SELF-REPORTED HEALTH STATUS AND MEDICAL HISTORY

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SELF-REPORTED HEALTH STATUS
AND MEDICAL HISTORY
M L Wahlqvist
Mark L Wahlqvist
Monash University, Department of Medicine
Clayton Road, Clayton 3168, Victoria, Australia
7.1 SELF-RATED HEALTH
The relationship of food intake and lifestyle to health is a central theme in this study. Thus, a
valid and reliable method of measuring health was required. Fillenbaum (1984) [4] reviews all
available questionnaires measuring the health status of the elderly and concludes that the
multi-level assessment instrument (MAI) designed by Lawton et al (1982) [9] is a valid and
reliable measure to use on such populations (see Appendix A1). It is carefully constructed and
has been tested for reliability and validity. It includes a physical health domain index (or total
health score), composed of subindices measuring self rated health, health behaviour and health
conditions. The subindices can be scored by counting or summing and can be used in isolation
from each other and from the rest of the questionnaire. A higher score in all cases indicates better
health. All questions and subindices are based upon subjective reports from the interviewee.
The health questions and subindices include:
1. Total Health score (33-74)
a) Self rated health subindex (score 4-13): Questions H34, H35, H36, H37 (e.g. how would
you rate your overall health at present, is your health better, same or not as good as
people your age).
b) Health behaviour subindex (score 3-9): Questions H38, H39, H40 (e.g. frequency of
physician visits, days spent in hospital, days spent in bed because of illness).
c) Self reported health conditions subindex (score 25-50): Question H43 (23 item check-list
of common health conditions e.g. diabetes, high blood pressure), question H41 and H42
on eyesight and hearing and question on whether arms or legs are missing/ handicapped
(H46).
d) Non index item (score 1-2): use of a wheel chair (H47c).
e) Total (General) Health Score = self rated health + health behaviour + health conditions +
non index item = 33-74.
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Figure 7.1 (young elderly) shows that, when health status is categorised as poor, fair, good or
excellent, the combination of poor and fair did not exceed 58% for men (Filipino men), but was
as high as 77% for Japanese women in Okazaki. On the other hand, this combination had a
prevalence as low as 3% for Chinese men in urban Tianjin and 3% for Chinese women in rural
Tianjin. Thus it is possible for Chinese elderly to rate their health well where socio-economic
means and the food supply are limited, and where life expectancy at birth is relatively less good;
and at the same time, for elderly Filipino men or Japanese women to note their health more often
as poor or fair. In the case of the Japanese, socio-economic factors are more favourable and their
life expectancy at birth is amongst the best in the world.
Figure 7.1. Prevalence of the self-reported health status, by study
community, age group and gender, for young elderly.
These apparent paradoxes are worthy of further enquiry and may suggest that self-reported
health is, in significant measure, attitudinal or psychological and, to a lesser extent physical.
Figure 7.2 shows similar findings for the older elderly. It will also be of interest to ascertain
prospectively how predictive self-rated health is of subsequent morbidity and mortality. Recent
Australian work, from the Australian Institute of Health and Welfare suggests that such indices
have considerable predictive power.
Figure 7.2. Prevalence of the self-reported health status, by
study community, age group and gender, for old
elderly.
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An interesting additional insight into the state of mind of elderly people is further provided by
Figure 7.3 where at least 50%, and usually more than 80% of elderly people, men or women,
European or Asian, feel happy on an every day basis. This clearly does not necessarily translate
into feeling healthy, as indicated earlier. So that attitude may allow one to adjust to varying
levels of medically-defined health, to differing extents, but, whatever is achieved in this respect,
in the aged, one tends to be happy with one's lot.
Figure 7.3. Self-rated happiness of every day life, by study
community, age group and gender, for young
elderly.
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On the other hand, 20 to 30% of the elderly reported feeling sad or depressed, except Spatan and
Japanese women (50%). Overall, a greater proportion of women reported feeling depressed or
sad compared with the men (Figure 7.4).
Figure 7.4. Percentage feeling sad or depressed, by study
community, age group and gender.
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Women tend to report sleeping less well than men, and older women less well than younger
women. The range of self-reported sleep disorder is wide, from 8% in older Japanese women to
43% in older Anglo-Celtic Australian women (Figure 7.5). It is interesting that Chinese men and
women in Tianjin reported sleeping more than their Anglo-Celtic or Swedish counterparts
(Figure 7.6).
