Personal insight may predict future health events for older people

An older person’s perceptions about their health—known as health-related quality of life (HRQoL)—may predict their health in the future, new Monash research shows.

Four studies led by researchers at the Monash School of Public Health and Preventive Medicine found that self-perceptions of health were a valuable tool in helping to identify older adults at risk of death and adverse health events, and could assist doctors in patient care.

In the latest study, researchers found older adults who reported a decline in physical aspects of quality of life over almost five years were 51% more likely to develop cardiovascular disease compared to those who reported high physical HRQoL. A consistently low physical HRQoL trajectory was associated with greater likelihood of dying compared to the highest ranking group.

This study, published in American Heart Journal Plus: Cardiology Research and Practice, marks the first time researchers have established a link between declining physical HRQoL trajectory and the risk of cardiovascular disease over an extended period of time.

Researchers analyzed self-reported quality of life data in 16,871 participants in the ASPREE (ASPirin in Reducing Events in the Elderly) trial and tracked their health for a further two years in the follow-up ASPREE-XT study. Study participants were mostly aged over 70 years, healthy and living independently in Australia and the U.S. at enrolment into ASPREE. Participants reported HRQoL—a method to rate aspects of their physical, psychological and social (mental) well-being—at entry into the study and annually for an average of 4.7 years.

67% of participants consistently rated their physical HRQoL in the high category; 13% as intermediate, 14% as declining and 7% as low.

Earlier, in separate analyses of ASPREE data that examined HRQoL at the beginning of the study only, researchers found:

Better physical HRQoL at enrolment was associated with lower risks of cardiovascular disease (14%), cognitive decline (6%) and death (17%) over an average of 4.7 years.
Higher mental HRQoL at study entry was associated with lower risks of cognitive decline (12%) and dementia (15%) over the same period.
The strong correlation between low physical HRQoL at enrolment and cardiovascular disease and death led researchers to the latest analysis, tracking participants’ health perceptions (i.e. HRQoL) over an extended period of almost five years.

Lead researcher, Ph.D. candidate Aung Zaw Zaw Phyo said:

“The studies indicate that self-reported HRQoL could be used to supplement objective measures, such as weight, blood pressure and cholesterol in outpatient health assessments and care.”

“Our research strengthens the importance of HRQoL as a predictive measure of cardiovascular disease, dementia, cognitive decline and deaths among older adults living independently in later life.”

The studies were reported in papers published in four separate journals:

“Trajectories of physical health-related quality of life and the risk of incident cardiovascular disease events and all-cause mortality in older people” in American Heart Journal Plus: Cardiology Research and Practice
“Health-related quality of life and incident cardiovascular disease events in community-dwelling older people: A prospective cohort study” in International Journal of Cardiology
“The utility of assessing health-related quality of life to predict cognitive decline and dementia” in Journal of Alzheimer’s Disease
“Health‑related quality of life and all‑cause mortality among older healthy individuals in Australia and the United States: A prospective cohort study” in Quality of Life Research