Open Access Open Badges Research article

Self-rated health in multimorbid older general practice patients: a cross-sectional study in Germany

Anna Nützel1*, Anne Dahlhaus2, Angela Fuchs3, Jochen Gensichen4, Hans-Helmut König5, Steffi Riedel-Heller6, Wolfgang Maier7, Ingmar Schäfer8, Gerhard Schön9, Siegfried Weyerer10, Birgitt Wiese11, Martin Scherer8, Hendrik van den Bussche8 and Horst Bickel1

Author Affiliations

1 Department of Psychiatry and Psychotherapy, Technical University of Munich, Munich, Germany

2 Institute of General Practice, University of Frankfurt/Main, Frankfurt, Germany

3 Institute of General Practice, University of Düsseldorf, Düsseldorf, Germany

4 Institute of General Practice, University of Jena, Jena, Germany

5 Department of Medical Sociology and Health Economics, University Medical Medical Center Hamburg-Eppendorf, Hamburg, Germany

6 Institute for Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany

7 Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany

8 Institute of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

9 Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg-Eppendorf, Germany

10 Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany

11 Institute for Biometry, Hannover Medical School, Hannover, Germany

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BMC Family Practice 2014, 15:1  doi:10.1186/1471-2296-15-1

Published: 3 January 2014



With increasing life expectancy the number of people affected by multimorbidity rises. Knowledge of factors associated with health-related quality of life in multimorbid people is scarce. We aimed to identify the factors that are associated with self-rated health (SRH) in aged multimorbid primary care patients.


Cross-sectional study with 3,189 multimorbid primary care patients aged from 65 to 85 years recruited in 158 general practices in 8 study centers in Germany. Information about morbidity, risk factors, resources, functional status and socio-economic data were collected in face-to-face interviews. Factors associated with SRH were identified by multivariable regression analyses.


Depression, somatization, pain, limitations of instrumental activities (iADL), age, distress and Body Mass Index (BMI) were inversely related with SRH. Higher levels of physical activity, income and self-efficacy expectation had a positive association with SRH. The only chronic diseases remaining in the final model were Parkinson’s disease and neuropathies. The final model accounted for 35% variance of SRH. Separate analyses for men and women detected some similarities; however, gender specific variation existed for several factors.


In multimorbid patients symptoms and consequences of diseases such as pain and activity limitations, as well as depression, seem to be far stronger associated with SRH than the diseases themselves. High income and self-efficacy expectation are independently associated with better SRH and high BMI and age with low SRH.

Trial registration

MultiCare Cohort study registration:ISRCTN89818205.

Quality of life; Self-assessment; Chronic disease; Depression; Pain; Functionally- impaired elderly; General practice