Figure 7.5. Self reported sleeping disorders, by study community,
age group and gender.
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Figure 7.6. Duration of sleep at night, by study community, age
group and gender.
According to Birrel, a psychologist and sleep expert at the University of New South Wales in
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Sydney, Australia, historical evidence indicates that people used to sleep for longer periods than
they do presently, so that repeat studies in subsequent years may reflect interesting cohort effects
on the sleep patterns of the elderly.
Birrel also indicates that the literature suggests that in women, at least during the child-bearing
and child-rearing years, more sleep appears to be required than for men. To what extent these
patterns reflect eating habits or contribute to nutritional states is worthy of further exploration.
Chapter 17, which deals with disability, discusses activities of daily living (ADL); some of the
histograms are shown here for convenience (Figures 7.7-7.9). Questions regarding degree of
difficulty in coping with basic bodily function (e.g. using the toilet, eating) and with performing
basic tasks (e.g. cooking, housework, walking between rooms) are encompassed in questions
ADL88a-n2, ADL880 and ADLP. These questions were taken from the WHO 11 country elderly
study questionnaire [5] which were originally adapted from the validated instrument developed
by Katz and Apkom (1976) [8].
The Euronut-Seneca study of elderly in Europe (de Groot et al; 1991) [3] have also used these
questions from the WHO elderly study. For each item, the level of competence or grades of
difficulty are measured on a 4-point scale (4 = without difficulty, 3 = with difficulty but without
help, 2 = with help only, 1 = unable to complete).
A total ability score or ADL score was created for the study as a sumscore over all items,
ranging from 15-62 (a higher score indicates better performance) (Figure 7.7) (see Appendix
A1).
Figure 7.7. Mean score for activities of daily living, by study
community, age group and gender.
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One aspect of ADL is the ability to walk between rooms, or about the house (Figures 7.8, 7.9).
Most older and younger elderly people do this without difficulty which reminds us just how
independent people over 70 years old can actually be.
Figure 7.8. Percentage reporting difficulty with walking between
rooms, by study community and gender, young
elderly.
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Figure 7.9. Percentage reporting difficulty with walking between
rooms, by study community and gender, old elderly.
7.2 SELF-REPORTED HEALTH CONDITIONS
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The health conditions reported with frequencies in excess of 5% in 2 or more communities were
"heart trouble", strokes, hypertension, diabetes, cancer, rheumatism, "broken bones" and
cataracts. These frequencies are depicted in the ensuing histograms (Figures 7.10-7.17). Thus
cardiovascular disease (heart and cerebrovascular) is a major source of morbidity affecting both
occidental and oriental elderly, up to 58% for heart disease (Anglo-Celtic Australian men) and
30% for stroke (younger elderly Chinese men in rural Tianjin) (Figures 7.10, 7.11). Some of the
heart disease was valvular or cardiomyopathic of a non-ischaemic kind, but most were ischaemic
heart disease.
Figure 7.10. Prevalence of self-reported heart trouble, by study
community, age group and gender.
Figure 7.11. Prevalence of self-reported strokes, by study
community, age group and gender.
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For ischaemic heart disease and cerebrovascular disease (thrombo-embolic and haemorrhagic)
hypertension is a risk factor, as shown in Figure 7.12 as self-reported rates (actual recorded
blood pressures are shown in Section 14.3). Other cardiovascular risk factors of body fatness
(Chapter 13) and serum lipids (Section 14.4) are to be found elsewhere in this report where they
are available.
Figure 7.12. Prevalence of self-reported hypertension, by study
community, age group and gender.
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Diabetes itself is a risk factor for atherosclerotic or macrovascular disease affecting several
territories. In the younger elderly, it has already reached self reported rates which exceed 10%
(Greeks in Melbourne and Spata) (Figure 7.13). The fasting blood glucose concentrations, as a
criterion for diabetes, are also available for some communities (Section 14.4) and prevalences of
abnormal values exceed the self-reported rates for diabetes. Thus diabetes looms large as a
health problem amongst the aged in quite culturally disparate communities.
Figure 7.13. Prevalence of self-reported diabetes, by study
community, age group and gender.
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Photo 7.1. Melbourne, Australia (Greek) (1990-91): A woman turning
eighty (with diabetes), photographed here with her two
younger sisters.
