FIGURE IT OUT… poor subjective health in old age is a significant marker of risk of loss of autonomy and early mortality.

Yvanna SIMON is interested in identifying, in population surveys, warning signs of the loss of autonomy with ageing. In particular, she has studied how people's self-assessment of their health is linked to the risk of severe functional decline, or even early death.

She used data from three French cohorts on ageing, set up in Aquitaine (Paquid, 3C and AMI), which follow more than 4,400 people aged 65 and over (up to 20 years for Paquid). She combines two indicators by which people have stated their situation: self-rated good/poor health and absence/presence of difficulties in carrying out housework activities. A longitudinal analysis associates these situations with three events encountered during follow-up: the onset of limitations in personal care activities, entry into a nursing home or death.

The analysis shows that reporting difficulties with housework doubles the risk of onset of limitations in personal care, even after adjusting for the presence of illnesses, etc.; this risk is more than doubled when the difficulties are accompanied by poor self-rated health. This risk is also increased in the case of poor self-rated health, even in the absence of difficulties with housework. These associations are also found for mortality and, with one difference, for the third event: in the case of good self-rated health, difficulties with housework do not “significantly” preclude institutionalization.

These findings underline the added-value of including subjective dimensions when monitoring the functional decline. They contribute to our knowledge and understanding of the dynamics at work and to the identification of potentially at-risk profiles; valuable steps that will ultimately contribute to the development of targeted preventive measures.