Determinants of change in perceived health in a longitudinal study of older adults.

To determine the factors that are predictive of a negative decline in perceived health in a longitudinal study of 251 men and women aged 62 and older, we developed a "synthetic" cohort of individuals who experienced a decline in perceived health between two time points and a control cohort of those who did not. The longitudinal design of the study made it possible to evaluate the effects of "baseline" predictors, gathered prior to the time interval during which the reported change in perceived health occurred, in addition to measures assessed at the two time points between which the change in health was reported. Hierarchical logistic regression models were used to examine the effect of demographic, psychosocial, and illness measures on change in perceived health. These analyses revealed that increases in new illnesses, increased physician visits, and worsening of preexisting conditions (in subjects who had higher feelings of self-efficacy) were all associated with a decline in perceived health, after controlling for the effects of baseline illnesses and medication use. After accounting for these effects of changes in objective illness indicators, we found that changed psychosocial factors also predicted a decline in perceived health. Lower life satisfaction and higher depression at baseline were predictive of a later decline in perceived health. In addition, data collected at the third consecutive time point were evaluated to assess determinants of a sustained vs transient decline in perceived health. A sustained decline in perceived health was associated with increased depression and decreased self-efficacy.