In regard to cancer (Figure 7.14), the self-reported rates refer to all forms of cancer, including
skin cancer. This particular cancer (of skin) undoubtedly accounts for the disproportionately high
rates amongst Anglo-Celtic Australians, where the rates are appreciably higher in men (35% in
younger elderly) than women (22% in younger elderly). By contrast, the cancer prevalences as
reported by younger Greek Melburnian and Spatan elderly are around 6%, increasing in the older
Greek elderly. It is known that the cancer incidences of Australian-born individuals and Greek
born Melburnians for lung (in men) and breast (in women) are comparable and, for colo-rectal
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cancer, approach those of locally born individuals after about 16 years of residence [10].
Figure 7.14. Prevalence of self-reported cancer, by study
community, age group and gender.
Most of the difference between Anglo-Celtic and Greek Melburnian elderly in reported cancer
prevalence is likely to be attributable to skin cancer. Future enquiries about cancer must be
specific about type. In the meantime, leaving aside Anglo-Celtic Australians, in European and
Asian elderly, cancer prevalences in those between 70 and 80 years of age are less than 10%,
increasing in the older aged. Regional differences in cancer type are likely to reflect lower
incidences of large bowel prostate and breast cancers and higher incidences of gastric, primary
liver cell, nasopharyngeal and oral cancers amongst Asian than European elderly.
Musculo-skeletal problems are generally regarded as contributory to a significant proportion of
morbidity amongst the aged and this is borne out in the detail of the ADL (activities of daily
living). However, there are high prevalences of self-reported "rheumatism", meaning pain or
discomfort in muscles and/ or joints, in younger and older elderly Anglo-Celtic Melburnians
(40-60%), Greeks in Melbourne and Spata (about 30-60%), and Filipinos in Manila (30-60%)
(Figure 7.15). It is acknowledged that the Filipinos may be less representative of their
communities than are those of Anglo-Celtic or Greek ethnicity, but the prevalences are
undoubtedly indicative. Much lower prevalences of "rheumatism" were reported amongst
Chinese and Japanese elderly, and this provides an interesting comparison for hypothesis
generation in relation to cultural, including food cultural, determinants of rheumatism. For
example, what do higher fish intakes amongst Japanese, or lower animal fat intakes, or higher
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rice intakes amongst Chinese and Japanese signify for rheumatism? And why should rice eating
Filipinos experience more rheumatism than rice-eating Chinese and Japanese?
Figure 7.15. Prevalence of self-reported rheumatism, by study
community, age group and gender.
Photo 7.2. Spata, Greece (1988): an elderly couple in their late 70s,
complaining of "arthritis".
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Proneness to fracture amongst the young is seen more amongst men than women and is usually
related to significant trauma, but amongst the elderly it is generally a result of the twin risk
factors of falls and osteopenia (mainly osteoporosis, but sometimes osteomalacia as well [11]. In
Australia, we know that life-time fracture experience for men and women involves about 40% of
the population [11] and the Anglo-Celtic Melburnians would appear to fit this picture.
However, other communities of aged people seem to have a lesser experience of fracture, and
usually less than 20% for Swedes, Chinese, Filipinos, Greek elderly (except younger elderly in
Spata and older elderly in Melbourne-- less than 30%), and younger Japanese elderly (but not
older Japanese elderly where it exceeds 20%) (Figure 7.16).
Figure 7.16. Prevalence of self-reported broken bones, by study
community, age group and gender.
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Impaired vision is also an important potential adverse contributor to quality of life in the elderly.
Peculiar to the aged are senile cataracts, macular degeneration and glaucoma, with added risk of
diabetic retinopathy and cerebrovascular disease affecting vision. There may also be a legacy of
earlier life problems affecting vision like trachoma (e.g. with Aboriginal Australians) and
xerophthalmia (in Asia). Presbyopia is progressive throughout life and usually becomes
significant in the 5th decade of life, although correctable with spectacles. Amenable to simple
inquiry is the phenomenon of cataracts about which many elderly people will have been
informed by health care workers, doctors or opticians. We found in the IUNS study communities
a big change in prevalence from about 10-15% overall in younger elderly to about 20-50% in
older elderly (Figure 7.17). This age period may, therefore, present an opportunity for
intervention and prevention. There were also cross-cultural differences in this change with late
age-related increased cataract prevalence being less reported by Japanese elderly. There is a
growing interest in nutritional factors, like antioxidants found in fruits and vegetables, being
protective against cataract formation.
