Jelicic, M

Kempen, GIJM

English

The objective of this study was to examine the effect of self-reported health on. cognitive function in community dwelling elderly (N = 4,528). Research participants were divided into four groups with regard to self-rated health. Statistically controlling for the effects of depression, age, and education, participants with poor self-reported health harl lower scores on the Mini-Mental Status Examination than those who believed themselves to be in good health. Our results show that cognitive performance in older adults is influenced by health factors.</p

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   University of GroningenEffect of self-rated health on cognitive performance in community dwelling elderlyJelicic, M; Kempen, GIJMPublished in:Educational GerontologyIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:1999Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Jelicic, M., & Kempen, GIJM. (1999). Effect of self-rated health on cognitive performance in communitydwelling elderly. Educational Gerontology, 25(1), 13-17.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 20-06-2022EFFECT OF SELF-RATED HEALTH ON COGNITIVEPERFORMANCE IN COMMUNITY DWELLING ELDERLYMarko JelicicGertrudis I. J. M. KempenNorthern Centre for Healthcare Research and Department of HealthSciences, School of Medicine, University of Groningen,The NetherlandsThe objective of this study was to examine the e ect of self-reported health oncognitive function in community dwelling elderly (N 5 4,528). Research partici-pants were divided into four groups with regard to self-rated health. Statisticallycontrolling for the e ects of depression, age, and education, participants with poorself-reported health had lower scores on the Mini-Mental Status Examination thanthose who believed themselves to be in good health. Our results show that cognitiveperformance in older adults is inuenced by health factors.There is controversy as to whether self-reported health a ects cogni-tive function among older adults. Salthouse, Kausler, and Saults(1990) found no signicant e ect of self-reported health on cognitiveperformance in both young and older research participants, whereasHultsch, Hammer, and Small (1993) and Emery, Huppert, and Schein(1995) did nd self-rated health to be predictive of cognitive func-tioning in the elderly. Emery et al. (1995) argued that these conict-ing results could be explained by either di erences in the assessmentof cognitive skills or sampling technique. Salthouse et al. (1990) useda few selected tests of speed and memory, whereas Hutsch et al. (1993)The research reported here is part of the Groningen Longitudinal Aging Study(GLAS). GLAS is conducted by the Northern Centre for Health Care Research andvarious departments of the University of Groningen. The primary departmentsinvolved are Health Sciences (Dr. G. I. J. M. Kempen and Prof. Dr. W. J. A. van denHeuvel), Family Medicine (Prof. Dr. B. Meyboom-de Jong), Psychiatry (Prof. Dr. J.Ormel), Sociology (Prof. Dr. S. Lindenberg), and Human Movement Sciences (Prof. Dr.P. Rispens). The director of GLAS is Prof. Dr. J. Ormel (Health Sciences andPsychiatry). GLAS and its substudies are nancially supported by the Dutch Govern-ment (through NESTOR [Netherlands Stimulation Programme on Aging Research] )the University of Groningen, the School of Medicine, the Dutch Cancer Foundation,and the Netherlands Organisation for Scientic Research.Address correspondence to Dr. Marko Jelicic, Department of Psychiatry and Neuro-psychology, Neuropsychology Section, Faculty of Medicine, Maastricht University,P.O. Box 616, 6200 MD Maastricht, The Netherlands. E-mail : m.jelicic@np.unimass.nlEducational Gerontology, 25: 13–17, 1999Copyright 1999 Taylor & FrancisÓ0360-1277/99 $12.00 1 .00 1314 M. Jelicic and G. I. J. M. Kempenand Emery et al. (1995) used more comprehensive test batteries toassess cognitive functioning. Also, Salthouse et al. (1990) studiedaquaintances and friends, whereas Hultsch et al. (1993) recruitedresearch participants through advertisements in the public media,and Emery et al. (1995) used participants randomly selected from anelectoral register.Cognitive impairments have frequently been observed in depres-sive patients (cf. Poon, 1992). Unfortunately, none of the three above-mentioned studies controlled for the e ect of depression on cognitivefunction. Given the association between physical