Self-rated Health in the Elderly: A Comparative Study of Seven States of India

 

Nasim Ahamed Mondal1 Akif Mustafa2 Mohai Menul Biswas3

1Statistician, Indian Council of Medical Research (NIRRH), Mumbai, Maharashtra, India

2Research Fellow, International Institute for Population Sciences, Mumbai, Maharashtra, India

3Research Fellow, International Institute for Population Sciences, Mumbai, Maharashtra, India

*Corresponding Author Email: nasimamu32@gmail.com, akifmustafa13@gmail.com, biswas.belief@gmail.com

 

ABSTRACT:

Introduction: Health status in the elderly can be appropriately assessed through self-rated health because it includes a combination of physical, emotional, and cognitive components as well as characters related to well-being and satisfaction with one’s own life. Objectives: To know the prevalence and determinants of self-reported health status in the elderly across seven states of India. Data Source and Methodology: The present study based on ‘Building a Knowledge Base on Population Ageing in India (BKPAI)’ reports of seven states since the survey comprised only seven major states of India based on speedier ageing and relatively higher proportions of the elderly in the population. Published reports were obtained from appropriate sources. The present study made a comparative study of determinants of self-reported health (SRH) status of selected seven states of India. The self-rated health status contains three options: Excellent/Very good, Good, and Fair/Poor respectively (as reported in the report). Findings: The performance of Himachal Pradesh and Tamil Nadu is awe-inspiring. In Himachal Pradesh, around 27 per cent of respondents reported their health as excellent which is highest among all the seven states. In Tamil Nadu, around 44 per cent of respondents rated their health as ‘Good’ which is the highest among all the seven states. The performance of Punjab and West Bengal is worst among the seven states. Age, sex, marital status and wealth have been found as the important determinants of self-rated health status of elderly.   

 

KEYWORDS: Health of the Elderly; Self-Assessment; Seven States; India.

 

 


INTRODUCTION:

Health status in the elderly can be appropriately assessed through self-rated health because it includes a combination of physical, emotional, and cognitive components as well as characters related to well-being and satisfaction with one’s own life. (Pagotto et al., 2013; Pavão, 2012; Lima-Costa et al., 2004).

 

This measure has been widely used in population-based studies of the elderly (Borim et al., 2012; Sargent-Cox et al., 2008, Fayers and Sprangers, 2002). In epidemiological surveys, self-reported health status has been well studied and applied, and it has been an important indicator for many health-related issues (Arokiasamy et al., 2013).  Self-reported health not only serving as a tool but also used for developing health policies intended for improving the elderly population’s health status (Borim et al., 2012). Self-rated health status prevalence differs substantially among studies with the same question and options for the answer. This inconsistency in prevalence rates may be attributable to short-term fluctuations in health or disease (Confortin et al., 2015). There might be two possible reasons which may explain the ins and outs behind the differences in self-rated prevalence rates in the various studies: first, options variation for answers to the question or variation in categorization, and second, differences among the settings in term of socioeconomic and demographic or both (Confortin et al., 2015).

 

There are several risk factors recognized for self-assessed health of elderly from the exist literatues, some most precarious risk factors for self-assessed health are  male gender (Confortin et al., 2015, Hirve, 2014,  Hirve et al., 2010, Ishizaki et al., 2009, Robert et al., 2009, Asfar et al., 2007, Barros and Hirakata, 2003), age (Hirve et al., 2010, Ishizaki et al., 2009; Asfar et al., 2007), schooling (Simsek et al., 2014, Schneider et al., 2012, Robert et al., 2009, Subramanian et al., 2009, Mirowsky and Ross, 2008), higher income (Simsek et al., 2014), alcohol consumption (Lang et al., 2007, Poikotainen et al., 1996), Smoking or consumption of tobacco (Hirve, 2014), diseases (Confortin et al., 2015, Lorenzo et al., 2013, Pavão, 2012, Lee and Shinkai, 2005, Tay et al., 2005, Albert et al., 2005), less dependence in ADL (Silva et al., 2012, Alves and Rodrigues, 2005), higher socioeconomic status and higher quality of life (Hirve, 2014), functional disability and disease (Lee and Shinkai, 2005, Tay et al., 2005, Albert et al., 2005), Widowhood for both men and women (Sudha et al., 2006), wealth (Roy and Chaudhuri, 2008, Bobak et al., 2000), marital status (Mansyur et al., 2008, Subramanian et al., 2002, Vaillant and Mukamal, 2001 ), Family cohesion, number and type of kin ties and social trust (Mansyur et al., 2008, Subramanian et al., 2002, Vaillant and Mukamal, 2001).