Figure 7.17. Prevalence of self-reported cataracts, by study
community, age group and gender.
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7.3 SELF-REPORTED USE OF MEDICATION
Whilst there is little doubt that life-saving and quality-of-life-improving medication has become
part of the lives of elderly people, the risk-benefit ratio is often a problem. This problem arises
because of errors in drug usage, decreased physiological ability to handle drugs by gut, liver or
kidneys, and through the need for multiple medication because of multi-system disease [12].
Added to this may be the effects of protein energy malnutrition on drug handling, and the
exacerbation of states of marginal nutrition by drugs themselves, through loss of appetite, nausea
or drug-nutrient interactions.
Knowledge of medication use, whether medically prescribed or self-initiated, is therefore of
considerable importance in the health assessment of the elderly. Its analysis is complex because
extent of medication use may reflect:
a) severity and extent of disease
b) access to the health care system
c) personal concern about disease which may be responsive to medication
d) inappropriate use of medication
Elsewhere in this book, the interplay between medication use and health and nutritional status
are explored.
7.4 SELF-REPORTED USE OF MICRO-NUTRIENT SUPPLEMENTS
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A particular form of medication, whether it is medically-prescribed or self-initiated, is the use of
micro-nutrients and other putatively nutritional supplements like dietary fibre, herbs and natural
remedies. We specifically asked about micro-nutrient supplements in the IUNS study. Where we
have the data, use is significant. For example, vitamin supplement use was about 15% amongst
Greek men and 25% amongst Greek women in both Spata and Melbourne. The most common
supplements used were:
• vitamin B12 injection (4%),
• potassium (4%),
• iron/ folate (4%),
• calcium (3%),
• multivitamins (2%),
• B group vitamins (2%)
• and vitamin C (1%).
In Australian [6] and North American studies (NHANES) reported elsewhere [2], the prevalence
of usage of nutritional supplements exceeds 30% amongst the elderly. The most popular
supplement used by elderly in Australia and America include multivitamins, vitamins B, C & E ,
bran and wheat germ.
7.5 ADDITIONAL INFORMATION
7.5.1 Aboriginal Australians (A Kouris-Blazos)
It had been our intention in the IUNS study to have a statement by people about their perceived
health status. However, it was found that the Junjuwa elderly did not have a concept of health,
but instead the issue appeared to be one of spiritual well-being. So for health status we were
entirely dependent on medical records for 48 subjects. These provided us with the percentages of
occurrences of the following, between the period 1958-1988:
• hypertension 44%,
• heart disease 21%,
• diabetes 27% (13% <5 years, 13% >5 years),
• obesity, BMI >30 14% (F 12%, M 2%, n=42),
• alcohol abuse 10%,
• cataract 33%,
• arthritis 21%,
• leprosy 10%,
• breast cancer 8%,
• trachoma 8%,
• anaemia 19%,
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• bronchopneumonia 27%,
• asthma 8%,
• urinary tract infection 21%,
• kidney stones 4%,
• renal failure 4%,
• and leprosy 10%.
Photo 7.3. West Australia, Fitzroy Crossing, Junjuwa (1988): man in his
70s with rickets.
The health worker and nurse indicated that most of the elderly have had worms (tape worms,
giardia, hook worm), sexually transmitted disease and boils at some stage. The anaemia is
thought to be mainly caused by worms. Most of the elderly had pterygia. The elderly frequently
used the medical centre at Junjuwa as well as the community health centre and hospital located
at the Fitzroy Crossing townsite. Even though medications were prescribed to the elderly, to treat
their diabetes or heart condition, they did not see the importance of taking the required daily
dose of tablets.
7.5.2 Chinese in Beijing (Y Wang & D Roe)
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The characteristics of the health status and health behaviour of the study participants presented
here includes self-reported health status, self-reported current disease problems, use of
medications and vitamin supplements.
Photo 7.4. Rural Tianjin, China (1989): a woman in her 80's.
7.5.2.1 Self-reported health status
The subjects evaluated their health status and reported it as being one of four levels: better than
others, the same as others, worse than others, and don't know. Table 7.1 shows the numbers and
percentages of self-reported health status for males, females and total subjects. Over half (53%)
considered their health status was better than others; 24% reported their health status as the same
as the other elders in their community; and about 10% answered as "I don't know".