disease and depres-sion (e.g., Zeiss, Lewinsohn, Rohde, & Seeley, 1996), an e ect of self-reported health on cognitive performance may have been found insome studies, because participants with poor health had more depres-sive symptoms than more healthy seniors. For this reason, we useddata from the Groningen Longitudinal Aging Study (GLAS) toexamine the relationship between self-reported health and cognitivefunction—while controlling for depression.M ETHODGLAS is a population-based prospective follow-up study of the deter-minants of health-related quality of life (Kempen, Ormel, Brilman, &Relyveld, 1997).Research Partic ipantsThe source population consists of older adults, living independentlyor in adapted housing for elderly people, in the northern parts of TheNetherlands. The study population was comprised of 8,723 personsaged 57 and over on January 1 1993, who were in the patient panels ofthe 27 family physicians (FPs) participating in a morbidity regis-tration network. In The Netherlands, virtually all community dwel-ling elderly are on an FPs panel. A total of 3,214 persons refused toparticipate in the study, 152 had passed away or left the practice bythe time the contact was initiated, and 78 individuals were excludedbecause of severe cognitive impairments at the baseline interview.Thus, useful data were obtained for 5,279 research participants (62%;5,279 out of [8723 2 152] ). Because of nancial constraints, 487 par-ticipants were interviewed by telephone and were not administeredthe Mini-Mental Status Examination (MMSE). Another 264 partici-pants were excluded from the MMSE analysis because of missingdata on at least one item of the MMSE. Hence, data from 4,528 par-Self-Reported Health and Cognitive Function 15ticipants (mean age 69.9 years; 2,554 females) were available foranalysis.Dependent M easureCognitive function was assessed with the MMSE (Folstein, Folstein,& McHugh, 1975). The MMSE is a widely used method for assessingmental status in both clinical practice and in research (Tombaugh &McIntyre, 1992). It consists of 20 items measuring orientation, regis-tration, attention and calculation, recall, and language. Scores rangefrom 0 to 30.Independent M easuresSelf-rated health was assessed by asking the participants ‘‘Would yousay your health in general is excellent, very good, good, fair, orpoor?’’. The potential confounding variable, depression, was mea-sured with the Depression scale of the Hospital Anxiety and Depres-sion Scale (Zigmond & Snaith, 1983). This scale contains seven itemspertaining to depressive symptoms. Scores range from 0 to 21.Because age and education also a ect cognitive performance in theelderly (Tombaugh & McIntyre, 1992), these two variables were alsotreated as confounders.Data AnalysisBased on self-rated health judgments, we created four groups of par-ticipants. Group I consisted of participants who thought their healthwas excellent or very good, Group II believed their health was good,Group III thought their health was fair, and Group IV believed theirhealth was poor. Because ‘‘excellent’’ and ‘‘very good’’ are almostsynonymous, the rst group contained both participants with excel-lent and very good self-rated health. Analysis of variance (ANOVA),controlling for depression as well as age and education, was used tond out whether there were di erences between the four groups withrespect to MMSE score. In case of (borderline) signicant di erences,separate ANOVAs would be used, again controlling for depression,age, and education, to see which groups di er from each other.Because of the large sample size, p , .001 was considered signicant,and .001 # p , .005 was regarded as ‘‘borderline’’ signicant.RESULTSMean MMSE scores of the four groups—adjusted for depression, age,and education—are presented in Table 1.16 M. Jelicic and G. I. J. M. KempenTABLE 1 Mean Mini-Mental Status Examination (MMSE) Scoresof Older Adults Di ering in Self-Reported Health (Adjusted forDepression, Age, and Education)aSelf-reported healthExcellent/very good Good Fair Poor(N 5 1176) (N 5 1760) (N 5 1311) (N 5 101)MMSE 27.40 27.43 27.28 26.25Note. Because of missing data, the Ns of the participants do not add up to4,528.a F(3,4341) 5 5.296, p 5 .001Table 1 shows that there were borderline signicant di erencesbetween the four groups with respect to MMSE scores. (Depression,age, and education all had a signicant e ect on MMSE score [allps , .001] .) Post hoc