Journal of Gerontological Nursing

HEALTH STATUS PERCEPTIONS AFFECT HEALTH-RELATED

Patricia A Horgan, MS, RNC

Abstract

Self-perceived health has been an area of interest in the gerontology literature. It has been correlated with medical factors such as objective health1"7 and nonmedical factors such as lifesatisfaction.2·8

Larson's review of 30 years of research on the subjective well-being of older Americans indicated self-reported well-being to be most strongly related to positive health status for the general population of Americans over 60. A 1982 study of the elderly9 suggested that a positive relationship exists between health-promoting habits (ie, getting adequate exercise and not smoking), and self-ratings of health; a negative relationship exists with morbidity. Therefore, knowledge of subjective health status is of great significance to nursing if it provides a quick clue to objective information.

Positive health habits or behaviors are appropriately advocated by the professional nurse since promotion of health and prevention of illness are among nursing's primary goals.10 When the nurse is aware that elders' perception of their health can affect their habits, the nurse is in a better position to enhance and support their self-responsibility and collaborate with them in their plan of care.

Purpose

Does a relationship exist between subjective health status and common health practices among a group of elders? The author asked this question and researched the relationship. The interpretation of such a relationship has important implications to nursing as it increases understanding of psychological influences on health behaviors.

TABLE 1

CORRELATIONS COEFFICIENTS BETWEEN DEMOGRAPHIC DATA, HEALTH-RELATED BEHAVIORS, AND SELF-PERCEIVED HEALTH

TABLE 2

DISTRIBUTION OF SELF-PERCEIVED HEALTH STATUS SCORES

TABLE 3

FREQUENCY OF POSITIVE HEALTH-RELATED BEHAVIORS…

Self-perceived health has been an area of interest in the gerontology literature. It has been correlated with medical factors such as objective health1"7 and nonmedical factors such as lifesatisfaction.2·8

Larson's review of 30 years of research on the subjective well-being of older Americans indicated self-reported well-being to be most strongly related to positive health status for the general population of Americans over 60. A 1982 study of the elderly9 suggested that a positive relationship exists between health-promoting habits (ie, getting adequate exercise and not smoking), and self-ratings of health; a negative relationship exists with morbidity. Therefore, knowledge of subjective health status is of great significance to nursing if it provides a quick clue to objective information.

Positive health habits or behaviors are appropriately advocated by the professional nurse since promotion of health and prevention of illness are among nursing's primary goals.10 When the nurse is aware that elders' perception of their health can affect their habits, the nurse is in a better position to enhance and support their self-responsibility and collaborate with them in their plan of care.

Purpose

Does a relationship exist between subjective health status and common health practices among a group of elders? The author asked this question and researched the relationship. The interpretation of such a relationship has important implications to nursing as it increases understanding of psychological influences on health behaviors.

Knowledge acquired from the study will provide support to Dorothea Orem's Self-Care Model by drawing attention to the importance of listening to the elderly 's assessment of their own health and the relationship this has on their self-care.

Orem stressed the importance of seeking subjective as well as objective information to provide data as an aid in the appropriate approach to a person's health care.11 Nurses must continue, and in some instances, begin to assume their part in this effort.

Orem's framework has relevance for the current study because within the theory the physical, psychological, interpersonal, and social aspects of health are inseparable in the individual, and emphasis has been placed on health status perspective and effective selfcare practices. The views of Orem, as well as others who have studied the relationship between perceptions and behavior, include three assumptions: there is a relationship between the body and the mind; individuals evaluate their own states of wholeness and appraise what state of health they are in; and health-related behavior is learned and is acquired according to the cultural beliefs, habits, and practices of the group to which the individual belongs.

Research Design

To test the hypothesis, a descriptive correlational study was used. The data were gathered from face-to-face interviews with a convenient sample of elderly adults.

Subjects

The sample population ranged in age from 60 to 96 years with a mean age of 72.9 (SD = 11.1). The majority was female.

Measures and Scoring

The measurement of health status that was used in the current study has been widely used in gerontological,7 epidemiological,12 and health services research.2 Results from these studies suggested that this is a valid and reliable indicator of an individual's objective and subjective health status.