As had been observed during the interview, 96% of study participants could take care of
themselves. Many of them could do some types of housework, such as cooking, cleaning,
washing clothes by hand, food shopping for daily meals and taking care of their grandchildren.
The gender difference in self-reported health status was not statistically significant (P >0.05),
although more males (60%) reported having better health status than females (50%).
Table 7.1. Self-reported health status
Male Female Total
N % N % N %
Better 74 59.7 88 48.6 162 53.1
Same 23 18.6 49 27.1 72 23.6
Worse 19 15.3 22 12.2 41 13.4
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Don't Know 8 6.5 22 12.2 30 9.8
Chi-Square = 6.942P = 0.074
7.5.2.2 Current health problems
The diseases considered as the major health problems in the study population are listed in Table
7.2. These diseases are ranked by the number of people reported as having the following:
hypertension, various heart diseases, respiratory system diseases, diabetes, arthritis/ rheumatism,
stroke, etc. All of the health problems were reported by participants and these had been
previously diagnosed by their doctors. Hypertension has been a very common disease in the
northern part of China. In this study, a high prevalence of hypertension was also observed in the
study population. More than one third of study participants (36%) reported that they had been
diagnosed as "having hypertension" by their doctors. Heart diseases that include coronary heart
disease, rheumatic heart disease and cor pulmonale were also reported by the elderly subjects.
Respiratory diseases have long been a problem for the elderly in Northern China, although the
Chinese government has run numerous programmes for prevention of respiratory system disease.
Respiratory system disease was very closely related with smoking (P<0.05). Table 7.3 indicates
that among a total of 41 people who had respiratory system diseases, 56.1% (23) of them were
either regular smokers or had stopped smoking under their doctor's order. Differences in the
prevalence of respiratory disease was found between the two communities (P<0.05). Seventeen
per cent (30) of the subjects in Community 1 suffered respiratory disease, compared to only 9%
in Community 2 (11).
Another common health problem listed in Table 7.2 is stomach/ intestine problems, which
influenced 28% (28) of the study participants. Twenty-one of the study participants reported they
had diabetes (gender differences were not found for this disease). However, 4 subjects in
Community 1 did not report diabetes even though they had elevated blood glucose values.
Arthritis/ joint symptoms, which were mainly reported in women, affected 9% [16] of female
subjects, however, only 2.5% [3] complained of arthritis. Only one person was diagnosed as
"having osteoporosis" by her doctor although 3 females subjects had a history of broken bones.
Psychiatric diseases were not reported by the study participants. Dental problems were reported
by 25 people (8.2%), and their ability to eat certain foods had been affected. Differences in the
incidence of dental problems were not found either between genders and communities, or among
elderly in different age groups (P<0.05) and education levels (P<0.05). Blood pressure and blood
glucose were also measured during the home visit. The average systolic/ diastolic blood pressure
for males and females were 149/84 and 152/85 mmHg respectively. Significant differences were
not found for blood pressure between genders. The average blood glucose of females (139mg/dl)
was found to be significantly higher than males (119 mg/dl) (P>0.05).
Table 7.2. Description of health problems.
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Disease N %
Hypertension 110 36.1
Heart Diseases 55 18.0
Respiratory Diseases 41 13.4
Stomach/Intestine Problems 28 9.2
Diabetes* 21 6.9
Arthritis/Rheumatism* 19 6.2
Stroke 11 3.6
Stomach Ulcer 11 3.6
Cataracts* 11 3.6
Tenseness 10 3.3
Gall Bladder Trouble 8 2.6
*Gender difference
Table 7.3 Smoking and respiratory diseases.
Respiratory diseases
Smoking Yes No Total
Yes 23 (18.7%) 10 (81.3%) 123 (40.5%)
No 18 (9.9%) 163 (90.1%) 181 (59.5%)
Total 41 (13.5%) 263 (86.5%) 304 (100.0%)
Chi-Square = 8.104; P = 0.017
7.5.2.3 Use of Medicine
Both western medications and traditional Chinese medicines were taken by the elderly for the
various health problems found in this study. Among the total study participants, more than half
(58%) reported not taking any kind of medication, which corresponds with the proportion
reporting to be in good health condition (53%). Among the total 305 elderly participants, only
126 of them reported that they had taken medicines. The maximum reported number of western
medicines per subject was 4. Fourteen elderly people regularly took 3 types of medication, 41
took 2 different medications and 70 reported taking 1 type of medication. The medication most
frequently reported was an antihypertensive (13.8%), which was lower than the reported
percentage of subjects with hypertension (36%). Other commonly used medications included
anti-anginals for chest pain (11.5%), digestants (5.6%), anti-diabetes medicine (3.9%), and
medications taken for problems related to the respiratory system (3.3%). Sleeping pills were
taken by 2.6% of the study participants.