comparisons, using ANOVA (controlling fordepression, age, and education), revealed that research participantswho reported to be in good health had higher MMSE scores thanthose who rated their health as poor (p , .001). The other compari-sons did not yield any signicant di erences.DISCUSSIONParticipants with poor self-rated health had lower MMSE scores thanthose with good self-reported health. Hence, our results indicate thathealth factors inuence cognitive function in the elderly even aftercontrolling for depression. Note that we used the MMSE to assesscognitive performance in older adults. Several researchers (e.g.,Dijkstra, 1997) have argued that the MMSE is a rather crude instru-ment to examine neuropsychological dysfunction. Possibly, more sen-sitive cognitive measures would have shown more pronounceddi erences between the four study groups.Our ndings, as well as those reported by Hultsch et al. (1993) andEmery et al. (1995), lend support to the idea that cognitive dys-function in the elderly may be mediated by changes in physicalhealth associated with aging, rather than by age per se. Houx, Vreel-ing, and Jolles (1991) argued that cognitive decline in older peopleis—to a considerable extent—due to biological life events such asmedication, head injury, and surgical interventions under generalanesthesia. An accumulation of these biological life events wouldlead to neuropsychological problems in old age.It is not clear what underlies reduced cognitive function in individ-uals with poor self-reported health. Age-related structural and func-Self-Reported Health and Cognitive Function 17tional changes in the brain have been well documented (Scheibel,1996). It may be that these changes in the brain are greater in olderadults with poor self-rated health than in more healthy seniors.Therefore, it would be interesting to use modern neuroimaging tech-niques (e.g., Magnetic Resonance Imaging) in research on healthfactors and cognition.REFERENCESDijkstra, J. B. (1997). A n operation under general anaesthesia and cognitive ageing.Maastricht, The Netherlands: Neuropsych Publishers.Emery, C. F., Huppert, F. A., & Schein, R. L. (1995). Relationships among age, exercise,health, and cognitive function in a British sample. The Gerontologist, 35, 378–385.Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). ‘Mini-Mental State’ : A practi-cal method for grading the cognitive state of patients for the clinician. Journal ofPsychiatry Research, 12, 189–198.Houx, P. J., Vreeling, F. W., & Jolles, J. (1991). Age-associated cognitive decline isrelated to biological life events. In K. Iqbal, D. R. C. McLachlan, B. Winblad, & H.M. Wisniewski (Eds.), A lzheimer’s disease : Basic mechanisms, diagnosis and thera-peutic strategies (pp. 353–359). Chichester, England: John Wiley.Hultsch, D. F., Hammer, M., & Small, B. J. (1993). Age di erences in cognitive per-formance in later life: Relationships to self-reported health and activity life style.Journal of Gerontology, 48, P1–11.Kempen, G. I. J. M., Ormel, J., Brilman, E. I., & Relyveld, J. (1997). Adaptive responsesto chronic medical conditions: A comparative analysis of eight older patientgroups. American Journal of Public Health, 87, 38–44.Poon, L. W. (1992). Toward an understanding of congitive functioning in geriatricdepression. International Psychogeriatrics, 4(Suppl. 2), 241–266.Salthouse, T. A., Kausler, D. H., & Saults, J. S. (1990). Age, self-assessed health status,and cognition. Journal of Gerontology, 45, P156–160.Scheibel, A. B. (1996). Structural and functional changes in the aging brain. In J. E.Birren & K. W. Schaie (Eds.), Handbook of the psychology of aging, fourth edition(pp. 105–128). San Diego, CA : Academic Press.Tombaugh, T. N., & McIntyre, N. J. (1992). The Mini-Mental State Examination: Acomprehensive review. Journal of the A merican Geriatrics Society, 40, 922–935.Zeiss, A. M., Lewinsohn, P. M., Rohde, P., & Seeley, J. R. (1996). Relationship of physi-cal disease and functional impairment to depression in older people. Psychology andAging, 11, 572–581.Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale.Acta Psychiatrica Scandinavica, 67, 361–370.

Effect of self-rated health on cognitive performance in community dwelling elderly

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Effect of self-rated health on cognitive performance in community dwelling elderly

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