Table

TABLE 1CORRELATIONS COEFFICIENTS BETWEEN DEMOGRAPHIC DATA, HEALTH-RELATED BEHAVIORS, AND SELF-PERCEIVED HEALTH

TABLE 1

CORRELATIONS COEFFICIENTS BETWEEN DEMOGRAPHIC DATA, HEALTH-RELATED BEHAVIORS, AND SELF-PERCEIVED HEALTH

Seven health-related behaviors considered were based on a survey of 6,928 adults. Belloc and Breslow concluded that this measure was highly reliable and corresponded favorably with medical records in circumstances where it was possible to make comparisons.13 Moyer reaffirmed this appraisal.14 He noted that the criterion-orientated validity for Belloc and Breslow's tool appears to be excellent.

Results

This study was specifically concerned with examining the relationship between health-related behaviors and self-perceived health. Preliminary analysis indicated no sex differences on the research variables. Therefore, all subsequent analysis combined males and females. See Table 1 for correlations between demographic variables, health status, and health-related behaviors. The significant correlations are noted.

Responses for the survey of self-perceived health were grouped into four broad categories: excellent, good, fair, and poor with excellent health having the high score (Table 2).

Responses for the survey of positive health-related behaviors were tabulated (Table 3). The majority of the respondents (50%) reported sleeping six hours or less. The data relating to patterns of eating between meals indicated 69% of the sample ate between meals and 90% of respondents reported eating breakfast almost every day. Forty-six percent judged themselves to be within 5% of their desirable weight.

A large majority (81%) engaged in a physical activity often, 14% reported they were physically active sometimes, and a small minority (5%) reported never participating in any form of physical activity. The most popular activities reported were swimming or long walks, working in the garden, and weekend auto trips. This behavior was positively related to health status (Table 1).

The moderate or no alcohol consumption reported was not significantly correlated with perceived health status. The last item on the questionnaire dealt with smoking habits. A large percentage (60%) of the respondents claimed to have never smoked and 17% of the former smokers claimed to have smoked one pack or less a day.

Kendall Tau correlations were conducted between 27 variables and selfperceived health. These analyses revealed three significant correlation coefficients providing partial support for the hypothesis. (See Table 1 for significant correlations between physical activity and health-related behaviors.)

Discussion

Data analysis revealed that 63.7% of the respondents considered themselves to be in good to excellent health. Only 7.5% considered themselves to be in poor health. The majority of respondents to a large number of other studies have rated their health as excellent or good. Shanas reported that 80% of persons over 65 reported one or more chronic illnesses.15 He suggested the slow onset of many of the illnesses has permitted the older person to adapt successfully to body changes and maintain self-care in daily activities. Most elderly viewed themselves as healthy when compared with others their own age.

Analysis of health-related behaviors revealed that certain practices are positively related to perception of one's health status. Frequency of physical activity was identified as the leading behavior that was positively related to health status perception. This finding suggests that elders who are able to maintain some form of physical activity perceive themselves in a better state of health than their counterparts who perceive themselves as being less active. This is an important finding because it alerts the nurse to the need of addressing the issue of physical activity during a nursing assessment.

Table

TABLE 2DISTRIBUTION OF SELF-PERCEIVED HEALTH STATUS SCORES

TABLE 2

DISTRIBUTION OF SELF-PERCEIVED HEALTH STATUS SCORES

A surprising finding was a negative correlation between self-perceived health and eating breakfast frequently. A possible explanation for this is much of the attention in current research concerning nutrition. The United States has focused on the consequences of excess consumption, for example of calories, cholesterol, salt, simple carbohydrates, and food additives. The typical American diet has been correlated with morbidity of cardiovascular disease, the number-one killer. A typical breakfast of this older age group may possibly have been bacon and eggs, which contains cholesterol, fat, and nitrates. This type of meal has fallen into disrepute and currently is viewed as detrimental to one's health if consumed on a regular basis.

A significant correlation was not evident between self-perceived health status and sleep habits. There is general agreement in the literature that, as a rule, the aged do get less sleep, but tend to catnap during the day. If all the catnaps and night sleep were totaled, there most likely would be an adequate amount of sleep.