Table 7.4. Use of the western medications.
Medications N %
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High Blood Pressure Medicine 42 13.8
Nitro-glycerine Tablet 35 11.5
Digestants 17 5.6
Medicines for Diabetes 12 3.9
Medicines for Respiratory Diseases 10 3.3
Sleeping Pills 8 2.6
Traditional Chinese medicine was also commonly used by the study population for various
health problems, especially for some chronic diseases such as hypertension, diabetes, respiratory
diseases, as well as for the flu, the common cold, and others. About 35% (n = 107) of the elderly
reported taking traditional Chinese medicines. There was no significant gender difference in
those taking traditional Chinese medicines. Moreover, education level and age were not
significantly correlated with the usage of traditional Chinese medicine.
7.5.2.4 Use of vitamin supplements
Vitamin supplements were taken by study subjects either because they were prescribed by their
doctors or they were self prescribed. About 13% (n = 41) of study participants reported taking
vitamin supplements and this correlated with their education level. Table 7.5 shows that
percentages taking vitamin supplements from lower to higher education level were 3.7%, 7.4%,
29.8% and 27.9%, respectively. This suggests that those elderly with higher education levels
were more likely to take vitamin pills than those with lower education levels. No gender
difference was found in those using vitamin supplements.
Table 7.5. Use of vitamin supplements by education levels.
Taking Level of Education (Year)
vitamins 0 1-6 7-12 >12 Total
Yes (n) 3 9 17 12 41
(%) 3.7 7.4 29.8 27.9 13.4
No (n) 80 113 40 31 264
(%) 96.4 92.6 70.2 92.1 86.6
Total (n) 83 122 57 43 305
(%) 27.2 40.0 18.7 14.1 100
Chi-Square = 31.6; P = 0.000
7.5.3 Filipinos in Manila (P De Guzman)
7.5.3.1 Memory, eyesight and general health of the elderly
The elderly's awareness of the current year, month, day, their address and direct questions on
whether they could recall names of friends and relatives or where they last left things were used
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to gauge memory. On the whole, it was most common to have memory lapses with regard to
names of friends/ relatives or where things were last left. Memory lapses of such sort were more
prevalent among the elderly who resided with family members, presumably because they have
access to all parts of the house while their counterparts in institutions have designated rooms and
limited space. For all memory questions, the proportion of correct responses was lowest among
the elderly in the public institution for the aged. Perhaps the fact that the elderly in such
institutions tend to be abandoned and destitute cases (many found wandering in the streets) could
explain their poorer memory.
Eyesight was good or adequate for about two-thirds of the elderly residing with family members
and in the private home for the aged. On the other hand, more than one-half of the elderly in the
public institution had impaired vision; the government does not cover the cost of correction.
Having, in a sense, found a home and friends to share life with, a smaller proportion of the
institutionalised elderly believed their health was not as good as it was three years ago compared
with the community based subjects. When asked to compare themselves with their
contemporaries, the majority of the elderly in all community types considered their health to be
better. Most experienced low incidence of hospitalisation and sickness in bed, and generally felt
it unnecessary to visit the doctor.
The most common health problems that afflicted the elderly in the barangays was bladder trouble
or difficulty in urination. None of the institutionalised elderly suffered the same disorder. The
prevalences of high blood pressure, heart disorders, arthritis and cancer/ tumour, (commonly
associated with affluence), are higher among the elderly confined in the private institution (see
Table 7.6).
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Table 7.6. Percentage distribution of respondents by community by health problems
experienced in the past year.
