Epidemiol 53:563–570CrossRefGoogle Scholar
  41. Perlman F, Bobak M (2008) Determinants of self rated health and mortality in Russia—are they the same? Int J Equity Health 7(19):1–8Google Scholar
  42. Prince MJ, Reischies F, Beekam ATF, Fuhrer R, Jonker C, Kivela SL, Lawlor BA, Lobo A, Magnusson H, Fichter M, Van Oyen H, Roelands M, Skoog I, Turrina C, Copeland JRM (1999) Development of the EURO-D scale—a European Union initiative to compare symptoms of depression in 14 European centres. Br J Psychiatry 174:330–338CrossRefGoogle Scholar
  43. Sacker A, Wiggins R, Bartley M, McDonough P (2007) Self-rated health trajectories in the United States and the United Kingdom: a comparative study. Am J Public Health 97(5):812–818CrossRefGoogle Scholar
  44. Sargent-Cox KA, Anstey KJ, Luszcz MA (2010) The choice of self-rated health measures matter when predicting mortality: evidence from 10 years follow-up of the Australia longitudinal study of ageing. BMC Geriatr 10:18CrossRefGoogle Scholar
  45. Schröder M (2008) Chapter 8.4 Attrition. In: Börsch-Supan A, Brugiavini A, Jürges H, Kapteyn A, Mackenbach J, Siegrist J, Weber G (eds) First results from the survey of health, ageing and retirement in Europe (2004–2007): starting the longitudinal dimension. Mannheim Research Institute for the Economics of Ageing (MEA), MannheimGoogle Scholar
  46. SHARE (2011) Sample (documentation online). Accessed 30 Nov 2011
  47. Shields M, Shooshtari S (2001) Determinants of self-perceived health. Health Rep (Stat Canada) 13(1):33–52Google Scholar
  48. Simon JG, De Boer JB, Joung IMA, Bosma H, Mackenbach JP (2005) How is your health in general? A qualitative study on self-assessed health. Eur J Public Health 15(2):200–208CrossRefGoogle Scholar
  49. Smith AMA, Shelley JM, Dennerstein L (1994) Self-rated health: biological continuum or social discontinuity? Soc Sci Med 39(1):77–83CrossRefGoogle Scholar
  50. Tsimbos C (2010) An assessment of socio-economic inequalities in health among elderly in Greece, Italy and Spain. Int J Public Health 55:5–15CrossRefGoogle Scholar
  51. Van Doorslaer E, Gerdtham UG (2003) Does inequality in self-assessed health predict inequality in survival by income? Evidence from Swedish data. Soc Sci Μed 57:1621–1629Google Scholar
  52. Verropoulou G (2009) Key elements composing self-rated health in older adults: a comparative study of 11 European countries. Eur J Ageing 6(3):213–226CrossRefGoogle Scholar
  53. Vuorisalmi M, Lintonen T, Jylhä M (2005) Global self-rated health from a longitudinal study predicted mortality better than comparative self-rated health in old age. J Clin Epidemiol 58(7):680–687CrossRefGoogle Scholar
  54. Vuorisalmi M, Pietilä I, Pohjolainen P (2008) Comparison of self-rated health in older people of St. Petersburg, Russia, and Tampere, Finland: how sensitive is SRH to cross-cultural factors? Eur J Ageing 5:327–334CrossRefGoogle Scholar
  55. Zimmer Z, Natividad J, Lin HS, Chayovan N (2000) A cross-national examination of the determinants of self-assessed health. J Health Soc Behav 41(4):465–481CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Department of Statistics & Insurance ScienceUniversity of PiraeusPiraeus, AthensGreece

Personalised recommendations