Self-ratings of health: do they also predict change in functional ability?

Self-ratings of health by individuals responding to surveys have shown themselves to be potent predictors of mortality in a growing number of studies; they appear to contribute significant additional independent information to health status indicators gathered through self-reported health histories or medical examinations. A key question raised by these studies is: What are the mediating processes involved in the association? Specifically, do poor self-ratings increase the risk of disability and morbidity, and are these outcomes intervening steps in the link to mortality? In this report we address the first question, of self-ratings predicting future levels of functional disability, our choice of an index of overall impact of morbidity. Data come from the New Haven Established Populations for Epidemiologic Studies of the Elderly (EPESE) site (N = 2,812). Results show that self-ratings of health in 1982, net of baseline functional ability, health and sociodemographic status, are associated with changes in functional ability over periods of one through six years. These findings extend our understanding of the meaning of excellent, good, fair, and poor ratings of health, and that they have implications not just for survival but for the loss or maintenance of functional ability in daily life.