San Golden RVM All
Juan Acres Groups
Diabetes 6.9 5.9 15.8 7.3
High blood 36.1 25.0 57.9 34.9
Heart trouble 19.3 13.2 31.6 18.7
Circulation problem 2.0 1.5 - 1.7
Paralysed 2.5 1.5 15.8 3.1
Effects of stroke 3.0 2.9 10.5 3.5
Arthritis 45.5 47.1 63.2 47.1
Stomach ulcer 13.9 4.4 10.5 11.4
Asthma 10.0 11.8 - 10.4
Glaucoma 1.0 4.4 - 1.7
Cataracts 16.3 29.4 42.1 21.1
Cancer/ tumour 2.5 - 10.5 2.4
Liver trouble - - - -
Gall bladder 3.5 - 5.3 2.8
Kidney trouble 5.9 2.9 5.3 5.2
Bladder trouble 91.6 - - 64.0
Broken hip 0.5 - - 0.3
Broken bones 4.0 5.9 15.8 5.2
Anaemia 6.4 2.9 5.3 5.5
Parkinson's 0.5 - - 0.3
Insomnia 12.9 7.4 - 10.7
Nervousness 23.3 11.8 15.8 20.1
Prostrate 2.0 - - 1.4
Osteoporosis - - - -
UTI 3.5 1.5 5.3 3.1
Uric acid 4.0 - 5.3 3.1
Constipated 9.4 11.8 15.8 10.4
Stomach/ intestinal. 4.5 2.9 10.5 4.5
Lung trouble 11.4 7.4 10.5 10.4
Other ailments 13.9 26.5 26.3 17.6
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Table 7.7. Percentage distribution of respondents by community by medications
regularly taken.
San Golden RVM All
Juan Acres Groups
Arthritis 15.3 16.2 15.8 15.6
Pain killer 5.9 4.4 5.3 5.5
Aspirin 10.4 10.3 5.3 10.0
High blood pressure 27.7 19.1 47.4 27.0
To loose water/ salt 1.5 - 5.3 1.4
Digitalis pills (heart) 10.9 14.7 5.3 11.4
Nitroglycerine(chest pain) 1.0 2.9 5.3 1.7
Anticoagulants - 1.5 - 0.3
To improve circulation 2.5 - - 1.7
Insulin injections - - - -
Diabetes pills 1.5 2.9 5.3 2.1
Ulcer 4.5 - 15.8 4.2
Seizures - - - -
Thyroid pills/cortisone - - - -
Antibiotics 11.4 4.4 - 9.0
Tranquillisers 1.0 - 5.3 1.0
Sleeping pills 0.5 - - 0.3
Hormones - - - -
Anxiety/ depression - - - -
Glaucoma 1.5 - 5.3 1.4
Muscle relaxant 4.5 2.9 - 3.8
Allergy 3.0 2.9 - 2.8
Constipation 1.5 - - 1.0
Lung medication 4.0 7.4 5.3 4.8
Others 8.4 20.6 15.8 11.8
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Table 7.8. Percentage distribution of respondents by community by psychological
character.
San Golden RVM All
Juan Acres Groups
Worry too much 59.4 38.2 21.1 51.9
Lost interest, often sad/depressed50.0 58.8 15.8 49.8
(felt like dying) 25.7 26.5 5.3 24.6
Often tired 66.3 55.9 42.1 62.3
Not happy/contented with life 17.8 13.2 5.3 15.9
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7.6 SUMMARY
Elderly people generally regard themselves as happy. Perceived health is more variable
cross-culturally with a majority or a minority regarding their health in the “least good” category.
Functionally, by way of activities of daily living or, specifically, ability to independently move
around their place of abode, most (more than 80%) elderly people in various cultures managed
without difficulty. Furthermore, most slept at least 6 hours at night, although it was common to
regard this as disordered sleep.
Self-reported health disorders were, in the main, cardiovascular, diabetes, cancer,
rheumatological, visual or incontinence.
The importance, and complexity, of medication use as an index of and risk factor for health
states was borne out in the IUNS studies. Elderly people were often interested in nutrient or
nutritional supplementation.
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7.7 REFERENCES
1. Bunce GE. Antioxidant nutrition and cataract in women: a prospective study. Nutr Rev
1993; 51(3):84-86.
2. Chapman N, Sorenson A, Ory M, Morijan A. Nature, causes, and consequences of
harmful dietary practices: implications for older people. Clin Appl Nutr 1991; 1(4):32-50.
3. de Groot LCPGM, van Staveren WA & Hautvast JGAJ (1991). Euronut-Seneca, Nutrition
and the elderly in Europe, A concerted action on Nutrition and health in the European
Community. Eur J Clin Nutr 45 (Suppl 3), 5-185.