 

OBJECTIVE:

To know the prevalence and determinants of self-reported health status in the elderly across seven states of India.

 

MATERIALS AND METHODS:

The present study entirely based on ‘Building a Knowledge Base on Population Ageing in India (BKPAI)’ reports of seven states (James et al., 2012; Giridhar et al., 2012; Sathyanarayana et al., 2012; Alam et al., 20121; Raju et al., 2012; Alam et al., 20122; Kumar et al., 2012) since the survey comprised only seven major states of India based on speedier ageing population growth and relatively higher proportions of the elderly in the population.


 

Fig 1: Population aged 60 years and above in 2011, (in %)

 

Fig 2: Excellent self rated current health status of selected states by three background characteristics, 2011 (in %)

Authors did not discuss Fig2 in the text since it extracted from table2 which is already discussed in the text.


The survey conducted by United Nations Population Fund with three collaborating institutions which are located three different corners of the country: Institute for Social and Economic Change (Bangalore), Institute of Economic Growth (Delhi), Tata Institute of Social Sciences (Mumbai). Published reports were obtained from appropriate sources (http://www.isec.ac.in/prc-Aging-publications-reports.html). The present study made a comparative study of determinants of self-reported health (SRH) of selected seven states of India. Self-Rated health status contains three options. These are Excellent/Very good, Good, and Fair/Poor respectively (as reported in the report).

 

Study Settings:

We have selected only those States which are covered by BKPAI survey for having speedier ageing and relatively higher proportions of the elderly in the population. Those States are Kerala (12.6%), Tamil Nadu (10.4%), Punjab (10.3%), Himachal Pradesh (10.2%), Maharashtra (9.9%), Orissa (9.5%) and West Bengal (8.5%) (Figure1).

 

Variable Measures:

Outcome Variable:

The self-assessed health status (SRH) was utilized as the outcome or dependent variable in the study. The SRH was divided into three categories: Excellent/Very good, Good and Fair/Poor.

 

Explanatory Variables:

Male Age group (60-69, 70-79 and 80 and above age group), Female Age group (60-69, 70-79 and 80 and above age group), Marital Status (Currently married, Widowed and others), Caste (ST/SC, OBC and others), Wealth Index (Poor and non-Poor) have been selected as independent variables..

RESULTS:

Punjab:

Self-rated health (SRH) is a measure that provides the condition of health-related quality of life. Table1 is showing the SRH ratings in Punjab; the ratings indicate that as the age increases the perception about health status decreases, and perception about health is better among males than females. SRH ratings for Punjab indicating that around 67 per cent males and 71 per cent females rated their health as ‘Fair or poor’. Overall around 69 per cent of the elderly rated their health as ‘Fair’ or ‘poor’. Only around 8 per cent elderly rated their health as excellent.

 

Table2 shows that there is an insignificant variation in ratings of ‘Fair/Poor’ between married, widowed and others. We find similar insignificant variation among Castes/Tribes in ratings of ‘Fair/Poor’. About 69 per cent elderly from highest wealth quintile rated their health as ‘Fair or poor’; on the other hand, 79.2 per cent elderly from lowest wealth quintile rated their health as ‘Fair or poor’

 

West Bengal:

SRH ratings of West Bengal showing (Table1) that perception about health is better among males than females. The data show that among the elderly of West Bengal around 81 per cent of men and 83 per cent of women rated their health as ‘Fair or poor’. The ratings indicate that as the age increases the perception about health status decreases. Overall around 82 per cent elderly of West Bengal rated their health as ‘Fair or poor’.

