Factors related to perceived health among elderly people: the Albertina project

Age and Ageing, July, 1994 by Alette-Marie Lindgren, Kurt Svardsudd, Gosta Tibblin

Summary

The Albertina Project is an epidemiological study of the medical, social and economic situation among people aged 75 years or older in Uppsala, Sweden. In this report, health conditions, quality-of-life measures and housing problems affecting it are presented. A postal questionnaire was sent to an 11% random sample (n = 959) of the eligible population out of which 706 (74%) persons responded.

Nearly one-third of the elderly people could not read a newspaper with or without glasses, more than one-third had impaired hearing, 47% had some sort of mobility problem and 66% reported some form of sleeping problem. Forty-two per cent felt lonely sometimes or often and 65% were worried, in most cases about the risk of falling. In spite of this, 87% rated their health as good and 79% were content or rather content with their situation.

Even though eyesight and hearing problems were common in this study, they did not affect perceived health to any large extent. Mobility problems and sleeping problems had a greater impact. The most important factors related to perceived health were activity score, contentment and mobility problems. Contentment was affected by activity score and loneliness and the latter was in turn affected by age and type of dwelling. The practical implication of these findings is that perhaps more attention should be focused on efforts to improve old people's satisfaction with their life situation rather than on marginal improvements of their medical situation.

Introduction

Among health care staff, it is generally believed that old people in general have a poor state of health and a poor social situation(1)(2). This view is probably coloured by the fact that health care staff are mainly confronted with sick elderly people. Old age has been regarded as synonymous with poor health.

Poor eyesight and hearing, sleeping problems and mobility problems are fairly frequent in old age(3)(4)(5)(6). In young people such conditions would probably be regarded as disabling. However, old people may take a different view since these conditions may be regarded as part of the ageing process and thus to some extent be 'natural'. On the other hand, perceived health may be affected by other factors, such as loneliness, contentment, type of dwelling, social network/social support, etc.(7)(8)(9)(10)(11). The interrelation of these factors and their common impact on perceived health are not known.

The purpose of this study was to measure the prevalence of poor eyesight, hearing problems, sleeping problems, mobility problems, loneliness and discontentment and to analyse to what extent these conditions affect well-being.

The study population has been described in detail previously(12). Briefly, 9440 persons 75 years or older were living in the city of Uppsala on 1 September 1985. From the population register, a random sample consisting of 11% of this population segment was drawn. One thousand and forty-one persons fulfilled the criteria. Out of these, 82 (7.9%) persons died after sampling but before the study was started, leaving 959 persons eligible for the study. Seven hundred and six persons (73.6%) agreed to participate.

Methods

A postal questionnaire was sent to the 959 eligible persons in the study population. In this questionnaire the participants were asked to indicate if they could read a newspaper, with or without glasses. Those who could not were classified as having an eyesight problem. Perceived hearing was classified as no hearing problem without a hearing aid, no hearing problem with a hearing aid, sometimes problems with or without an aid, and always problems with or without an aid.

Mobility was measured as indoor and outdoor mobility. Each of these was classified as no mobility problem, using a mobility aid, using a wheelchair, or mobile only with help from another person. The participants were also asked to indicate if they could rise from a kitchen chair. The responses were graded as 'on my own with no problems', 'on my own with some difficulty', 'with assistance', or 'cannot rise from a kitchen chair'.

Sleeping problems were defined as difficulty falling asleep, waking up in the middle of the night and not being able to fall asleep again, or waking up early and not falling asleep. The participants were also asked to indicate if they had dreams or nightmares. In addition, they were asked if they were taking sedative drugs during daytime, or sedative or hypnotic drugs at night.

The participants were asked whether they had a good friend outside the household unit, to estimate the frequency of phone calls, and to indicate whether they felt lonely, whether they were worried and whether they were in need of help. They were asked to indicate their contentment with their situation on a verbal scale ranging from 'very contented' to 'very discontented' and to grade their perceived health on a visual analogue scale ranging from 'very healthy' to 'very unhealthy'.

Finally, the questionnaire contained a list of activities. The participants were asked to indicate which of these they did. Each activity was coded yes (= 1) or no (= 0). Activity score was computed as the sum of the codes for cooking, dishwashing, washing, bed-making, cleaning, shopping, walking, visiting the bank or post office, going to church, going to the library, visiting friends, driving a car or travelling by bus, train or aeroplane.