4. Fillenbaum, GG. The well-being of the elderly: approaches to multidimensional
assessment. Geneva, World Health Organisation, (Offset, Publication no.84), Geneva;
1984.
5. Heikinnen E, Waters WE and Brzezinski ZJ (1983). The elderly in 11 countries - a
sociomedical survey. Copenhagen: World Health Organization, Public Health in Europe,
series no.21.
6. Horwarth CC. Dietary intake studies in elderly people. IN: GH Bourne (ed). Impact of
nutrition on health and disease. Basel Karger. World Rev Nutr Diet 1989; 59:1-70.
7. Jacques PF. Antioxidants and cataracts. Epidemiology 1993; 4(3): 191-193.
8. Katz S, Akpom CA (1976). A measure of primary sociobiological functions. Int J Health
Services 6(3): 493.
9. Lawton MP, Moss M, Fulcomer M, Kleban MH. A research and service oriented
multilevel assessment instrument. J Gerontol 1982; 37: 91-99.
10. McMichael AJ, McCall MG, Hartshorne JM, Woodings TL. Patterns of gastro-intestinal
cancer in European migrants to Australia: role of dietary change. Int J Cancer 1980;
25:431.
11. Prince RL, Knuiman MW, Gulland L. Fracture prevalence in an Australian population.
Aust. J. Public Health 1993; 17(2): 124-128.
12. Roe DA. Nutrient and drug interactions. Nutrition Review 1984; 42(4): 141-154.
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7.8 LEGEND FOR FIGURES
Figure 7.1 Prevalence of the self-reported health status, by study community, age group and
gender, for young elderly.
Figure 7.2 Prevalence of the self-reported health status, by study community, age group and
gender, for old elderly.
Figure 7.3 Self-rated happiness of every day life, by study community, age group and gender,
for young elderly.
Figure 7.4 Percentage feeling sad or depressed, by study community, age group and gender.
Figure 7.5 Self reported sleeping disorders, by study community, age group and gender.
Figure 7.6 Duration of sleep at night, by study community, age group and gender.
Figure 7.7 Mean score for activities of daily living, by study community, age group and
gender.
Figure 7.8 Percentage reporting difficulty with walking between rooms, by study community
and gender, young elderly.
Figure 7.9 Percentage reporting difficulty with walking between rooms, by study community
and gender, old elderly.
Figure 7.10 Prevalence of self-reported heart trouble, by study community, age group and
gender.
Figure 7.11 Prevalence of self-reported strokes, by study community, age group and gender.
Figure 7.12 Prevalence of self-reported hypertension, by study community, age group and
gender.
Figure 7.13 Prevalence of self-reported diabetes, by study community, age group and gender.
Figure 7.14 Prevalence of self-reported cancer, by study community, age group and gender.
Figure 7.15 Prevalence of self-reported rheumatism, by study community, age group and
gender.
Figure 7.16 Prevalence of self-reported broken bones, by study community, age group and
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gender.
Figure 7.17 Prevalence of self-reported cataracts, by study community, age group and gender
7.9 ILLUSTRATIONS
Photo 7.1. Melbourne, Australia (Greek) (1990-91): A woman turning
eighty (with diabetes), photographed here with her two younger
sisters.
Photo 7.2 Spata, Greece (1988): an elderly couple in their late 70s,
complaining of "arthritis".
Photo 7.3 West Australia, Fitzroy Crossing, Junjuwa (1988): man in his 70s
with rickets.
Photo 7.4. Rural Tianjin, China (1989): a woman in her 80's.
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CHAPTER 7
SELF REPORTED HEALTH STATUS AND MEDICAL HISTORY
7.1 SELF-RATED HEALTH
7.2 SELF-REPORTED HEALTH CONDITIONS
7.3 SELF-REPORTED USE OF MEDICATION
7.4 SELF-REPORTED USEOF MICRO-NUTRIENT SUPPLEMENTS
7.5 ADDITIONAL INFORMATION
7.5.1 Aboriginal Australians (A Kouris-Blazos)
7.5.2 Chinese in Beijing (Y Wang & D Roe)
7.5.2.1 Self reported health status
7.5.2.2 Current health problems
7.5.2.3 Use of medicine
7.5.2.4 Use of vitamin supplements
7.5.3 Filipinos in Manila (P de Guzman)
7.6 SUMMARY
7.7 REFERENCES
7.8 LEGEND FOR FIGURES
7.9 ILLUSTRATIONS
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