 


 

Table 1 Male and femaleself-rated current health status of selected states by age, 2011 (in %)

States

Self-reported health

Male

Female

60-69

70-79

80+

60-69

70-79

80+

Punjub

Excellent/Very good

12.4

8.3

3.7

8.8

3.8

3.7

Good

30.9

24.0

18.8

29.2

20.6

18.8

Fair/Poor

56.7

67.7

77.6

62.0

75.6

77.6

West Bengal

Excellent/Very good

5.1

3.5

0.1

2.6

2.1

0.0

Good

22.7

16.2

9.6

20.5

9.3

15.9

Fair/Poor

72.1

80.4

90.3

77.0

88.6

84.1

Odisha

Excellent/Very good

19.3

12.6

10.4

13.6

9.6

6.7

Good

40.8

32.9

29.9

42.3

37.1

25.9

Fair/Poor

39.8

54.5

59.7

44.1

53.3

67.4

Maharashtra

Excellent/Very good

33.3

34.1

20.4

28.2

21.9

13.9

Good

32.4

22.7

25.5

35.8

22.5

18.1

Fair/Poor

33.9

43.3

54.1

35.3

55.7

66.7

Kerala

Excellent/Very good

19.3

12.0

9.0

12.9

8.8

9.4

Good

23.9

15.9

20.1

18.8

16.8

15.0

Fair/Poor

56.8

70.9

70.9

68.2

73.5

71.5

Tamil Nadu

Excellent/Very good

5.9

11.4

0.9

4.7

10.9

6.1

Good

58.4

25.8

23.8

54.9

18.5

20.5

Fair/Poor

35.7

62.8

75.4

40.4

70.6

73.4

Himachal Pradesh

Excellent/Very good

30.7

32.8

29.0

24.3

26.8

10.2

Good

30.7

28.7

16.1

28.7

26.4

21.6

Fair/Poor

38.6

47.0

55.0

47.0

46.7

68.2

Table 2 Self rated current health status of selected states by marital status, caste/tribe and wealth quintile, 2011 (in %)

States

Self-reported health

Marital status

Caste/Tribe

Wealth Quintile

Currently married

Widowed

Others

SC/ST

OBC

Others

Lowest

Highest

Punjub

Excellent/Very good

9.3

7.4

2.9

7.5

10.7

8.5

1.8

8.9

Good

26.3

24.6

24.8

29.9

23.1

23.6

18.9

22.1

Fair/Poor

64.4

68.0

72.3

62.6

66.2

67.8

79.2

69.0

West Bengal

Excellent/Very good

4.6

1.4

3.9

2.0

1.7

4.0

0.0

12.8

Good

21.5

14.3

16.0

16.5

13.9

14.7

13.9

35.8

Fair/Poor

74.0

84.3

80.0

81.5

84.4

76.3

86.1

51.5

Odisha

Excellent/Very good

16.6

10.1

2.6

11.7

14.2

18.8

9.6

35.9

Good

40.9

34.4

16.8

44.2

33.3

37.2

40.5

28.5

Fair/Poor

42.5

55.5

80.7

44.1

52.5

44.0

49.8

35.6

Maharashtra

Excellent/Very good

33.2

21.9

13.2

23.2

29.0

32.1

22.8

33.5

Good

29.3

31.4

37.6

31.4

29.3

30.3

25.8

33.1

Fair/Poor

37.0

46.1

49.1

45.3

41.5

36.8

51.0

31.8

Kerala

Excellent/Very good

15.6

10.7

7.4

16.2

11.5

15.6

11.1

18.2

Good

19.8

17.2

29.0

14.3

18.9

20.8

11.9

19.2

Fair/Poor

64.4

70.9

63.6

69.5

68.7

63.3

77.0

62.1

Tamil Nadu

Excellent/Very good

8.0

4.5

1.8

6.8

6.5

0.0

5.7

13.1

Good

48.6

46.0

29.0

40.1

47.6

72.2

27.4

43.4

Fair/Poor

43.4

49.5

69.1

53.0

45.9

27.8

67.0

43.5

Himachal Pradesh

Excellent/Very good

30.7

18.4

36.2

24.8

28.6

27.4

18.6

33.0

Good

26.7

28.0

13.6

21.7

36.7

26.9

24.0

29.4

Fair/Poor

42.6

53.6

50.2

53.5

34.7

45.8

57.3

37.6

 

Fig 3: Good self rated current health status of selected states by three background characteristics, 2011 (in %)

Authors did not discuss Fig3 in the text since it extracted from table2 which is already discussed in the text.