Eating between meals, weight for height, alcohol consumption, and smoking habits were not significantly correlated with perceived heajth status. A possible explanation for alcohol and smoking not having a significant correlation is the lack of variability. A large number of respondents (72.3%) reported no consumption of alcohol and 59.5% claimed to have never smoked.

Interpretations

The lack of positive relationships between the variables, other than physical activity, suggests the complexity of determining a correlation with self-perceived health.

The characteristics of the sample must be considered. The mean age of the sample was 72.9 years. In the early 1900s, when many of the sample population were born, life expectancy was 47 years, and today it is approximately 75 years.16 Therefore, the sample may view themselves to be in good to excellent health (63.7%) by virtue of the fact they have survived to this age. Maadox reported that among those whose health is medically and subjectively good, a positive and statistically significant relationship was found between the subjective estimate of good health and being older (age 70 and above).4

It has only been within the last 30 years that emphasis has been placed on the importance that our health behaviors play in determining our state of health and within the last ten years that self-responsibility for health has been stressed. 17 This cohort of subjects have spent most of their lives without the benefit of information that is now readily available to enable the general public to choose a lifestyle that is believed to have positive impact on their health status. If this study was conducted on a different cohort, who grew up with the benefit of this information, the results might have been different.

Numerous other studies, across diverse populations, have found associations between well-being and general measures of activity, which lends significance to the findings of the current study. Further consideration has to be given to all aspects of the elders' lifestyle because even an activity such as walking might be restricted to an elder who is living in a real, or imagined, threatening environment where he is fearful to go outside of his home.

Orem" discussed self-care activities, ie, health-related behaviors, as measures executed daily that tend to become integrated into the fabric of daily living, and the purpose to be achieved through use of the measures may not be kept in mind. It may be that the sample regarded their behaviors as habits and did not relate them to their perceived health status. This could account for the limited number of variables that support the hypothesis which left the author unable to reject the null hypothesis. However, the results do suggest that keeping physically active has important implications on perceived health status.

Limitations

Even though correlations between physical activity and health status were significant, their magnitude was low. Many correlations were conducted, increasing the probability of making a Type 1 error. Many influential factors were not included that could have been related to self-perceived health status. Thus, these areas are in need of further study to detemine their impact on subjective health status.

Recommendations

Further studies are needed to examine the relationship between self-perceived health and health-related behaviors using a broader range of scores for perceived health and including the question, "Compared with others of your age, how would you rate your health at the present time?" A physiological measure of well-being should also be included adding credibility to the measurement of self-perceived health status. A questionnaire of health-related behaviors geared specifically to the elderly, should be included and additional information should be obtained that might be significant to the study (eg, life satisfaction, life changes, locus of control, activity patterns, patterns of motivation, and handling stress).

Implications for Nursing

The study did present some implications for nursing. It was evident that perceived health status is an important bit of information to include in the initial data base, and it must be reassessed at periodic intervals because of its relationship with so many influential factors. Because a relationship was evident between physical activity, income, and health status, knowledge of these variables may be important information to include in the data base in addition to perception of health status. Nursing is committed to the promotion of wellness, therefore the nurse is the ideal person to utilize this essential data to work with the clients in achieving their optimal level of health.

Table

TABLE 3FREQUENCY OF POSITIVE HEALTH-RELATED BEHAVIORS

TABLE 3

FREQUENCY OF POSITIVE HEALTH-RELATED BEHAVIORS

References

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  • 15. Shanas E: Social myths as hypothesis. Gerontologist 1979; 19(13).
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TABLE 1

CORRELATIONS COEFFICIENTS BETWEEN DEMOGRAPHIC DATA, HEALTH-RELATED BEHAVIORS, AND SELF-PERCEIVED HEALTH

TABLE 2

DISTRIBUTION OF SELF-PERCEIVED HEALTH STATUS SCORES

TABLE 3

FREQUENCY OF POSITIVE HEALTH-RELATED BEHAVIORS

10.3928/0098-9134-19871201-08

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