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Open Access Research article

What determines the self-rated health of older individuals with stroke compared to other older individuals? A cross-sectional analysis of the Medical Research Council Cognitive Function and Aging Study

Nahal Mavaddat1*, Rianne Van der Linde2, George M Savva3, Carol Brayne2 and Jonathan Mant1

Author Affiliations

1 Department of Public Health and Primary Care, University of Cambridge Strangeways Laboratory, Worts Causeway, Cambridge CB1 8RN, UK

2 Department of Public Health and Primary Care, University of Cambridge Forvie Site, Robinson Way, Cambridge CB2 0SR, UK

3 School of Nursing Sciences, University of East Anglia Norwich Research Park, Norwich NR4 7TJ, UK

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BMC Geriatrics 2013, 13:85  doi:10.1186/1471-2318-13-85

Published: 22 August 2013

Abstract

Background

Poor self-rated health has been associated with poorer objective health outcomes across a range of conditions including stroke. Identification of factors associated with poor self-rated health in stroke survivors has received little attention compared to that in other older individuals. This study identifies determinants of self-rated health in older individuals with or without a history of stroke participating in the population-representative MRC Cognitive Function and Aging Study (MRC CFAS).

Methods

The MRC CFAS is a multicentred longitudinal survey of a population representative sample of people in their 65th year and older at baseline. Baseline interview included questions about functional disability, psychiatric history, independent living status, social interactions, and cognitive function. Multiple logistic regression was used to determine associations between demographic, physical, cognitive, psychological and social factors with poor self-rated health among those with and without stroke.

Results

After excluding those with impaired cognitive function, 776 individuals out of 11,957 reported a stroke. Factors associated with self-rated health were similar between those with or without a stroke in older individuals. Poorer self-rated health in those who had suffered a stroke was associated predominantly with the presence of comorbidity with diabetes (OR 3.5; 95% CI 1.5-8.1) and not “getting out and about” (OR 2.6; 95% CI 1.7-4.1) even after adjustment for disability levels and for depression. In those without a stroke the most important determinants were disability (OR 3.9; 95% CI 3.2-4.8) and not “getting out and about” (OR 2.9; 95% CI 2.5-3.3). The presence of disability was less strongly associated with poor self-rated health in those with a history of stroke than those without due to a substantially higher reporting of poor self-rated health in the non-disabled stroke group than the non-disabled stroke-free group, while those with disabilities reported poor self-rated health irrespective of stroke status.

Conclusions

Self-rated health is determined by a range of psychological and social factors in addition to disability in older patients with stroke. Addressing social integration and mobility out of the home is an important element of rehabilitation for older people with stroke as well as those without.

Keywords:
Stroke self-rated health old age rehabilitation mobility