 


Table2 shows that around 86.1 per cent elderly in lowest-wealth quintile rated their health as ‘Fair or poor’ and 51.5 per cent elderly in highest-wealth quintile rated their health as ‘Fair or poor’, it shows that the health perception among lowest wealth quintile elderly is very poor in comparison of highest-wealth quintile elderly. The variation is insignificant in other sections.

 

Odisha:

SRH ratings for Odisha in table1 shows that, the age group 60-69, the health perception is pretty decent as more than 50 per cent of the respondents rated their health as ‘excellent’ or ‘good’, but in the higher age groups, the condition is not as good. Here again, health perception is better among males than females.

 

 

 

Table2 demonstrates that married elderly have better health perception than widowed and others. The variation in perception about health is less among castes/tribes. In the lowest wealth quintile, 49.8 per cent of respondents rated their health as ‘Fair or poor’, which is much higher than lower wealth quintile respondents (35.6 per cent).

 

Maharashtra:

Table1 depicts that health perception in the age group 60-69 is far better than higher age group, in the age group 60-69 only 34.6 per cent respondents rated their health as ‘Fair or poor’ while in the age group 80+ this percentage was 60.2 per cent. Table also shows that more women rated their health as poor than men.

 

 

 


Fig 4: Fair/poor self rated current health status of selected states by three background characteristics, 2011 (in %)

Authors did not discuss Fig4 in the text since it extracted from table2 which is already discussed in the text.

 


Table2 shows that less proportion of married respondents (37%) reported poor perception about health than widowed (46%) and others (49.1%). A higher percentage of SC/ST respondents rated their health as poor than OBC and Others. Regarding health perception, there is a significant difference between respondents from most top wealth quintile, and lowest wealth quintile, 51 per cent respondents from lowest wealth quintile reported their health as ‘Fair or poor’, while only 31.8% respondents from highest wealth quintile reported their health as ‘Fair or poor’.

 

Kerala:

The condition of Kerala is poor concerning SRH current status. Table1 depicts that only around 13 per cent elderly of Kerala reported their health as Excellent. Men reported less their health status as poor in comparison to women. As age increases, health perception becomes poorer.

 

Table 2 shows that more respondents from the lowest wealth quintile reported their health as poor than respondents from the highest wealth quintile. More widowed respondents rated their health as ‘Fair or poor’ than ‘others’ and ‘currently married’.

 

Tamil Nadu:

Table 1 depicts that the elderly population of Tamil Nadu have a better perception of health than other states. In the age group, 60-69 around 62 per cent rated their health as Excellent or Good, but as we move to a higher age group this percentage decreases.

 

Table 2 shows that there is less variation between married and widowed in SRH ratings. Still, health perception is a little better among married than widowed. The higher proportion of SC/ST has a poor perception of health than OBC and Others. From the table2, we can see that perception about health is much poorer among the elderly from the lowest wealth quintile than the elderly from the highest wealth quintile.

 

Himachal Pradesh:

Table 1 shows that around 42 per cent of the elderly from the 60-69 age group rated their health as ‘Fair or poor’, this percentage increases to 61 per cent in the age group 80+. From the table1, we can see that men have significantly good perception than women.

 

Table 2 depicts that in Himachal Pradesh, perception about health is better among married than widowed, better among OBC than SC/ST and better among the highest wealth quintile than lowest wealth quintile.

 

DISCUSSION:

Self-rated health (SRH) status provides a valid estimate of the health status of an individual (Sathyanarayana et al., 2012) it provides good information about life satisfaction, familial factors and functional ability, an account of life satisfaction, (Zimmer et al., 2000). If we talk about interstate performance, then from the figures we can see that the performance of Himachal Pradesh and Tamil Nadu is awe-inspiring. In Himachal Pradesh, around 27 per cent respondents reported their health as excellent which is highest among all the seven states, and around 46 per cent respondents rated their health as ‘Fair or poor’, which is lowest among all the seven states. In Tamil Nadu, around 44 per cent of respondents rated their health as ‘Good’ which is the highest among all the seven states. The performance of Punjab and West Bengal is worst among the seven states. In West Bengal, around 77 per cent of people have a poor perception of health, which is the highest among all the seven states. In Punjab, around 68 per cent of respondents rated their health as ‘Fair or poor’, which is the second highest among the states. In West Bengal, only around 4 per cent of respondents rated their health as excellent. The performance of Odisha, Maharashtra and Kerala is in the average category. Though the performance of Punjab and Tamil Nadu is good in comparison to other states, still we cannot say that the health status is in good condition.

 

We saw some similar patterns of self-rated health ratings in all the seven states. In all the selected states, the present study found that perception about self-assessed health worsen as the age increases, corroborating previous studies (Hirve et al., 2010; Ishizaki et al., 2009; Asfar et al., 2007), it can be attributed to the fact that immune system becomes weaker and suffer from a number of diseases as the age increases, and the person becomes more likely to sick which reduced self-assessed health status (Confortin et al., 2015; Lorenzo et al., 2013, Pavao, 2012, Lee and Shinkai, 2005, Tay et al., 2005, Albert et al., 2005). Moreover, the association between SRH and ageing is maybe mediated through disease and functional disability (Lee and Shinkai, 2005; Tay et al., 2005; Albert et al., 2005). So in such a situation, people from higher age group need special care. In all the states female gender had comparatively low level self-reported health rather than male gender, corroborating previous studies (Confortin et al., 2015; Hirve, 2014, Hirve et al., 2010, Ishizaki et al., 2009; Robert et al., 2009, Asfar et al., 2007, Barros and Hirakata, 2003). There is a contrast in the health status of men and women among aged people, the differences in health status between men and women can be ascribed to a combination of social, biological and biological factors (Crimmins et al., 2010; Lawlor et al., 2001). It has been found that women have more tendency to visit healthcare services, have higher life expectancy, are more susceptible to diseases and decrement in physical and/or cognitive functioning (Camarano and Kanso, 2009) and are more susceptible to less fatal conditions (Camarano and Kanso, 2009; Lang et al., 2007), so they perceive their health inferior to men. The present study also found that self-rated health is significantly better in the population from highest wealth quintile than the population from lowest wealth quintile in all the seven states which is the very much consistent result with existing literature (Simsek et al., 2014; Roy and Chaudhuri, 2008). One study done by Bobak et al. found that poor SRH is associated with poor financial security, indicates that economic status is a strong determinant of the health status of a person. So, it can be said that health status is low in low wealth quintile population may be because they have insufficient money to have better nutrition and healthcare, so policy is needed to eradicate health status disparity due to financial status. Almost in all the seven states, we saw that health perception is better among married than widowed which is a similar result with several existing literature (Sudha et al., 2006). Sudha et al. found that for both men and women poor SRH is strongly associated with Widowhood.

 

Self-rated health (SRH) status provides a valid estimate of the health status of an individual. The profile of older persons can be exposed by this study with self-rated health which is crucial for monitoring their overall health status. Several factors were identified like age, sex, marital status and wealth index that can affect self-rated health in the elderly. 

 

Strengths and Limitations:

Building a Knowledge Base on Population Ageing in India (BKPAI) encompasses a full range of issues which older adults face in their daily life. The present data source (BKPAI) covered only the seven states from different parts of India (there is no state from the northeast). So, the results cannot be generalized for the whole of India. The present study contains only four background characteristics since the data source provided the same. Lastly, since the self-rated health assessment is a subjective matter, it can vary from person to person. So, there is always a question of generalization.

 

CONFLICT OF INTEREST:

The authors declare that there are no conflicts of interests.

 

INFORMED CONSENT:

No primary data were collected for this study, so informed consent was not obtained from individual participants in the study.

 

ETHICAL TREATMENT OF EXPERIMENTAL SUBJECTS:

The Present study did not contain any studies either with human or animal participants performed by any of the authors.

 

ETHICAL STATEMENT:

The study is based on secondary (publicly available) data and no ethical issues are involved.

 

FUNDING:

This research did not receive any grant from any funding agency in the public, commercial, or not-for-profit sectors.

 

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Received on 08.04.2019         Modified on 21.04.2019

Accepted on 09.05.2019      ©AandV Publications All right reserved

Res.  J. Humanities and Social Sciences. 2019; 10(2):414-420.  

DOI: 10.5958/2321-5828.2019.00070.6